Paramedic Risk Assessment & Root Cause Analysis

Supporting the sector by identifying high-risk hazards and the root causes fundamental to their elimination and control

The purpose of the Paramedic Risk Assessment and Root Cause Analysis project is to support the sector in preventing injury and illness by identifying the occupational health and safety hazards that paramedics are most exposed to and developing solutions to mitigate risk. The results of the Risk Assessment and Root Cause Analysis will better inform future prevention efforts and programming for the paramedic sector.


The two-part project is industry-led and represents a collaborative effort among sector representatives (labour and employer), paramedic networks, industry experts, health and safety professionals and Ministry representatives across Ontario.

Part 1: Risk Assessment


The Risk Assessment was completed in Fall 2021 utilizing a “by the industry, for the industry” approach, where sector stakeholders came together to identify a comprehensive list of hazards and their associated risks that they perceived paramedics faced in the workplace.




All stakeholders were asked to complete a list of workplace hazards affecting frontline paramedics. These were then consolidated and categorized into 26 main hazard categories (e.g., musculoskeletal disorders, personal protective equipment, ambulance design, workplace violence, psychosocial hazards). In the end, the group identified a total of 105 hazards.


Following an open discussion of the hazard and any supporting evidence on the impact of the hazard in subsequent working group sessions, the stakeholders individually and anonymously rated each of the hazards’ associated risk level using an online voting system. The stakeholders ranked both the likelihood and consequence of the hazard to determine overall risk rating for all hazards, resulting in a prioritized list of sector hazards.


Key Findings


  • Of the 105 identified hazards, stakeholders evaluated 48 to be high-risk, 54 to be medium-risk and 3 to be low-risk.
  • There was an important level of congruence between the employer and worker groups in that there was 70% agreement in the top 10 hazards rated by employer and worker representatives.


Top ten high-risk hazards identified by the Risk Assessment:

   1. Post-traumatic stress disorder (PTSD) injuries (Psychosocial Hazards)

   2. Inability to use seat belts during patient care while the vehicle is in motion (Ambulance Design)

   3. Usage of portable radios, communications, CACC and cell phone use (Equipment Concerns)

   4. Support in exigent circumstances when responding to calls for service (Workplace Violence)

   5. Violence and abuse in the workplace (Workplace Violence)

   6. Reliability of CCAC radio system (Equipment Concerns)

   7. Vehicle collisions (Traffic Protection)

   8. General design of the ambulance (Ambulance Design)

   9. Lack of sleep (Fatigue)

   10. Use of traffic protection plans while paramedics are working on the roadway (Traffic Protection)

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Download the Risk Assessment Report

View the full Risk Assessment Report to access more key findings and background information related to the first component of this project.

Part 2: Root Cause Analysis


The Root Cause Analysis identified root causes fundamental to the elimination and control of a select hazard identified in the Risk Assessment component. The EMS Section 21 Sub-Committee reviewed the top ten hazards which resulted from the Risk Assessment and selected the top identified hazard – Post-traumatic stress disorder – to be explored in the Root Cause Analysis component of the project. The Root Cause Analysis was completed from January to March 2022.




Sector stakeholders came together for a two-day workshop. On the first day, 36 causal factors for psychological harm in paramedics and ambulance communication officers (ACO) were identified and documented. Employer and worker representatives then rated on the importance of the 36 primary causal factors identified using a seven-point scale. On the second day, workshop participants brainstormed solutions and controls for each of top 12 primary causal factors.


Key Findings


The following themes emerged from the list of possible solutions and controls:


  • Updating training (i.e., materials, facilitation, time allotted, methods) for the following topics: workplace violence, psychological health and safety, fatigue, handling traumatic events, stigma, self-care, stay at work and return to work, and resiliency.
  • Providing trauma-informed and paramedic-specific mental health supports.
  • Increasing collaboration between educational institutions, base hospital programs and service providers on training, mentorship and program development.
  • Allowing for protected or dedicated time for training and continuing education, breaks and pause time to reset and re-energize.
  • Highlighting the need for paramedic-specific health and safety legislation in addition to increased participation of and consultation with paramedic services and ACO when there are system or legislation changes.
  • Continuing of forums and workshops where various workplace parties and decision makers can focus on issues and brainstorm solutions.
  • Encouraging self-care at the service level by enhancing facilities (e.g., gyms, break rooms, quiet spaces), and spreading awareness.
Download the Root Cause Analysis Report

View the full Root Cause Analysis Report to access more key findings and background information related to the second component of this project.

Additional Resources

Cognitive Demands Analysis
Learn about Cognitive Demands Analysis, a structured process designed to identify the specific cognitive requirements of the essential duties of a job.
Job Demands Description
Learn about Job Demands Description, a structured process designed to identify the physical, cognitive and psychological demands of the essential duties of a job.
FirstRespondersFirst PTSD Resource Toolkit
Resources and services for the First Responder community to understand the various steps of a PTSD program.
EMS Section 21 Sub-Committee
The EMS Section 21 Sub-Committee is made up of members from OAPC, Unifor, CUPE, OPSEU, and the SEIU Local 1 Canada.
CSA Standard Z1003.1-18: Psychological health & safety in the paramedic service organization
A voluntary standard that specifies requirements for a documented and systematic approach to develop and sustain a psychologically healthy & safe workplace.
Mental Health Stay at Work & Return to Work for First Responder Organizations
This one-day course helps supervisors build a toolkit of resources to support Stay at Work and Return to Work.


A free, 30-minute self-guided microlearning program that focuses on 6 areas: mental fitness, physical fitness, nutrition, financial fitness, sleep and social connections. It incorporates highly effective strategies and tools designed to increase your capacity for resilience.


Ready for Duty eLearning Series

Evidence-based guidance, support, tools and strategies to help paramedics improve and maintain their health and wellbeing in the face of difficult job demands.


Peer Support for First Responders

Boots on the Ground provide confidential, caring and compassionate Peer Support to First Responders across the Province of Ontario.



For more information about this project, methodology and findings, or to learn more about applying this process in other high-risk sectors, contact:


Henrietta Van hulle

Vice President, Health, Safety & Wellbeing




PSHSA thanks the working group members for their active participation in this important project. Sector representatives included land and air ambulance as well as representatives serving urban, rural, and remote communities.


  • Canadian Union of Public Employees (CUPE)  
  • Conestoga College
  • Cornwall SDG Paramedic Services
  • County of Lennox and Addington, Emergency Services
  • Essex-Windsor EMS
  • Fanshawe College 
  • Frontenac Paramedic Services
  • Glen Stor Dun Lodge 
  • Greater Sudbury Paramedic Services  
  • Lambton EMS
  • Naotkamegwanning First Nation EMS  
  • Oneida Nation Paramedic Services
  • Ontario Ministry of Health
  • Ontario Ministry of Labour, Immigration, Training and Skills Development
  • Ontario Ministry of Long-Term Care
  • Ontario Public Service Employees Union (OPSEU), Ambulance Division  
  • Ornge 
  • Region of Durham Paramedic Services 
  • Renfrew Central Ambulance Communication Centre 
  • Service Employees International Union (SEIU) Healthcare 
  • Unifor  
  • University of Waterloo
  • York Region Paramedic Services 

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