In this episode of the Pre-Hospital Care Podcast, we're joined by Dr Jo Mildenhall to explore a critical and often under-discussed issue in pre-hospital medicine: burnout.

Frontline ambulance staff experience some of the highest rates of sickness absence in the NHS, with stress, anxiety, and depression frequently cited as the cause. While much attention has traditionally focused on the impact of major traumatic incidents, Jo's research has consistently challenged this narrative, highlighting that the cumulative burden of daily hassles, operational pressures, organisational friction, resource constraints, moral distress, and relentless demand may be equally, if not more, damaging to psychological wellbeing.

Drawing on her latest work on the social psychological dynamics within ambulance service culture, Jo examines how group identity, workplace relationships, and collective experiences of adversity shape the way ambulance clinicians perceive, process, and respond to stress and trauma. Her research suggests that the cultures we work within profoundly influence our emotional responses, coping behaviours, and willingness to seek support. We unpack the informal coping mechanisms paramedics often turn to, including cognitive strategies, gallows humour, and peer support, and examine what it is about these strategies that they find particularly helpful.

With Jo's extensive experience in both clinical and educational settings, we reflect on how workplace culture, leadership, social identity, and peer relationships shape how paramedics manage stress, and what more can be done to protect psychological wellbeing on the front line. Ultimately, this episode asks an important question: if burnout is driven as much by the accumulation of everyday pressures as by extraordinary events, how do we build ambulance services that are not only operationally effective but also psychologically sustainable?

Please find Jo's latest research here: https://www.researchgate.net/publication/272449530_Occupational_stress_paramedic_informal_coping_strategies_a_review_of_the_literature