Abstract
Emergency medical service (EMS) ambulance employees play a critical role in emergency healthcare delivery. However, work-related experiences can compromise their mental health and job satisfaction. Despite available supportive services offered by EMS organizations, employee uptake remains low, while mental ill health and suicide rates remain higher than those of the general population. Understanding barriers to and enablers of such support is crucial for addressing factors that connect employees with the services designed to help. This systematic review identified 34 relevant articles and utilized an innovative process of integrating quantitative and qualitative aspects of the primary and gray literature to provide a qualitative synthesis of barriers and facilitators as perceived by EMS employees. Themes of employee (in)ability to ask for help, tailored person-centered support, and education and training about mental health were overarched by organizational culture. Barriers included perceived organizational obligation rather than genuine care, alongside machismo and stigma. Enablers included valuing and acknowledging employee risk by providing time and normalizing support utilization at work. Reframing machismo from dominance, competition, and toughness to respect, perseverance, and courage; promoting adaptive coping; and providing time and training were essential. Future research should aim to understand the factors influencing employee utilization of supportive interventions based on these themes.