Show Notes
In this episode of EMS One-Stop, Rob Lawrence sits down with Dr. Maria Koeppel to explore a topic that has long existed in the shadows of EMS culture — alcohol use among providers. | MORE: First responders and alcohol – how much is too much? Drawing on NIH and FEMA supported research, Koeppel outlines how EMS clinicians may be engaging in higher-risk drinking behaviors than the general population, with patterns influenced by stress, exposure and workplace culture. What emerges is not a story of individual weakness, but one of systemic pressure — where both major traumatic incidents and the accumulation of low-acuity, high-frequency calls contribute to a steady burden of stress that many providers attempt to manage off-duty. The conversation moves beyond statistics into culture, leadership and generational change. Koeppel highlights how traditional “crew bonding” through alcohol — what one participant termed “hydraulic debriefing” — may be giving way to a new, more wellness-focused approach among younger clinicians. At the same time, gaps in education, policy and peer support remain evident across EMS systems. For leaders, the message is clear: alcohol use is not a fringe issue, but a workforce health, safety and performance issue that requires thoughtful engagement, cultural awareness and proactive support structures. Key quotes from Maria Koeppel
“Over 50% of firefighters surveyed had binge drank in the last 30 days — about twice the rate of the general population.”
“EMS providers tend to drink a little bit more frequently than the general population — and that’s tied directly to stress.”
“It’s not just the big trauma calls — it’s the micro-stressors that add up over time.”
“A third of clinicians in our sample engaged in high-risk drinking behaviors.”
“Younger clinicians are at higher risk — but that risk declines with age as coping mechanisms develop.”
“Paramedics are at higher risk than EMTs, likely due to increased responsibility and patient exposure.”
“Some described going out after shift as ‘hydraulic debriefing’ — using alcohol to process the day.”
“Gen Z is driving a more sober culture — they’re choosing connection without alcohol.”
“Leadership isn’t just policy — it’s culture, awareness and how you care for your people.”
“Alcohol and coping has to be part of the conversation if we care about workforce health and patient safety.”
Episode timeline
01:06 – Maria’s background: firefighter and researcher 02:24 – Overview of NIH/FEMA research and EMS focus 04:14 – Key findings: stress, frequency of drinking and EMS culture 05:08 – Micro-stressors vs. major trauma calls 06:54 – Risk factors: age, role, education, multiple jobs 10:11 – Culture and “hydraulic debriefing” 11:46 – Fire vs. private EMS cultural differences 14:38 – Generational shift: Gen Z and sober culture 19:24 – Alternative substances and coping trends 21:20 – Leadership roles: policy vs. culture 24:11 – Peer support gaps in EMS 26:41 – Workforce impact: sleep, stress, retention 27:14 – Education gap and need for EMS-specific training 29:11 – Conferences and future research dissemination 30:13 – Episode wrap-up
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