Our framework is the result of various resources on trauma-informed care: The Substance Abuse and Mental Health Services Administration (SAMHSA), the Crisis Prevention Institute, the Centre for Addiction and Mental Health, the National Library of Medicine, and the Journal of Collegiate Emergency Medical Services. The most significant influence was SAMHSA, with its pillars of safety, peer support, trust, collaboration, cultural awareness, and empowerment.
This was then combined with the results of a January 2024 study on collegiate EMS providers, which assessed experience, confidence, and best practices for treating patients with medical trauma.
The first and most fundamental principle is safety: both physical and psychological. This requires ensuring the patient is safe, but also making sure they feel safe.
Physical safety: maintaining overall scene safety, keeping assessment areas clean and well-lit, ensuring proper storage of supplies, following infection and PPE protocols, and coordinating effectively with campus security and additional resources, as needed. These measures help prevent harm and create a structured, predictable environment.
Psychological safety: using a calm, reassuring tone, avoiding sudden movements, explaining each action/procedure before doing it, always asking for consent, and maintaining open communication about next steps.
In a crisis, a patient’s ability to trust can shape the entire experience.
This starts with consistency -following through on what we say, actively listening, and validating a patient’s concerns. It means staying patient and empathetic, even when a situation is stressful or the patient is resistant to care.
Transparency goes hand in hand with trust. Patients feel safer when they understand what’s happening and why. This means outlining the patient’s options and making sure they feel involved in decisions about their care.
It also includes practical details, like introducing our team members at the start of an interaction, and maintaining open, clear communication.
To demonstrate peer support in EMS, providers can actively listen to patients, maintain patience, offer reassurance and empathy, encourage patients to contact a support person, educate patients on their condition and available resources, and connect patients to the appropriate social or mental health resources beyond the initial emergency response.
Collaboration starts with strong partnerships. As collegiate responders, we work alongside various support networks to provide the best possible care. A patient’s needs often extend beyond our immediate role, and recognizing when to bring in other resources is key.
Mutuality takes this one step further. It’s about recognizing the patient’s lived experiences as important, acknowledging their concerns, treating them with respect, and fostering a sense of partnership.
Cultural awareness means respecting norms around physical touch, personal space, and communication. Some cultures have specific views on eye contact, authority figures, or expressions of pain, and recognizing these differences helps us avoid unintentional discomfort.
Historical trauma is particularly relevant for marginalized communities who have experienced systemic discrimination, medical mistreatment, or generational trauma. Many Indigenous, Black, and other historically oppressed populations may have deep-seated mistrust in medical systems due to past harm. While we can’t change history, we can acknowledge it and approach every patient with humility and understanding.
Gender sensitivity means things like respecting pronouns, being mindful of gender-based violence, and offering a same-gender responder when appropriate. It also means recognizing that gender expectations can shape how someone expresses distress.
At the core of trauma-informed care is the idea that patients should feel heard, respected, and in control of their care. Trauma often strips people of their sense of agency, and as responders, we have the opportunity to help restore it.
Empowerment means giving patients a sense of control over their own care. This can be as simple as allowing them to express preferences about positioning during the assessment or deciding if they want that support person present. We can also reinforce their strengths, reminding them of their resilience in navigating a difficult situation.
Voice is about truly listening. Patients in distress need to feel that their concerns matter. That means letting them speak without interruption, validating their experiences without judgment, and taking their fears seriously.
Providing choice is also key. Whenever possible, we should present patients with options, allowing them to make decisions that feel safest for them.
Video 1: Foundations of Effective Trauma-Informed Care (coming soon)
MP3: Foundations of Effective Trauma-Informed Care (coming soon)