When a rural paramedic rushes to help after an emergency, it's likely to hit close to home.
"It's not just somebody who's had a cardiac arrest, or has been assaulted by their partner or a child who has drowned in a pool, it's their neighbours or their friends," nursing academic Rikki Jones told AAP.
"That adds another layer of secondary trauma that you wouldn't experience as much in a metro area."
A study is set to examine the unique stresses experienced by Australia's rural emergency workers, in a bid to minimise burnout and stop frontline staff leaving their jobs.
Previous research has shown higher levels of post-traumatic stress disorders (PTSD) among first responders than the general population due to the distressing and unpredictable nature of the work.
But Dr Jones, a lecturer at the University of New England and the study coordinator, said rural emergency staff are likely to feel added layers of trauma, compounded by fewer resources.
"If we don't start to manage the mental health, the PTSD, the depression and anxiety they have from dealing with trauma in rural areas, then we're not going to have a workforce left to do the first response," she said.
Rural emergency workers' unions have been vocal about stretched resources and low morale in recent years, particularly after the COVID-19 pandemic.
Representatives from the Australian Paramedics Association of NSW told a parliamentary inquiry into rural health late last year the attrition rate was at its highest level in nearly a decade.
The research, which is a collaboration between Charles Sturt, Sydney and Griffith universities and the Black Dog Institute, will involve a panel of police, paramedics, SES and fire and rescue organisations.
Lisa Clegg, a former paramedic and senior lecturer in paramedicine at CSU, said travelling long distances with critically ill patients puts added strain on rural workers.
"There's also the isolation and trying to access support," Dr Clegg said.
"Access to mental health support is more difficult in those areas, than it is in metropolitan areas and access to online support can be difficult because the internet isn't always great."
Researchers hope the study will help form guidelines for rural employers to manage workers' mental health before it reaches a critical stage.
"It's taking care of those who are caring for us," Dr Jones said.
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