Introduction

EMDR is a first‑line trauma‑focused psychotherapy in the UK and internationally, supported by robust trial evidence across populations (National Institute for Health and Care Excellence, 2018; World Health Organization, 2013). In England, EMDR is commissioned within NHS talking therapies (formerly Improving Access to Psychological Therapies). These therapies emphasise evidence‑based delivery, routine outcome monitoring and clinical governance, (Health Education England (HEE) & NHS England (NHSE), 2024).

Ambulance paramedics face chronic, repeated exposure to potentially traumatic events including cardiac arrests, paediatric emergencies, sudden deaths, violent incidents and catastrophic injuries. Systematic reviews indicate markedly elevated PTSD prevalence in ambulance personnel compared with the general population, with pooled estimates around 11% for PTSD (pre 2018 literature) and around 20% for 12-month PTSD in high income settings, compared with around 3% in nonexposed populations (Petrie et al., 2018; Hoell et al., 2023). These epidemiological realities create a pressing need for tolerable, effective, guidelineconcordant trauma care within NHS settings (NICE, 2018).

Literature review

Clinical effectiveness of EMDR

Meta‑analyses and network/meta‑analytic syntheses show that EMDR produces large improvements relative to waitlist/usual care and performs comparably to trauma‑focused CBT post‑treatment with sustained effects at follow‑up (Bisson et al., 2019; Lewis et al., 2020; Mavranezouli et al., 2020).

Ambulance/paramedic mental health

Global reviews demonstrate elevated PTSD, depression and anxiety in ambulance personnel (e.g. pooled PTSD ≈11% with 15% depression/anxiety and 27% general distress) far above general population baselines. More recent pooled 12‑month PTSD estimates near 20% underscore the cumulative occupational burden (Petrie et al., 2018; Hoell et al., 2023).

Remote/technology‑assisted EMDR

Service evaluations and systematic reviews during and after the COVID‑19 period indicate that remote EMDR can be feasible and effective when delivered with appropriate safety and fidelity procedures, which is relevant for shift‑based paramedic work (McGowan et al., 2021; Kaptan et al., 2024).

Theoretical framework

Adaptive information processing conceptualises PTSD as arising from maladaptively stored traumatic memories; bilateral stimulation facilitates linkage to adaptive networks and reconsolidation. Concurrent neurophysiology during EMDR sessions suggests a functional shift from limbic to cortical associative activity as processing progresses (Pagani et al., 2012). Complementary experimental work supports a working‑memory taxation account; pairing aversive memory recall with a concurrent dual task reduces subsequent vividness/emotionality and shows persistence at follow‑up when the load is sufficient (Van den Hout & Engelhard, 2012; Leer et al., 2014).

Bone‑conduction bilateral stimulation uses specialised headphones to deliver alternating auditory and tactile input without requiring visual engagement, which may reduce visual trigger activation in paramedics while maintaining adequate dual‑task demand. Bone‑conduction headphones provide lateralised auditory/tactile cues without visual load, which may reduce visual‑trigger risks in paramedics while maintaining adequate dual‑task demand. Although ocular movements may produce larger working memory load effects in laboratory settings, clinical sufficiency rests on adequate load plus therapeutic pacing (Van den Hout & Engelhard, 2012; Pagani et al., 2012).

Methods

Design and setting

A single case service evaluation in an NHS talking therapies service, adhering to national governance (Health Education England (HEE) & NHS England (NHSE), 2024) reporting an adult ambulance paramedic who met PTSD criteria linked to a workplace critical incident. The history included childhood adversity and cumulative adult traumas that increased vulnerability. Measures included the Impact of Event Scale Revised (IES‑R), Patient Health Questionnaire–9 (PHQ‑9), Generalised Anxiety Disorder-7 (GAD‑7), Work and Social Adjustment Scale (WSAS), all standard instruments in UK services (Creamer et al., 2003; Kroenke et al., 2001; Spitzer et al., 2006; Mundt et al., 2002).

Intervention

Standard eight phase EMDR using bone conduction bilateral stimulation (BLS; alternating left/right tones, adjustable speed/intensity) instead of visual BLS, with stabilisation, target sequencing, desensitisation, installation, body scan and re evaluation. (NICE, 2018; Shapiro, 2018).

Ethics/governance

The client was fully anonymised. Written permission for anonymised use of the patient’s clinical information was obtained.

Results

The patient demonstrated significant reductions in symptoms across all outcome measures (Table 1). The IES-R score decreased from 68 to below the clinical threshold (probable PTSD threshold ≈33) within eight sessions, while scores on the PHQ-9 and GAD-7 also improved markedly. Functional improvements were reflected in WSAS scores, with changes consistent with clinically meaningful improvement and in line with those observed in EMDR trials. Patient feedback indicated enhanced comfort and engagement compared to prior EMDR using light bars.

The patient reported that their nightmares remitted, flashbacks reduced in frequency and intensity, sleep improved and they completed a graded return to work, including revisiting the incident location with manageable distress. This is consistent with traumafocused therapy goals in the national guideline (NICE, 2018; Lewis et al., 2020).

Table 1: Scores across outcome measures

Measure	Pre treatment	Post treatment	Clinical threshold
IES-R	68	24	<33
PHQ-9	14	5	<10
GAD-7	13	4	<8
WSAS	28	10	<10

Discussion

The observed symptoms and functional gains align with meta‑analytical evidence supporting EMDR’s effectiveness and with NHS talking therapies’ focus on recovery and reliable improvement (Bisson et al., 2019; Lewis et al., 2020; NHS England, 2024). Given the elevated and chronic exposure profile of ambulance personnel, modalities that are acceptable, portable and efficient are advantageous (Petrie et al., 2018; Hoell et al., 2023).

For paramedics with visual sensitivity or incident‑linked visual triggers, bone‑conduction offers lateralised stimulation while minimising visual load. Although laboratory working memory studies sometimes find stronger effects for eye movements than simple tones, clinically adequate working memory taxation can be achieved by tuning audio parameters and pacing, which is consistent with the results for this patient (Van den Hout & Engelhard, 2012; Leer et al., 2014). The approach is also compatible with remote delivery models shown to be feasible in evaluations (McGowan et al., 2021; Kaptan et al., 2024).

Limitations and future research

This single case design and lack of long‑term follow‑up limit generalisability and durability claims. Future studies should compare bone conduction, ocular and tactile BLS modalities in randomised designs, including mechanistic endpoints (e.g., electroencephalogram/functional magnetic resonance imaging) and should report implementation outcomes salient for ambulance services (acceptability, drop‑out, time‑to‑response; Pagani et al., 2012; Lewis et al., 2020).

Conclusion

Within NHS talking therapies, EMDR using bone‑conduction BLS produced clinically significant reductions in PTSD, depression, anxiety and functional impairment for an ambulance paramedic, alongside meaningful real‑world gains (return to work; trigger mastery). The modality is feasible, acceptable and theoretically coherent. Further controlled evaluation is warranted for ambulance/paramedic populations.