But when the NSW paramedic was called to the gruesome job that tipped him into post traumatic stress disorder, NSW Ambulance racheted up the pressure, he said.

Mr McCormack had treated children turning blue from asphyxiation, violent assaults, stroke victims and attended the scenes of gut-wrenching road crashes. He thought he was coping, until he and his partner responded to a "concern for welfare" in 2015.

"On entering the house it was all dark. We called out 'ambulance' and no one responded to us. We went down the corridor switched on the lights and found a gentleman lying on the bed … he had blown his head off with a shotgun," he said.

"I couldn't sleep. I was waking up having horrific nightmares, I broke down, I was in tears."

"I said 'I can't do this anymore', and I went off operational duties for therapy," he said.

But his time off-road was blighted by repeated phones calls from ambulance service officers asking when he'd be back on duty.

"There was no support. Just constant harassing calls questioning what was wrong and trivialising my symptoms.

"I found out that certain people in the service were calling my GP and specialist and putting pressure on them.

"They'd ask why my doctors kept signing off on my leave, asking what I'd been telling my GP and what I looked like when I showed up for my appointments," Mr McCormack said.

"I was just constantly pressured … immense pressure from all angles," he said.

Mr McCormack - now a delegate with the Australian Paramedics Association - says this harassing behaviour has been allowed to fester in the service, exacerbating the all too common mental health problems among his colleagues.  

Claims pressure breeds bullying and mental distress

NSW Ambulance is facing renewed claims of endemic bullying and harassment from paramedics still working within their ranks who say the toxic culture has not been quashed despite numerous inquiries and calls for help.

But the service has rejected the suggestion it has not taken steps to address the culture problems and mental distress among its staff, with the new chief executive making mental health and wellbeing a key focus of his tenure.

A number of paramedics agreed to speak to Fairfax Media on condition of anonymity, fearing their harassment would intensify if they were known to have spoken publicly.

They described ongoing bullying and the lack of support they were given as they battled the severe mental toll of their work.

One veteran paramedic said he was left "mentally destroyed" after years of targeted bullying by managers to the point of contemplating suicide, believing that a coronial report was the only way his harassers would be properly investigated.

Some staunchly believed there would be no meaningful change until the old guard of "dinosaurs" in management who are used to making militant demands are moved on.

Several female paramedics described a "boys' club" that tolerated aggression, misogynistic behaviour and humiliating pranks. Fairfax Media has decided not to provide specific detail so as not to identify the female paramedics involved.

"Things were so much better before 1979" - referring to the year the first female paramedic joined the service - was a verbal put-down recounted to Fairfax Media by several paramedics.

"The culture of management relies on intimidation and threats," said Dan McPhee, a paramedic for almost a decade in the Hunter New England area.

Answering an endless procession of phone calls from distressed paramedics has become a second fulltime job over the past few months since the station officer since he became one of the APA's delegate support contacts.

"There are attempts [to change the culture] but it has not filtered down to management in my area," he said.

Pregnant paramedics in the Hunter New England area reported being the victims of harassment and "schoolyard" bullying when they have requested maternity leave and alternate duties during their final trimester, Mr McPhee said.

"They will be stood over and feel intimidated. Their careers have been threatened," he said.

Their pregnancies were used to apportion blame when rosters were changed to accommodate their alternate duties, Mr McPhee said.

"They are constantly reminded and made to feel guilty about the impact their pregnancy and their time away from work has on their colleagues," he said.

Mr McPhee said much of the harassment stemmed from the pressure management was under to meet unrealistic targets amid an ongoing shortage of paramedics.

"We are simply so under-resourced and understaffed that we can't even tolerate a single female paramedic from a rural ambulance roster being absent, and they apply a lot of guilt and pressure to try and stop that from happening," he said.

'This needs to stop now'

And endemic culture of bullying and harassment was entrenched across the state, said APA president Steve Pearce.

"We've had two parliamentary inquiries over the last 10 years and the assertions were given that this culture would be stamped out. It certainly hasn't been," Mr Pearce said. 

"This needs to stop. It needs to be immediately arrested for the good of paramedics."

Mr Pearce said managers were not taking complaints seriously, or trivialising serious bullying allegations by treating them as interpersonal workplace issues.

"It really is affecting paramedics and their mental health at a time where they have never been under so much pressure on a day to day basis being so under resourced," Mr Pearce said.

"They end up taking workers compensation ... and then they are subject to a lack of support [and] often times criticised for not coming back quick enough," he said.

"They are already vulnerable … and then to find when they are looking for help about what to do next and not getting any support at all or indeed getting harassed about coming back to work they suffer more," he said.

"They have done all they can they are still not getting any assistance and response from an organisation saying really value paramedics and staff wellness and we want to build resilience and assistance for mental health it's just not transferring to the front line," he said.

A 2015 NSW Health survey of more than 1800 paramedics found 74 per cent said they were treated with respect by their line manager, but only 41 per cent said their workplace had a positive culture, and just 26 per cent said their was a positive relationship between senior management and staff. 

A changing of the guard at NSW Ambulance 

"We have so much more work to do," said NSW Ambulance chief executive Dominic Morgan, who made the mental health and wellbeing of staff a top priority when he took the job in early 2016.

"I could not hand on heart say that we've solved the problem [of harassment] ... I think any big and complex organisation would have to acknowledge that they could not say [with absolute certainty] bad things did not happen in pockets of their organisation," he said. 

But the state's chief paramedic did not believe a toxic culture of bullying and harassment was endemic or statewide.

"In terms of do I think there are examples of this happening? Highly likely. Do I think it is a massive issue? I think it's probably somewhere between the two," Mr Morgan said.

Nor does he believe understaffing is the source of the problem: "I don't know that there is a definitive link between it", he said.

"I've got to do the best with the resourcing we've got … it goes back to culture."

Mr Morgan said there were lingering perceptions from years past that NSW Ambulance would not act on complaints or take claims seriously.

He said his office had consistently written to staff asking victims to come forward and detail specific incidences of harassment.

"We've said if you're worried about confidentiality just bring it to me, or professional standards, or outside agencies, ombudsman, HCCC, take it to police so they can investigate," he said.

Over the past six months he was aware of only one former paramedic who had taken up the offer, despite relentless reports to the APA and social media posts detailing claims of ongoing and historic bullying in the service.

"We carry culture forward. Some paramedics may have given up hope that something would be done about it," he said.

"Even if there's one case where someone is getting those signals we need to change that, because it's not okay."

A professional standards unit had been established to investigate issues of harassment, Mr Morgan said, but punitive action was not the answer to a complex problem.

"There are always two sides to a story … sometimes bad behaviours in the workplace can actually be symptomatic of a problem in someone's life," he said.

Over the 20 misconduct cases investigated by NSW Ambulance between November 2015 and Sep 2016, 17 lead to disciplinary action.

Mr Morgan said the nature of their work meant first responders were at greater risk of developing mental health issues including depression, anxiety and  PTSD than the general community.

NSW Ambulance was working to provide paramedics with support and build resilience before these disorders developed, Mr Morgan said.

He said the service had also enacted a suite of initiatives aimed to addressed mental health and wellbeing issues among its staff, including integrating several departments, including worker's compensation officers, professional standards, workplace strategy to treat paramedics like people, instead of compo claims, Mr Morgan said.

• A mental health and wellbeing summit earlier this year to deliver support and education strategies and asked paramedics for feedback on ways of improving the workplace. 
• A significant event support register to help staff access follow up support after exposure to confronting events
• A 1800 information line to simplify access to workers compensation and early treatment for mental health issues
• Recruited additional first contact peer support officers and chaplain
• Improved training for management
• Cover the cost of up to 10 appointments with a psychologist or psychiatrist
• Working with the Black Dog Institute to develop guidelines for PTSD in emergency service workers

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