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Background: Exposure to traumatic stressors is potentially an integral part of the job for emergency medical services (EMS) personnel, placing them at risk for psychological distress and mental health problems., Study Objective: The prevalence of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms was examined in a sample of EMS personnel in a multiethnic locality in Hawaii. Commonly encountered traumatic incidents at work were also assessed., Methods: The PTSD Check List-Civilian version was sent to 220 EMS personnel. The survey included questions on demographics, traumatic incidents at work, general stressors, coping methods and post-traumatic stress symptoms., Results: 105 surveys were returned (48% response rate); 4% of respondents met clinical diagnostic criteria for PTSD, 1% met subclinical criteria for PTSD, 83% reported experiencing some symptoms but no PTSD and 12% had no symptoms. However, few had received treatment for these symptoms. Serious injury or death of a co-worker along with incidents involving children were considered very stressful. General work conditions also contributed to the overall stress levels. Most common coping strategies reported were positive reinterpretation (63%), seeking family and social support (59%) and awareness and venting of emotions (46%), with significant differences by ethnicity., Conclusion: EMS personnel are at high risk of experiencing post-traumatic stress symptoms. Early identification and treatment of potential stressors, psychiatric and medical problems is warranted and necessitates ongoing assessment and employee assistance programmes at the minimum.