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Paramedics are exposed to events involving human pain and suffering on a daily basis, many of which are the result of violence perpetrated by 1 individual on another. For the most part, these emergency workers have learned to deal with such events and take them in stride. At times, however, certain circumstances lead workers to develop an emotional connection with the victim or his or her family. When this occurs, paramedics report increased symptoms of traumatic stress. Aspects that can trigger this connection include the victim's alienation from others, profound loss, or the abuse of an innocent child. One of the coping strategies described in these circumstances is to manage the events on a cognitive and technical level while maintaining an emotional distance. Although such a strategy may be protective, it may also have long-term negative effects in terms of interpersonal relationships. This mixed-methods study attempts to better understand factors that lead to higher levels of distress among paramedics within the theoretical framework of emotional and cognitive empathy.