first responder in ambulance with patient

Emergency Services Personnel More Frequently Affected by Mental Health Problems

This entry was posted in Mental Health on June 7, 2018 and modified on April 29, 2019

First responders are facing high levels of stress and trauma and experts are trying to figure out how to get them the best mental health treatment.

When most people are running away from a disaster, emergency service personnel are running toward it. Police officers, fire fighters, EMS workers and other first responders are exposed to far more stress then the average citizen and then often suffer silently with related mental health issues and trauma.

They avoid asking for help because they are often in fields that demand quick action, which saves lives but offers little chance to express honest emotions. The Critical Stress (CS) survey in a 2015 edition of JEMS, a journal for EMS training, EMT news, paramedic education and ambulance operations, reported that  1,592 (40%) of the respondents had access to support but didn’t seek help. “Roughly a quarter of these respondents who didn’t seek help for their CS were concerned about how they’d be viewed at work if they had sought support,” the report concluded. “Over 40% of those who had either contemplated or attempted suicide and didn’t get help also listed scrutiny from others as the reason why they didn’t seek support.”

Yet mental health experts are finding that stress is having a significant impact on first responders and many need mental health treatment. One study found that 85% of first responders surveyed had experienced symptoms related to mental health issues. One-third of them were formally diagnosed with depression or post-traumatic stress disorder. Half received follow-up care after the traumatic event. But professionals worry about the other 50%.

Canada’s first national survey of operational stress injuries among first responders found that emergency personnel have a higher likelihood of developing a mental disorder than the general population. The Canadian Journal of Psychiatry reported that of 5,813 participants, 44.5% “screened positive for clinically significant symptom clusters consistent with one or more mental disorders.”

First Responders and Trauma

First responders are exposed repeatedly to dangerous, difficult situations. This creates cumulative trauma, which can impact the brain and body. Each time a first responder arrives at a disaster, the parasympathetic nervous system gets activated. They often witness horrible accidents, crimes, fires or disasters, moving from one stressful situation to another. They begin to live in a state of high alert. The brain becomes hyper-sensitized and is easily triggered by reminders of traumatic situations both old and recent. Trauma-related reactions may include:

  • Irritability
  • Aggression
  • Risky or destructive behavior
  • Hypervigilance
  • Heightened startle reactions
  • Difficulty concentrating
  • Difficulty sleeping
  • Trying to self-soothe with substances

As one officer put it, “The switch is never off because surviving in the job doesn’t allow it to be.”

Post-Traumatic Stress Disorder (PTSD)

PTSD among first responders is common but it too often is left to fester or find expression in an unhealthy way when people are too ashamed to report their symptoms. It is a state of persistent mental and emotional stress. It can develop after witnessing or being part of a traumatic incident or it can develop over time from cumulative trauma. The symptoms include high anxiety and frightening thoughts, night terrors, and heart racing or palpitation due to being triggered by physical reminders of the trauma. PTSD can lead to suicide and requires mental health treatment.

Guilt, Shame and Substance Misuse

Many first responders head out to calls expecting the worst, and often finding it. They witness scenes that most people only see in movies. Because of their training, they want to do their best on every call but there are many things they cannot help or change. Sometimes the car accident is fatal, a patient dies in the ambulance on the way to the hospital or shots ring out before a perpetrator can be caught. This leads many first responders to feel tremendous guilt about the crises they could not fix or the people they could not help. Self-blame can lead to maladaptive behavior and substance abuse.


Tracking depression in first responders is still a tricky task because it is under-reported, but in recent years there has been greater focus on studying depression as it relates to suicidality in first responders, especially police, fire fighters and EMS workers. A 2012 study of suicide rates showed 14 per 100,000 and 20 per 100,000 for Army, as compared to 11 per 100,000 in the general population. The Centers for Disease Control and Prevention reports that among females, the highest suicide rates occur among people in three occupational groups, including protective service occupations (e.g., law enforcement officers and firefighters). Sadly, research shows that police die more from suicide than from accidents on the job.

Early Trauma

People attracted to becoming first responders are sometimes people who endured early traumas that shaped them and possibly inspired them to help others. They may have been abused as children or had to protect siblings from an abusive or neglectful parent. They may have grown up in a home with an addict, or experienced some other form of emotional or physical abandonment.

It’s important to note that beneath the cumulative trauma on the job there may be unresolved childhood trauma that can make first responders more vulnerable to emotional and psychological issues. It’s important to break down the stigma so that they can get the best mental health treatment available.



Researchers Find Significantly Higher Rate of Mental Disorders Among First Responders

Survey Shows High Rates of Depression, PTSD Among First Responders

PTSD, Suicide and First Responders — A Lot of Talk, and not Much Progress

Police Suicide Studies

Work-Related Post-Traumatic Stress Disorder

Suicide Rates by Occupational Group — 17 States, 2012

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