First responders

Dispatchers and call-takers are often the very first responders. They hear screams, gunshots and people begging for help, and they must stay calm and give clear instructions. Then the call ends, and they may never find out what happened.

A 2024 review that pooled studies from nine countries found that about 17.8% of emergency call-handlers and dispatchers showed signs of PTSD and about 28.2% showed signs of depression. You do not have to be at the scene to be affected by trauma.

What can help

• Being included in debriefs and peer support, just like field crews
• Being told the outcome when possible
• Leaders who see dispatchers as first responders
• Short breaks after very hard calls

Paramedics and EMTs care for people at the scene and on the way to the hospital. They work fast, in tight spaces, often with family members watching. Then they clean up and take the next call.

One study cited by SAMHSA found that 69 percent of EMS professionals said they never had enough time to recover between traumatic events. Research reviewed by SAMHSA also suggests EMS workers may be more likely than the general public to think about suicide.

What can help

• A partner or supervisor who checks in
• A short reset after very hard calls
• Peer support and confidential counseling
• Time off that is truly off

Firefighters do far more than fight fires. Many calls are medical emergencies, crashes or rescues. SAMHSA notes that repeated exposure to painful scenes and broken sleep can put firefighters’ mental health at risk.

Most U.S. firefighters are volunteers (about 69 percent). Volunteers may face extra barriers to care, such as cost, travel, and getting time off from their other job. In one study, people who did both firefighting and EMS were more likely to report a suicide attempt than those who only fought fires.

What can help

• Crew support: talking and bonding after hard calls
• Peer support teams inside the department
• Protecting sleep on days off
• Watching alcohol use, which the U.S. Fire Administration says is a common and often unrecognized way of coping

Police officers face danger, violence and tragic scenes, sometimes in the same shift. In one study cited by SAMHSA, about three in four officers said they had experienced a traumatic event, but fewer than half had told their agency about it.

The U.S. Department of Justice’s COPS Office has described policing as a job made more stressful by an undercurrent of distrust and negative public opinion. A federal law, the Law Enforcement Mental Health and Wellness Act, led to reports on peer mentoring, crisis lines and officer wellness programs.

Pressures officers describe

• Feeling they must always look in control
• Seeing the same people and places in crisis again and again
• Split-second decisions that are later judged by others
• Worry that asking for help will affect their career

Research also links burnout at work with a higher risk of suicidal thoughts among officers. Caring for burnout early matters.

A dispatcher deciding which unit to send, a medic choosing a treatment, an officer making a split-second call: each decision can change someone’s life. Living with that pressure every day keeps the stress system switched on.

It can show up as

• Fear of making a mistake, or of being blamed
• Feeling responsible for outcomes you could not control
• Replaying decisions long after a shift ends
• Trouble switching off at home

Training, practice and a team you trust help. SAMHSA notes that specialized training, skill and confidence in yourself and your team are linked to lower stress.

The U.S. Fire Administration notes that a toxic work environment, such as poor leadership, discrimination, favoritism and exclusion, is one of the top two causes of stress for firefighters, ahead of the calls themselves.

SAMHSA’s review also found that poor relationships with supervisors are linked with more trauma symptoms, while approachable leaders and team spirit help protect responders.

Most people see a few truly frightening events in their whole life. Responders may see several in a single week: car crashes, fires, violence, a child who is badly hurt. Each one leaves a small mark, and the marks can build up.

The U.S. Fire Administration puts it simply: daily exposure to death, suffering and chaos builds up. It doesn’t take one catastrophic call to break someone down.

What can help

• A short pause after a hard call, even two minutes of slow breathing in the rig
• Leaders building recovery time into the schedule after very hard incidents
• Noticing when one call keeps replaying in your mind, and telling someone
• Talking it through with a trusted coworker who “gets it”

Your body has an internal clock that expects sleep at night. Night shifts, 24-hour tours and overtime push against that clock. The U.S. Fire Administration notes that sleep loss makes everything worse, including how strongly you react to stress.

Try this

• Avoid caffeine in the last few hours before you plan to sleep
• Make your room dark, cool and quiet (blackout curtains, earplugs, fan)
• Put your phone on do-not-disturb and tell family your sleep hours
• Wear sunglasses on the drive home after a night shift

Responders are often on the receiving end of people’s fear, anger and pain. Some calls put your own life at risk. Afterward, decisions may be judged in the news or on social media by people who were not there.

SAMHSA’s review notes that being injured yourself is one of the things that raises the risk of longer-lasting trauma reactions.

What can help

• Check in with your partner or crew after a scary moment
• Limit how much coverage of your own incidents you read
• Report every assault or threat, even “small” ones
• Talk with a peer supporter if a call keeps replaying

A line-of-duty death, a child who could not be saved, a scene with many victims. These events can shake your sense of safety and meaning, even if you have done the job for years.

In the first days

• Eat, drink water and try to rest, even if sleep is broken
• Expect waves of feeling, numbness, or replaying the call
• Spend time with people who steady you
• You don’t have to talk about details until you are ready

Many responders say it wasn’t one call that broke them. It was the slow pile-up of calls, overtime and missed sleep, with no time to process one before the next one came.

SAMHSA’s review cites a study where 69 percent of EMS professionals said they never had enough time to recover between traumatic events. When there is no time to recover, the mind can stay stuck on high alert.

What can help

• A regular check-in, like the “After-shift check-in” worksheet
• Days off that are truly off
• Small rituals that mark the end of a shift
• Telling someone when you notice the pile getting heavy

Secondary traumatic stress is emotional distress that comes from seeing or hearing about another person’s trauma. It can look like the reactions of people who went through the event directly: images that pop into your mind, bad dreams, feeling on edge, or avoiding reminders.

SAMHSA notes that responders who identify with survivors can be hit harder. A medic who cares for a child the same age as their own may find that call much harder to shake.

Sometimes the deepest wound is not fear but a sense that something went against what you believe is right: a rescue you couldn’t make, an order you disagreed with, or leaders who let you down. The VA calls this moral injury, and says first responders can experience it too.

The VA’s National Center for PTSD describes “anniversary reactions”: as a date comes round, people may feel sad, jittery or on edge, sleep badly, or relive what happened. It can happen even without realizing why.

What helps

• Do something meaningful: visit a memorial, volunteer, spend time with family
• Limit news or social media about the event if it stirs you up
• Mark the date in your calendar and plan ahead
• Protect sleep, food and exercise around the date
• Tell people you trust what kind of support you need

Some events land harder than others: the death of a child, a coworker hurt, or a person who reminds you of someone you love. Working with children who have been through trauma is a well-known hazard for secondary traumatic stress.

What helps

• Do a small ritual to mark the end of a hard shift, like a shower or a walk before going home
• Hug your people, and let them know it was a hard day, without sharing details
• Name it with your team: “That one got to me”
• Use peer support or a check-in after the shift, not weeks later

SAMHSA’s research review notes that long hours on scene, being injured yourself and poor support from coworkers are linked with stronger, longer-lasting reactions after hard events. A tired brain has less in reserve to process what it has seen.

What helps

• Eat and drink something during long shifts
• Lean on approachable coworkers and leaders
• Treat sleep as safety equipment
• Use your days off to truly rest and reconnect

Trauma memories store details of danger, so the brain can react to reminders as if the danger is back. SAMHSA notes that smells or sounds such as smoke or sirens can set off distress for people who lived through a disaster. For responders, these cues are part of the job, which can make them harder to escape.

What helps

• Ground yourself: feel your feet, name five things you can see
• If reminders keep pulling you back, talk to a trauma-trained therapist
• Notice the cue, and remind yourself: “That was then. I’m safe right now.”
• Slow your breathing for a minute

Exposure to trauma is part of emergency work. But lasting distress, burnout and a toxic workplace are not things you simply have to accept. Workplaces can change, and people can heal.

Untreated stress, trauma and burnout are far more likely to hurt your work than getting support. Many services, like peer support lines and employee assistance programs, are confidential.

Ask before you start

• Is this service separate from my employer?
• What, if anything, would ever be shared, and when?
• Who will see my information?

In emergency work, nobody works alone. You rely on partners, crews and squads. SAMHSA’s review found that social support and good relationships with coworkers and leaders protect responders’ mental health.

Peer supporters are coworkers trained to check in, listen and point people toward more help when needed. Because they have done the job, people often trust them more easily. The U.S. Fire Administration notes that trained peers are what firefighters respond to, and that programs are expanding nationwide.

In a study described by SAMHSA, firefighters said they benefited from peer support and from bonding with their crew after hard incidents.

A good peer program

• Has clear links to professional counselors
• Includes dispatchers, support staff and families
• Is voluntary and confidential
• Trains peers well and supports them too

CISM is a package of supports used by many agencies, such as briefings, check-ins, group talks and follow-up. One part, critical incident stress debriefing (CISD), is a structured group meeting soon after an event.

The evidence is mixed. SAMHSA notes that some firefighters found debriefing helpful while others found it intrusive and felt more upset afterward. A Cochrane review found no evidence that single-session debriefing prevents PTSD and said compulsory debriefing should stop.

What this means for you

• If reactions last weeks, reach out for trauma-focused therapy
• Practical support, rest and follow-up check-ins often matter more than one meeting
• Taking part should be your choice
• You don’t have to share details you aren’t ready to share

Many employers offer an employee assistance program (EAP) with a few free counseling sessions for you and your family. Ask HR or your union how it works and whether counselors understand first responders.

The U.S. Fire Administration notes that clinicians who understand fire service culture get better engagement and results than outside providers who don’t.

Therapies such as cognitive processing therapy, prolonged exposure and EMDR help people make sense of hard memories so they hurt less and lose their grip. They usually take a set number of weekly sessions. Cognitive behavioral therapy (CBT) can also help with stuck thoughts like “I should have done more,” worry, low mood and sleep.

What to expect

• Building skills to calm your body
• Learning how trauma affects the body and mind
• Looking at stuck thoughts like “It was all my fault”
• Slowly and safely facing memories you have been avoiding

When your whole identity is your job, a bad week at work can feel like a bad life. Hobbies, faith, friends who aren’t in the field, and time with family give you other places to stand. Regular exercise, slow breathing and time outdoors also help reset the stress system.

Ideas

• A friend group outside work
• A hobby that has nothing to do with emergencies
• Rituals that mark the end of a shift
• Volunteering for something joyful

Children may worry when a parent works in danger, or feel sad when a parent misses events. Simple, honest explanations help: “Dad had a hard day helping people. He’s tired, but he loves you.”

Ideas

• Keep routines steady when schedules change
• Let kids ask questions, and answer at their level
• Make special traditions for shift days
• Reassure them they are not the cause of a parent’s mood

Many departments include families in peer support, family nights and counseling through employee assistance programs. Copline serves the families of law enforcement officers, and Safe Call Now serves family members of public safety and emergency services workers.

Ideas that help

• Agree on a simple signal for “I had a hard shift and need a bit of quiet”
• Look after your own stress, too
• Plan small, regular time together that work can’t take
• You don’t need all the details of a call to offer support