"It’s The Bottom of the 25th, and the Score is 4 to 400."

Severity & Frequency

Earlier this year, while researching other topics I came across an interesting statistic that I believe easily illustrates the underlying root cause of mental health issues in the emergency services. The article stated that data studies in the United States show that the average adult has experienced around 4 major traumatic events (a serious accident, a sudden loss, a violent crime) in their lifetime. It also showed that people working in emergency services can experience 400 or more major traumatic events just in their 25 year long career. The rate of exposure is an astounding 100 times higher for first responders, and over only half of the timeframe. 

We all inevitably face unexpected, shocking, and damaging events in life. They are significant and can leave lasting impacts that derail us from the tracks of normalcy. Often requiring time and assistance to recover from. Now, imagine experiencing such events not just once in a while, but daily, weekly, or even multiple times within a single shift. This is the reality for first responders. I myself am writing these thoughts down after discussing the events of a 3 month old in cardiac arrest call that a co-worker had experienced the night before with him. It was an impromptu moment of decompression for him, but as I review the topic statistic I’m left wondering if it’s severity or frequency that is the larger issue for us. Most people would take some time to recover from a traumatic event like that, but here he is, back to work the next day. Which is not an uncommon occurrence in our industry.

A Constant Barrage of Critical Incidents

From the mangled wreckage of car accidents to the heart-wrenching scenes of child abuse, from responding to violent assaults and homicides to witnessing the devastating aftermath of natural disasters, first responders are routinely exposed to the darkest facets of human experience.

They are present during:

• Life-or-death emergencies: Every call holds the potential for a critical incident, where lives hang in the balance and the outcomes can be grim.

• Serious injury and death: They witness suffering, pain, and death up close and personal, often in the most gruesome and tragic circumstances.

• Human cruelty and violence: They confront the perpetrators and victims of violence, exposing them to the depths of human depravity.

• Mass casualty events: Disasters, whether natural or man-made, thrust them into overwhelming situations with widespread trauma and loss.

• The emotional toll of helping others: Even in successful rescues, the sheer emotional weight of the situations they navigate leaves a mark.

  
  

Beyond the Incident: The Cumulative Effect

It's not just the individual traumatic events, but the cumulative effect that truly distinguishes the first responder experience. Unlike a civilian who might process one traumatic event over an extended period, first responders often have little to no time to debrief or recover before they are called to the next incident. This relentless cycle prevents adequate emotional processing and can lead to a build-up of stress and trauma.

This constant exposure can manifest in various ways, often subtly at first, then more acutely:

• Post-Traumatic Stress Disorder (PTSD): While not every first responder develops PTSD, the risk is significantly higher due to the nature of their work and exposure to trauma.

• Anxiety and depression: Constant hypervigilance and exposure to suffering can lead to chronic anxiety and depressive disorders.

• Sleep disturbances: Nightmares, insomnia, and fragmented sleep are common as the mind struggles to process traumatic memories.

• Substance abuse: Some may turn to unhealthy coping mechanisms to numb the emotional pain.

• Strained relationships: The psychological toll can impact personal relationships, leading to isolation and difficulty connecting with loved ones.

• Moral injury: This can occur when responders are forced to make impossible choices or witness events that violate their deeply held moral beliefs.

  
  

Leveling the playing field:

The unique burden carried by emergency responders often goes unacknowledged. There's a pervasive culture of stoicism within these professions, a belief that they must be "strong" and not show vulnerability. This can make it incredibly difficult for them to seek help, even when they desperately need it.

As an industry, we have a responsibility to not just applaud their bravery, but to also acknowledge and address the profound psychological impact of their work.

This means:

• Prioritizing mental health resources: Ensuring easy access to specialized therapy, counseling, and peer support programs.

• Reducing stigma: Fostering an environment where seeking help is seen as a sign of strength, not weakness.

• Providing proactive support: Implementing regular mental health and wellness check-ins and preventative measures.

• Educating the public: Increasing awareness about the unique challenges first responders face.

  
  

Much of this can be accomplished through a well organized Peer Support Group. Our responders are on the front lines of the worst moments. By understanding the true extent of the trauma they endure, we can begin to provide the comprehensive support they so desperately deserve. B1C is highly experienced in all corners of the emergency services and peer support programs.  Reach out to us to see how we can help your organization and your people.

This article was written by FF/Paramedic Andrew Ruiz

Image is AI generated