Post-traumatic stress disorder is an important mental health care concern for first responders. Learn about PTSD, its symptoms and how to find help.

Despite training and mental preparation, first responders are at a higher risk for developing post-traumatic stress disorder, or PTSD, due to the stressful situations they witness. The development of PTSD for any first responder could potentially result from a single catastrophic event.

PTSD statistics indicate the condition is relatively common in first responders. Perhaps because they are sometimes exposed to multiple traumatic events in their careers, first responders’ lifetime prevalence of PTSD can be as high as 32%. Amongst first responders, rates of PTSD are estimated to be the highest at 14.6%. The numbers are 7.3% and 4.7% for prevalence of PTSD in firefighters and police officers, respectively.

Despite training and mental preparation, first responders are at a higher risk for developing post-traumatic stress disorder, or PTSD, due to the stressful situations they witness. The development of PTSD for any first responder could potentially result from a single catastrophic event.

Challenges Faced by First Responders

For first responders, trauma exposure is part of the job. Human beings are empathetic by nature, and witnessing others in distress can be very challenging.

Tough as it may be to imagine, traumatic events may include arriving on the scene of someone suffering an extreme injury caused by an accident or another person. Car accidents, falls, house fires, and gang-related activity are a few examples of situations where a first responder may develop PTSD as a result of the exposure to these unfortunate and sometimes horrific circumstances.

Having difficulty processing these challenges is one part of someone developing PTSD. Fortunately, PTSD is a recognized medical condition, and with proper diagnosis, treatment is possible.

Symptoms & Causes of PTSD in First Responders

According to the National Institute of Mental Health, PTSD symptoms must meet certain criteria for diagnosis. For example, symptoms must last more than one month and they must also be severe enough to impede relationships or work to be considered PTSD. Determining whether or not PTSD is present is very complex and should be done with the help of a healthcare provider. That being said, there are warning signs of PTSD to look out for in emergency responders including intrusive memories, avoidance and hyper-arousal symptoms.

Intrusive Memories

Intrusive memories are unwanted recollections of the traumatic experience that keep coming to the surface of consciousness. If experienced during waking hours, these recollections can take the form of vivid and distressing flashbacks. If asleep, intrusive memories might manifest themselves as realistic and disturbing nightmares. For people with PTSD, these experiences can feel incredibly real, sometimes causing an overwhelming sense that the sufferer is reliving the traumatic event in real time.

Avoidance Symptoms

Symptoms of avoidance may include feeling reluctant to return to the circumstances surrounding the traumatic event. This can manifest itself as a resistance to being around other people that were involved, or revisiting the location where the event occurred. Refusing to even think about or discuss an event could also be classified as avoidant behavior.

Hyper-Arousal Symptoms

Hyper-arousal indicates a heightened emotional state and could include:

  • Irritability
  • Angry outbursts
  • Insomnia
  • Difficulty concentrating

Common Causes of PTSD

PTSD is usually caused by highly disturbing or life-threatening events. Especially in the case of first responders, it’s worth remembering that the event doesn’t have to have actually happened directly to the person suffering from PTSD. Experiencing the event by proxy (that is, through another person) or from being in the vicinity of the disturbing scene, is more than enough.

Risk & Protective Factors

There are numerous PTSD risk factors that have been observed and studied before, during and after stressful events. Anything that might decrease a first responder’s resilience or their ability to adapt to and process new sources of stress may increase their risk of suffering from PTSD. This could range from previously or currently endured stressful situations such as dysfunctional work environments or financial strains, to maladaptive strategies for dealing with life’s challenges such as relying on substance use for emotional regulation.

Alternatively, protective factors for PTSD can work to increase resilience and shield a first responder from PTSD. Such factors include strong social support frameworks and using healthy coping strategies.

Why First Responders Often Don’t Seek Help

As prevalent as PTSD is in first responders, unfortunately they don’t always get the help that they deserve. In some cases, they may worry about their ability to cover the costs associated with proper treatment. While it is true that healthcare can be very expensive, mental healthcare, such as PTSD treatment, is covered by many insurance plans.

Alternatively, first responders may not seek help for more complicated reasons, sometimes fueled by the unfortunate stigma surrounding PTSD. Some institutions or workplaces may have a culture of self-reliance that discourages those suffering from PTSD symptoms from seeking medical attention. Emergency personnel may even worry about being fired due to their PTSD, even to the extent that they may be in denial about suffering from it at all.

However, any emergency worker looking for help dealing with what they have experienced would be far from the first to do so. In fact, seeking treatment can help not only the person affected but also those around them. Working with health care professionals to treat PTSD and its symptoms can help improve one’s performance, and in turn, improve their entire organization. First responders owe it to themselves, their families and their employers to be at their very best, and good mental health care can be an important and effective part of that.

Finding Help for First Responders

PTSD treatment for first responders is now more available than ever, thanks in part to a growing understanding of the condition and its importance. The International Association of Firefighters (IAFF) Center of Excellence is a great place to begin a search for help with various behavioral health conditions.

Additional Resources for First Responders and Their Families

First responder PTSD support resources and information are available via the following organizations:

  • The Code Green Campaign is a mental health advocacy and education organization that serves all types of first responders.
  • Fire/EMS Helpline is a hotline provided by the National Volunteer Fire Council (NVFC) that can be called anytime at 1.888.731.FIRE to assist first responders or their families with behavioral health issues.
  • Safe Call Now is a confidential crisis referral service for all public safety employees, all emergency services personnel and their family members nationwide and can be reached at 206.459.3020.
  • Firefighter Behavioral Health Alliance is an organization dedicated to providing workshops and training for organizations all over the world to improve behavioral health awareness for first responders and their families.

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Editor – Melissa Carmona
Melissa Carmona puts years of writing and editing experience to work helping people understand substance abuse, addiction and mental health disorders. Read more
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Medically Reviewed By – Eric Patterson, LPC
Eric Patterson is a licensed professional counselor in the Pittsburgh area who is dedicated to helping children, adults, and families meet their treatment goals. Read more

National Health Service. “Post-traumatic stress disorder (PTSD).” Reviewed September 27, 2018. Accessed September 28, 2019.

National Institute of Mental Health. “Post-Traumatic Stress Disorder.” Updated May 2019. Accessed September 28, 2019.

Phelps, Andrea. “Paramedics need more support to deal with daily trauma.” The Conversation, June 5, 2018. Accessed September 28, 2019.

Substance Abuse and Mental Health Services Administration. “Disaster Technical Assistance Center Sup[…]Response, and Trauma.” May 2018. Accessed September 28, 2019.

Walker, Anthony; McKune, Andrew; Ferguson, Sally; Pyne, David B; Rattray, Ben. “Chronic occupational exposures can influ[…]d military personnel.” Extreme Physiology and Medicine, July 15, 2016. Accessed September 28, 2019.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.