Medical Dramas like the hit TV show The Pitt have brought to light the hectic, unpredictable and often traumatizing nature of emergency work. Physicians, clinical staff and administrative staff often bear the brunt of the medical work to stabilize patients and ensure that people brought to hospitals receive the care they deserve.
But outside of the hospital, another group of professionals play a critical role in the event of emergencies. As their name implies, first responders such as police officers, firefighters and paramedics provide immediate assistance at accident scenes, disasters or medical events. They are often the first to respond in emergency scenarios on-site, and are subject to harsh, chaotic and traumatizing circumstances. The definition also extends to 911 dispatchers, correctional officers, military and search and rescue teams, all focused on protecting the public and providing critical initial support.
What is posttraumatic stress disorder and Who develops it?
Posttraumatic stress disorder (PTSD) is a mental illness that stems from exposure to an experience involving death or the threat of death, injury, abuse or sexual violence. It affects approximately eight percent of the population in Canada, and can affect a wide range of people across all racial and socioeconomic backgrounds.
An experience is described as traumatic when it is very frightening, overwhelming, causes a lot of distress or disrupts our sense of self and security. Circumstances may include neglect and abuse during childhood, crimes, natural disasters, experiences of racism or gender-based violence, violence based on sexual orientation, accidents, war, conflict or genocide, or other threats to life. Trauma, especially when it is experienced during childhood, can affect our ability to build trusting relationships with other people. It can also build up when we are exposed to many stressors that create a trauma response because it can make us more vulnerable and less able to bounce back.
However, not everyone that experiences a traumatic event goes on to be diagnosed with posttraumatic stress disorder. Psychologists refer to a watching and waiting period after someone experiences a traumatic event. The period immediately following a trauma is a natural recovery phase where most people experience stress reactions that gradually decrease over time. Most individuals will recover on their own with support from family and friends. There are various reasons some will develop PTSD and others won’t. People develop PTSD after experiencing or witnessing traumatic events like combat, assault, accidents, or disasters but not everyone will go on to develop PTSD. Risk factors can include past trauma, intense fear, lack of support, and pre-existing mental health issues.
Steps to caring for First Responders and Medical Professionals
Understanding that first responders are regularly involved in highly stressful and traumatic events, where they are often tasked with overriding their own biological response to provide support to others, gives us a glimpse at how impactful this can be on one’s psyche. Beyond mental health, they also face physical risks from strenuous duties, harmful exposures, and accidents, impacting their overall physical and mental well-being.
Knowing this, we should be vigilant when working with first responders to ensure that their mental health needs are addressed. Here are a few ways we can contribute:
- Anti stigma strategies - focuses on shifting organizational culture through leadership, education, peer support, and normalizing seeking help, reframing asking for help as strength for peak performance, using workplace champions to support employees/staff with accessing mental health resources for example, and providing accessible, confidential resources like trauma-informed counseling and debriefing sessions typically conducted by a therapist to reduce fear of judgment and career impact.
- Recognize signs and symptoms of trauma - This includes intrusive memories (i.e., flashbacks, nightmares), avoidance (job duties, people), negative changes in thinking/mood (numbness, guilt, detachment, poor focus), and hyperarousal (jumpiness, anger, sleep issues, irritability, physical tension), often leading to substance use, isolation, performance drops, and relationship problems, manifesting as PTSD or other mental health struggles.
- Education and training - programs are focused on building personal resilience, peer support, and implementing a trauma-informed approach in their work. These particular programs or initiatives address the unique occupational stress and repeated trauma exposure faced by first responders.
- Peer support for families and friends – to decrease isolation and reduce impact of stress it is important to connect individuals who experience trauma with others who understand the unique stresses of the job. This includes various support programs, hotlines and family-focused wellness programs, offering confidential spaces for sharing, education, and access to specialized mental health resources like Cognitive Processing Therapy (CPT) or counseling to build resilience and manage burnout.
(Note: see the Resources section at the bottom of this article for links to organizations that can provide support) - Accommodation for workers returning to work - focus on gradual reintegration, creating supportive environments, and modifying tasks, including flexible hours, quiet spaces (with noise-canceling tech), task-chunking, supportive supervisors trained in PTSD, peer support, and potentially temporary administrative roles before full return to active duty, all while balancing the employee's needs with the employer's duty to provide a safe, productive workplace. Many health professionals will support temporary or permanent accommodations for first responders to assist with returning to work in the environment to assist with a successful return to the work environment.
Helpful Coping Strategies
It’s important to understand that there are some coping strategies that can be used in stressful circumstances. While they do not take the place of seeking professional help, they might be able to provide a brief respite during situations that are fraught with stress. These strategies can extend beyond first responders and medical professionals, and adapted for anyone who finds themselves in overwhelming situations:
- Breathing strategies - for trauma focus on activating the to calm the body's stress response, using techniques like Diaphragmatic Breathing (belly breaths), Box Breathing (4-4-4-4 cycle), and 7-11 Breathing (inhale 7, exhale 11), which slow heart rate and promote relaxation by engaging the diaphragm and controlling breath pace. These methods involve slow, deep inhales through the nose and longer, gentle exhales, often using cues like a "calm" word or visualizing a relaxing scene, helping ground you in the present moment and away from overwhelming feelings.
- Mindfulness - involves adapting standard meditation to be trauma-informed, focusing on creating safety and self-regulation rather than diving into distressing internal experiences, using techniques like grounding, resourcing, and mindful movement (e.g., mindful walking) to stay within one's "window of tolerance," and complementing therapy by building self-awareness, emotional regulation, and resilience without causing overwhelm or flashbacks. It helps survivors manage triggers by gently orienting to the present moment through external focus, supporting the nervous system's need for safety and control
- Grounding - techniques for trauma help you return to the present moment using your senses, body, and mind, focusing on simple actions like deep breathing, using the 5-4-3-2-1 method (noticing 5 things you see, 4 you feel, 3 you hear, 2 you smell, 1 you taste), holding a comforting object, or repeating calming self-talk to manage distress and dissociation.
- Walking/exercise - Walking and other forms of exercise are effective complementary strategies for trauma recovery, working to regulate the nervous system, release physical tension, and build a sense of self-efficacy.
- Talking with others - When talking with others about trauma, the goal is to provide empathetic support and normalization, without forcing anyone to speak or inadvertently causing re-traumatization. Current evidence favors what is called Psychological First Aid (PFA) and voluntary support over mandatory single-session "psychological debriefing" immediately after an event.
The benefits of speaking to a Therapist or Psychologist who can provide formal trauma therapy
Beyond these practices, one of the most effective and comprehensive ways to seek help is to seek the services of a Psychologist or Therapist. They are specially trained to identify various forms of trauma and trauma response, and have the breadth of knowledge to support people dealing with trauma and PTSD. A few of the ways they can provide further benefits include, but are not limited to:
- Cognitive Behavioural Therapy (CBT) - helps people reprocess traumatic memories, manage thoughts, and develop coping skills, often including gradual, controlled exposure to trauma reminders in a safe setting to reduce avoidance and regain control. It connects thoughts, feelings, and behaviors, teaches relaxation, and aims to make memories less overwhelming and prevent trauma from dictating life.
- Cognitive Processing Therapy (CPT)- short-term trauma therapy, often 12 sessions, that helps people with PTSD challenge and change distorted thoughts about a traumatic event, transforming negative stuck points (like "It was my fault" or "I'm not safe") into balanced perspectives, leading to reduced distress, anxiety, and shame, and improving daily life. It involves writing and discussing the trauma, focusing on themes like safety, trust, and control, and teaches skills to reframe unhelpful beliefs for lasting healing.
- Eye Movement Desensitization and Reprocessing therapy (EMDR) - is a structured psychotherapy that helps people heal from trauma by reprocessing distressing memories, reducing their emotional impact, and shifting negative beliefs. It involves focusing on a traumatic memory while experiencing bilateral stimulation (like eye movements, taps, or sounds), allowing the brain to process the memory, making it less distressing and more like a regular past event, effectively reducing PTSD, anxiety, and depression symptoms.
Posttraumatic Stress Disorder can be challenging for first responders, medical professionals, or anyone who is tasked with providing immediate support in times of crisis. It is helpful when they are able to recognize the signs and symptoms, have access to appropriate mental health resources and peer supports. There are evidence-based treatments that are available to treat posttraumatic stress disorder and there are various coping strategies that can also be helpful to support individuals with their symptoms on a day-to-day basis. The symptoms can be challenging but there is help.
Resources
Empowering First Responder Families
Dedicated to providing professional and compassionate support for the First responders, families of first responders (police, fire, paramedics, 911 dispatchers) across Ontario and Alberta.
CopLine
A confidential, 24/7 international hotline for active and retired law enforcement officers and their families, providing peer support from trained, retired officers who understand the unique stressors of the job
Boots on the Ground
An anonymous, 24/7 peer support program in Ontario providing confidential mental health help via phone to serving or retired police, firefighters, paramedics, nurses, dispatchers, and corrections officers, offering a listening ear from trained peers who understand their unique work experiences
Wounded Warriors Canada
Specializes in providing culturally informed services that utilize a combination of education, counselling, and training approaches to support resiliency and recovery from post-trauma injuries, serving Trauma Exposed Organizations, Trauma Exposed Professionals and their Families
Mental Health Supports for Public Safety Personnel program
An Ontario government initiative to provide specialized mental health services and resources for first responders and public safety workers), all aiming to combat stigma and provide culturally relevant care for police, paramedics, firefighters, dispatchers, and correctional officers facing trauma.
