First responders, so often called upon to help those in despair, may feel selfish or guilty for talking about their own struggles. As such, the general public often doesn’t understand what their line of work really entails, and how taxing it can be on mental health.

In a similar vein, first responders often feel stuck with their struggles, and may resist seeking assistance from others. First responders’ stoic emotional culture, combined with the very real emotional pressures of their work, often leaves their unique emotional needs unmet.

Too frequently, first responders have little choice but to put their own needs on the back-burner, leaving small issues to fester until they reach crisis level. But especially in an age of increased personal pressure on all of us, how can EMS and Fire professionals balance the emotional stress of both home and work life?

Where do people go when they’re just getting through, doing their best, but dealing with difficult emotions? Fire fighters and other EMS professionals are just people who also happen to be emergency responders.

In the face of news about more intense issues, we wondered what kinds of measures are in place for EMS professionals and firefighters to get help for everyday emotional struggles – and what parts of mental health maintenance challenge emergency responders most.

To find out, we interviewed local officials at a medium-sized department, as well as an assistant fire chief, in the East San Francisco Bay Area.

They conveyed that while acute trauma is a real issue, hypervigilance and complex trauma pose the greatest everyday challenges. Additionally, these first responders believed self-care, self-reflection, and peer support play an integral role in maintaining mental wellness.

Hypervigilance: a necessary burden

Many first responders experience hypervigilance, or an increased sensitivity to activity out in the world, accompanied by a constant feeling of being on-edge. 

From the overt conflict of violent incidents, to the passive tension of the administration and working within a bureaucracy — first responders operate in a state of constant conflict and hypervigilance.

No, I can’t turn it off. The word for it is hypervigilance.

For first responders, this heightened attention to sensory stimuli becomes ingrained in one’s personality, making public safety work more than just a profession. 

One first responder explained, the increased attentiveness required for the job becomes part of who you are – you can’t shut it off: “It’s kind of funny. At first you want to say that sounds reasonable [to stop paying constant attention to what’s going on around you]. But that’s not how [it] works. No, I can’t turn it off. The word for it is hypervigilance.”

Individuals with PTSD or anxiety may relate to this feeling. Hypervigilance can make it hard to focus on what you’re trying to do, and the constant stress state it puts you in can harm your body through fight-or-flight hormones and prolonged sympathetic nervous system activation. 

These may contribute to inflammation and long-term depression in hypervigilant individuals, as well as make it hard to connect well with others — factors that can accumulate over time and compound into the less-publicized complex trauma of emergency response work.

An underrecognized struggle: complex trauma

The news tends to cover more sensational or graphic mental health struggles of first responders, like alcoholism or suicide, brought on by acute traumas, violent encounters, or deaths.

But for the majority of responders, trauma often builds up insidiously, when they dismiss their struggles as unworthy of mental health care.

One official we spoke with explains: “That’s the major misconception: you don’t need to be involved in a shooting or major critical incident to experience the trauma that we do. It’s the cumulated stress — not just the calls we respond to, but also the internal dynamics in the department. Plus the stress and pressure we get from politicians and activists.”

Another official shared that first responders “are dealing with all this stuff, but they don’t necessarily have the inner tools to realize the connections and unpack all the trauma.” 

What works

All of the first responders we interviewed for this piece agreed on one thing: the best way to lessen the impact of everyday, complex trauma, is to stay present to it and unpack difficult emotions as they come up.

This can be achieved a number of ways. Some took advantage of therapy, others used daily mindfulness meditation, and one in particular relied mostly on the power of peer support. 

Because first responders are especially vulnerable to the effects of built-up stress and hypervigilance, regular emotional maintenance is the key to avoiding severe, long-term mental health struggles. 

Self care

First responders we spoke with touched on the importance of meeting one’s own needs regularly, in a routine. 

Due to the strenuous schedule of firefighters, which can involve 2+ day, round-the-clock shifts, followed by blocks of a few days off for rest, self-care becomes paramount outside of work. 

We spoke with an assistant fire chief, who shared that in order to feel his best, he spends his days off intentionally.

He prioritizes sleep, takes care of to-dos in the house and yard, and spends one whole day on whatever he wants to do. Before going back to work, he spends extra time getting back into the proper mental perspective to do his job right — by laying out supplies and uniform, staying calm, and avoiding activities that might slow him down (drinking a lot, for example).

Other first responders also make self-care a priority, which helps them deal with the necessary stressors of the profession. The department we interviewed allows professionals to take an hour of paid time to work out, per day — a great way to burn off extra stress hormones that can damage mental health. They also have a wellness program that focuses on healthy eating, among other things.


For first responders who operate in stressful situations every day, self-reflection keeps difficult emotions from becoming internalized.

One responder explained how mindfulness helps her deal with the stress of her profession. She didn’t always prioritize self-reflection, but realized that stress could be taking away from her quality of life. Mindfulness meditation helps her mind stay clearer, especially under pressure.

The assistant fire chief we spoke with also explained how reflection and debriefing are built into fire department protocol, which minimizes the accumulation of smaller traumas over time. 

After each call, firefighters record what happened in a very precise way, for documentation. If multiple team members were on a call, or if it was particularly stressful or traumatic, these debriefings become a group effort.

This process encourages self-reflection, and helps individuals remember that in each call, they did the best they could. 

Peer support

Some responders we spoke to valued formal, profession-specific peer support, while others emphasized the importance of informal peer support (talking to friends in the profession, debriefing with colleagues, and checking in with team members).

All the public safety entities we connected with had growing peer support programs in place. In Fire, the peer support programs integrate directly into a department – the assistant chief we spoke with, who was also a trained peer counselor, explained how the department brings peer support teams in during difficult times.

For instance, after the Ghost Ship Fire, responders in Oakland were obviously “really affected.” In this situation, peer support came not from inside the department as usual, but from outside – Fremont or Berkeley peer counselors would come in to help officers get intense emotions off their chest, which allowed for more effective peer support. The fire impacted peer counselors from other departments less, so they had better perspective and clarity to help.

When individuals feel resistant to formal programs, informal peer support takes over; responders checking in with one another, encouraging therapy, and sharing resources become the first line defense against accumulated trauma.

Anonymous peer support for first responders

It seems that whether in a formal or informal setting, peer support works when responders trust who they’re talking to, check in regularly, and feel confident in seeking support.

Online peer support can offer all of the above, when responders don’t feel comfortable opening up in-person about personal issues.

Nobody knows your identity, and it’s available 24/7 to accommodate unpredictable schedules. While moderators and peers may not understand first-responder specific struggles, everyone listens openly — and they certainly understand the range of human emotional struggles.

Free peer support for first responders

We are making instant-access peer support available to all first responders, all Summer long [update: promotion offered through end of Summer 2020]. Between COVID and general unrest across the country, we believe responders can maintain their mental health by letting out difficult feelings.

Hit Chat Now, and get stuff off your chest anytime, anywhere, anonymously.

We want to honor the many levels of personal sacrifice our emergency responders make. Between the intensity of the job, normal human stress, and required hypervigilance… Firefighters and other EMS professionals have an unreasonable amount of stressors on their plate.

So thank you to all the first responders who keep us safe, despite being misunderstood by the public they serve.

If you’re a first responder struggling, please also consider checking out your department’s EAP free therapy services, in-house peer support, the First Responder Support Network, or even programs like the West Coast Post-Trauma Retreat Center.

We may not already understand your job, but we certainly understand the need to feel heard.

You never have to go through your emotions alone.