When most people imagine a first responder, they may imagine an ambulance with medical professionals aboard, a police unit, firefighters, or the Federal Emergency Management Agency (FEMA). Of course, these professionals are first responders, but in the United States, there are dozens more people in career fields considered first response. Some of these careers include animal control officers, air marshals, campus security officers, ATF agents, DEA agents, court officers, park rangers, members of the Red Cross, or members of the military.
First responders are the first to arrive at the scene of a crisis: a crime, accident, terrorist attack, or natural disaster. Their primary job is to prevent and mitigate harm to people, property, and pets using their skills. However, the nature of a first responder’s job means that they are more likely to suffer trauma than the general population. Until recently, many people – including medical professionals, therapists, and first responders themselves – believed that people who entered a first response career were more resilient than the average civilian. Very recently, however, many are beginning to understand ways in which first responders cope with trauma, post-traumatic stress disorder (PTSD), depression, and other mental health issues. Unfortunately, one of the ways that many first responders cope with the intensity of their jobs is through substance abuse.
Professional Trauma among First Responders
Those who work as first responders experience acute stress through their jobs and suffer trauma due to that acute stress. Many first responders are also likely to experience secondary trauma by experiencing the trauma of victims of the crime or disaster. Caring for those experiencing a crisis involves both physical and emotional work, which can take a toll on the body and mind together.
Psychologists understand first responder mental health in terms of professional trauma or the threat, whether actual or perceived, to oneself or others in the environment. This emotional perception and experience involves a sense of helplessness, which leads one to perceive the event as traumatic when evaluating it later. While the average person may experience a few traumatic events over the course of their life, first responders experience these events every day, as part of their career. This rapid buildup of stress over time has serious mental and physical health consequences for these professionals.
PTSD is one of the most widespread mental health problems among first responders. There is a roughly 7 percent prevalence of PTSD among the general population of American adults, but first responders are much more likely to develop this behavioral challenge. Those who have developed PTSD are three times more likely to develop metabolic conditions like:
- High blood pressure
- High cholesterol
- Glucose intolerance
First responders struggling with untreated acute and chronic stress issues are also more likely to develop other chronic health issues, such as:
- Heart disease
First responders may develop PTSD or other trauma-related mental health problems through forms of stress specific to their work. Some of these include:
- Line-of-duty traumas (LODT): These occur when first responders experience the death or near-death of people in the community, other professionals responding to the crisis, or themselves while actively working in a crisis scenario.
- Line-of-duty death (LODD): When a first responder dies in the line of duty, the stress on their fellows compounds as they attempt to rescue or treat a comrade.
- Post-shooting trauma in law enforcement (PSTLE): This involves the ongoing experiences after a police officer, law enforcement officer, or other protective officer shoots a civilian. Stress from an investigation, reports, questioning, and other events necessary to understand why the shooting occurred compound the stress created by the shooting itself.
Stress Affecting Specific First Responders
While all first responders are susceptible to trauma from a crisis, specific first responders experience this stress differently.
- Emergency service dispatchers and 911 operators may hear a traumatic event while it is occurring. They may listen to someone who has been severely injured, console a child, give directions to those fleeing a scene, and more. While they do not experience stress from seeing the crisis, they often later suffer visual recreations of the traumatic event.
- Law enforcement officers are more likely than other emergency responders to work alone, and they are more likely to be present in the community before a traumatic event occurs. Often, they experience additional stress if they are in a community that holds negative perspectives on law enforcement officers.
- Other first responders often work in tight-knit teams, which puts stress on everyone in the team if one member is severely injured or killed, especially in the line of duty.
- Families of first responders are more likely to experience secondary trauma because one member of the household experiences trauma on a regular basis.
The growing understanding of first responders’ trauma and its impact on their health has highlighted certain personality traits of many first responders. They are used to being caregivers and not used to being taken care of; those who need help are less likely to seek it, through a combination of their own personal feelings about needing care and a culture of reinforcing toughness. First responders are also more likely to be “adrenaline junkies,” or people who enjoy performing well in a high-stress situation. They may also be “Type A” personalities, meaning they are more competitive and impatient and have a sense of urgency about everyday life.
The personalities attracted to first responder careers, and the culture in those career fields, reinforce the need to pretend that everything is okay. However, this attitude prevents first responders from getting the healthcare they need, including mental and behavioral healthcare. This can make problems like substance abuse much worse over time.
A study conducted by the University of Phoenix found that as much as 85 percent of first responders developed mental health issues; however, 39 percent of the 2,000 first responders surveyed stated that there were negative repercussions for seeking mental health treatment at work, and 55 percent believed their supervisors would treat them differently if they sought help. The survey found that 69 percent stated that they never used mental health services.
First Responders Are at Greater Risk for Substance Abuse Problems
Mental health problems and substance abuse are closely tied together. The Substance Abuse and Mental Health Services Administration (SAMHSA) reported that, in 2014, about 7.9 million American adults ages 18 and older had co-occurring disorders, or both a mental health condition and a substance use disorder. The National Alliance on Mental Illnesses (NAMI) reported that about one-third of all people who experience mental illness, like anxiety or depression, abuse substances; about one-half of those with severe mental illnesses, like bipolar disorder and schizophrenia, struggle with substance abuse.
Because first responders are more likely than the general population to develop PTSD, depression, and other mental health issues due to their stressful jobs, they are consequently at greater risk of developing a co-occurring substance use disorder. One report found that 25 percent of first responders suffered from a form of substance abuse, including alcohol use disorder, prescription drug abuse, and illicit drug abuse.
An article in the Carolina Fire Journal noted that people who are employed, in any occupation, consume 75 percent of illegal drugs, and 10 percent of that consumption occurs on the job. Half of the problem involves alcohol, which is legal for adults but habit-forming, and it dangerously lowers cognitive and physical abilities. First responders and public safety workers are likely to abuse alcohol more than other drugs, which is true of the general adult population in the United States. Over 9 percent of firefighters surveyed, for example, reported heavy drinking in the past month (defined as more than seven alcoholic beverages in one week). Among firefighters, alcohol consumption is roughly twice that of the national average; however, firefighters and law enforcement officers were less likely than the general population to consume illegal drugs, with 1.5 percent reporting use of illegal substances in the past month.
Treatment for First Responders
Mobilizing therapists and case managers to help first responders immediately after they intervene in a crisis can be one step to ensuring that this group receives the mental and behavioral health interventions they need to avoid severe mental illness and substance abuse. Also, using existing healthcare avenues, including insurance, Employee Assistance Programs, and Labor & Industries (L&I) assistance, for treatment can help to prevent long-term problems. The TIM Network offers useful resources for first responders, their family, and friends, helping them to see signs of behavioral health problems and how to solve them; resources include information on seeking help and self-care for first responders.
While using workplace options to manage existing mental health and substance abuse issues is one step, changing the culture among first responders is also important. Many organizations are being created to help first responders know that they can get the help they need without compromising their job security or professionalism. These organizations also offer resources to help first responders find help nearby, so they can begin treatment for substance abuse and mental health problems.
First Responder-Focused Organizations
- Badge of Life: While the organization focuses on preventing suicide among law enforcement officers, the larger program offers psychological help to officers in need, which can also reduce or prevent substance abuse problems.
- Blue Wall Institute: this organization offers training and resources to first responders, especially law enforcement officers. One class, called Police Stress, helps first responders understand how acute stress affects them long-term and how to address the problem before it turns into mental illness and substance abuse.
- Code Green Campaign: This advocacy organization is focused on changing first responder culture and ensuring these professionals have access to needed behavioral treatment.
- Journal of Emergency Medical Services (JEMS) Responder Resilience: This online pamphlet details a program designed to help first responders, using techniques developed to improve mental health among veterans of the Afghanistan and Iraq Wars. While the focus is on preventing self-harm and suicide, substance abuse can also be reduced with these techniques.
- Safe Call Now: This confidential, 24-hour service for public safety and emergency services personnel offers support through personal behavioral or mental health crises and referrals to ongoing services.