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First Responders

Mental health issues are much more common among first responders compared to the general population due to the sometimes chaotic and often difficult requirements of their jobs.

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First Responders

Paramedic Mental Health

First responders work in extremely stressful professions that require long hours, intense working conditions, and frequent exposure to potentially traumatic events. The unpredictable nature of professions such as firefighters and paramedics can lead to a lack of balance and wellness in their lives. Mental health issues are much more common among first responders compared to the general population due to the sometimes chaotic and often difficult requirements of their jobs. Here we will look at some of the greatest challenges faced by first responders and provide some helpful resources that can help someone get the care they need to maintain balanced mental and physical health.

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Mental Health

Among First Responders

For years it has been known that EMTs and firefighters experience trauma much more often than the general population, however, the mental health of these populations is often overlooked. A study published in 2018 found that among firefighters and EMTs, 28% reported moderate-to-severe anxiety disorders, over 25% reported significant symptoms of PTSD, 93% reported significant sleep disturbances, and just over 34% were identified as high risk for suicidality. This is substantially higher than the general population, as seen in this graph below:

While trauma and mental health issues are much more common among first responders, this does not mean that there is no hope for a first responder to lead a happy, healthy life. While experiencing trauma may be a necessary part of their job, there are things that can be done to minimize the distress and harm this can do in their life. Studies show that if a first responder seeks help and treatment immediately after experiencing a traumatic event, there is significantly less long-term distress and mental health complications caused by the event. While employers may provide some mental health services, in some cases it may be necessary to seek additional, personalized care.

First Responders Mental Health
Information Sources: CDC Data Brief: Generalized Anxiety Disorder 2019 / National Institute of Mental Health: PTSD / Sleep Medicine Research 2011 / CDC Fast Facts: Suicide
Substance Abuse

Among First Responders

In addition to mental health issues, first responders also experience substance abuse at higher rates than the general population. There is no single cause for this, but the repeated exposure to trauma, combined with a brief or non-existent recovery period, can lead someone to seek comfort and emotional control in drugs or alcohol. The mental health conditions experienced by first responders can also contribute to substance abuse, as several of the most common mental health issues that first responders experience are strongly connected with someone’s susceptibility to substance abuse.

While data on paramedics and emergency room healthcare workers is scarce, there is a significant body of data examining alcohol use among firefighters. This is a sibling population that experiences similar exposure to trauma, an unpredictable work schedule, and long hours as do paramedics and emergency department hospital workers. The rates of substance abuse among firefighters compared to the general population are illustrated below:

Information Sources: SAMHSA – First Responders Behavioral Health / NIAAA – Alcohol Facts & Statistics
Paramedic Mental Health
Co-Occurring Conditions

Among First Responders

Both PTSD and anxiety disorders are strongly associated with substance abuse and, more importantly, associated with someone developing a drug or alcohol dependence. These conditions co-occurring alongside substance use disorders also result in a higher risk of suicidal ideation and suicide attempts. One study conducted over the course of 3 years and including firefighters from 7 cities across the US found that among firefighters who suffered from PTSD, experiencing more severe PTSD symptoms accurately predicted more drinks of alcohol per week. This suggests that mental health conditions can contribute in a significant way to substance abuse and addiction.

Substance abuse among first responders is a serious issue that can be helped, although more action is needed on the part of society and the healthcare systems of America. Suffering from co-occurring conditions can make recovery difficult, but by no means impossible. Finding comprehensive, integrated care and treatment for both conditions simultaneously is the most effective way for someone to achieve long-term recovery, and become free from the bondage of addiction and the distress of mental health struggles.

Firefighter Recovery
Where Can First Responders Go

To Get Help?

First responders work in all sectors, private and public. Most government agencies and private businesses will have a dedicated Employee Assistance Program (EAP) for first responders. These are a type of healthcare benefit that is specifically designed to help someone deal with the stresses of these oftentimes difficult professions. EAPs can provide mental healthcare, substance abuse counseling, and help someone find further detox and addiction treatment services if necessary.


In the rare case that an employer does not provide an EAP, there are also peer support groups available in many cities across the country that can address the specific challenges first responders may be dealing with. These groups are by first responders, for first responders and can introduce someone who is struggling to people who can relate, understand the challenges, and help them through difficult times.

First Responder Resources
Mental Health

More Resources for First Responders

While mental healthcare for first responders has historically been overlooked, the emergence of COVID has brought this issue to the forefront of public consciousness. There are now more resources for first responders than ever before, including telehealth services, in-person care, and government or charitable programs intended to support the mental health of this critical population.

Just a few of these resources include:


  • Reviving Responders: A non-profit organization that provides helpful resources and performs advocacy work to promote awareness for EMS mental health.
  • Safe Call Now1-206-459-3020 This crisis line is intended for any public safety professional or first responder and provides crisis intervention and support services.
  • Crisis Text LineText FRONTLINE or HOME to 741-741 to be connected with a crisis counselor. This service has provided a crisis text line for many years, but their “For The Frontlines” initiative they began in 2020 is intended specifically for first responders and healthcare workers who may be in a crisis.
  • National Volunteer Fire Council – Share The Load: This is an initiative that aims to provide mental health support for firefighters and paramedics and their site provides helpful resources and links to further mental healthcare.
  • Wings of Change: A peer support group for first responders, by first responders. Their website has information about online meeting times and additional helpful resources.
  • National Suicide Prevention Lifeline1-800-273-8255 Call the Lifeline anytime, 24/7 during a crisis to be connected with a crisis counselor and find help and support.
    • Para Español1-888-628-9454
  • SAMHSA Disaster Distress Helpline: 1-800-985-5990 This helpline is available 24/7/365 for anyone experiencing a crisis due to a disaster such as COVID. This helpline is intended for anybody, and not necessarily first responders in particular. SAMHSA also provides a helpful guide entitled “Preventing and Managing Stress – Tips for Disaster Responders” that is applicable to first responders of all kinds.
  • U.S. Department of Veterans Affairs: The VA has released a free app called “Mindfulness Coach” that can help someone develop mindfulness practices, lower stress, and promote relaxation. It is available through the Android and iPhone app stores.
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Substance Abuse

More Recovery Resources for First Responders

Substance abuse is not uncommon for first responders can be extremely challenging to overcome. This may be especially so for paramedics since they are surrounded by powerful drugs on a daily basis. Finding help for a substance use disorder is a crucial step in the recovery process, and can begin the journey towards a life free from addiction. Some helpful addiction recovery resources for first responders include:

  • Access EAP1-800-248-1688 This is a 24/7 confidential hotline that can connect a first responder struggling with substance abuse or mental health issues with a peer support officer. This is a free service and is staffed by first responder volunteers who have struggled and overcome their challenges.
  • Hazelden Betty Ford: An old and large national non-profit organization, Hazelden Betty Ford provides specialized addiction treatment programs and services tailored to the unique needs of first responders.
  • Rosecrance Florian Program: A dual diagnosis substance abuse and mental health treatment program, the Florian program is designed for first responders, by first responders. They are a private, not-for-profit corporation.
  • Livengrin Foundation: A nonprofit addiction treatment provider, their FRAT (First Responders Addiction Treatment) program specializes in providing treatment and recovery services to first responders and their families.
  • Caron Recovery Network: Caron is a non-profit addiction treatment center with a specialized program for first responders. They have several treatment centers across the Eastern U.S. and a very helpful article for first responders who are looking for treatment.
  • Serenity Lane: A non-profit addiction treatment facility, they have several locations throughout Oregon and provide programs designed for first responders struggling with addiction.
  • Harbor of Grace: An addiction treatment center in Maryland, their facility is designed with first responders in mind and provides premium addiction and mental health treatment services.

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