“Why is everybody so f*cked up now?” That was a common question from veteran firefighters during Dr. Nicole Sawyer’s early days delivering workshops to public safety agencies about behavioral health challenges facing first responders. To the veteran firefighters, it was a new issue, but as many others already understood, stress and trauma have always existed in the fire service; they were simply hidden: “We buried it. We just didn’t call it what it was,” Sawyer said.
During her keynote address at Fire-Rescue International 2025, Sawyer, a licensed clinical psychologist and public safety mental health consultant, detailed how survival instincts, chronic stress and generational expectations impact firefighters on and off duty. Her message was clear: Leaders must understand the biology behind firefighter behavior, acknowledge the emotional toll of the work, and model accountability. A key first step, though, is understanding the origin of our stress response.
The amygdala and survival responses
Sawyer explained how our amygdala — the part of the brain involved with the experience of emotions — drives fight, flight or freeze responses. Firefighters, by nature and training, lean toward “fight.” These instincts, while useful in emergencies, can complicate everyday life when stress is interpreted as threat: “When we’re interpreting threat in today’s society, that means stress,” Sawyer explained. “Your people are responding to survival instincts.”
On top of professional stressors, expectations for the workforce have changed. Sawyer contrasted her fire chief grandfather’s ability to “box up” emotions with today’s expectation that firefighters be emotionally available spouses and parents. “My grandfather could walk in that door from the worst day of his life … and he could box that sh*t up,” she said. But now, emotional demands on firefighters — and leaders — are greater than ever: “We have an expectation now that fathers will come home and be involved in the nurturing and development and emotional life of their children.”
This further adds to the stress piling onto firefighters.
Chronic stress as a job hazard
Sawyer labeled chronic stress a job hazard. The constant novelty, challenge and potential loss of control in firefighting create a baseline of anticipation that wears down the body and mind. “Those three factors are what contribute to the development of chronic stress in your body,” she said. “Biologically, your body has discovered that the only way to operate is at a level of anticipation of response. It makes us really good at our jobs, but it also contributes to all kinds of health problems.”
Specifically, Sawyer broke down the roles of cortisol and adrenaline in the body’s stress response. While necessary for survival, repeated exposure means firefighters’ brains and bodies experience every call as if it were their own emergency, leading to wear and tear. “No human body, no brain, was designed to tolerate that kind of stress,” she said.
Today, many firefighters normalize aches, irritability and fatigue. Sawyer explained that many of these are direct consequences of prolonged stress chemistry. For example, “Arthritis aches and pains; inflammation is a side effect of excess cortisol in our bodies …. If you are in a low grade level of activation for 20-plus years, if you’re prepared to respond, well that means you have just a little bit of fluid hanging out in those joints, prepared to respond … your joints were not designed to maintain that level of inflammation … so what happens? We get wear and tear; we get injured more often. It takes longer to recover.”
Additionally, Sawyer explained, the anger that was once a survival instinct, responsible for keeping us alive, combined with excess amounts of cortisol, trigger that primitive part of the brain to remain at a constant level of irritability and grumpiness so that in the event we are faced with a threat, we can respond and we can turn it right on.
“Now that makes you really good at your job; makes you not so great at home,” she said. “Suddenly you’re pissed off about something really minor. You snap about things, and it feels particularly worse when we have particularly challenging days.”
That’s a problem, she explained: “This is a job hazard. This is not something that we can prevent. This is not something that we can eliminate. This is a reality that we have to accept, and this is where accountability comes in. This is not an excuse to be a grumpy a**hole, but [we have to] make a call and say, hey, this is a thing that’s going to evolve in your body over the course of your career. That edginess is real, and it’s our responsibility to do something about it, to manage it, to own it.”
For example, when minor inconveniences like traffic or parking become overwhelming under chronic stress, recognizing these reactions as stress-related is key to managing your response, Sawyer said.
Burnout and compassion fatigue
Sawyer also spoke to the causes and impact of burnout — a state of physical, emotional and mental exhaustion caused by emotionally demanding situations. Burnout is unavoidable in meaningful, emotionally demanding work, Sawyer said, explaining that it’s not so much the challenging calls but the day-to-day frustrations that fuel burnout.
“It’s all that other bullsh*t — working with each other, living with each other, dealing with politics. … Feeling underappreciated and overworked — that’s the key to burnout.” Further, when firefighters can’t climb out of it, they risk compassion fatigue and loss of purpose, she shared: “Compassion fatigue is when we don’t come out of burnout. It’s when we get stuck.”
From cultural denial to open dialogue
The good news: We are making progress, Sawyer said. She shared an example from her own family history to highlight firefighters’ mindset shift around behavioral health issues. Sawyer recalled how her fire chief grandfather lost two firefighters to suicide. “Those two firefighters died by [air quotes] ‘gun cleaning accidents’ in the backyard,” she said. “Every single person was in on it — the family, the department, the neighbors.” Today, more open conversations and data collection reveal the longstanding scope of the problem: “Now we’re talking about it. We’re calling it what it is.”
Accountability and leadership
Sawyer concluded with a call for accountability that starts with skipping the go-to “I’m fine” answer, which dismisses concern and damages relationships. “‘I’m fine’ is the biggest bullsh*t statement that we say to each other over and over again,” she said. “What is wrong with saying to our spouses, to our loved ones when we get home, ‘This sucks. I’m not OK’?”
Instead, firefighters and leaders must own their stress, communicate it and take responsibility. Leadership means modeling this behavior for others, she said: “That’s leadership — owning our sh*t, being accountable for our psychological health, and asking [your members] to do the same. It’s that simple.”
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