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America’s first responders’ struggle with PTSD and depression

Honor and support EMTs, paramedics, firefighters and police officers on National First Responders Day by acknowledging the toll trauma can take


Emergency medical personnel load a simulated victim on a gurney during a mass casualty training exercise, Thursday, Sept. 19, 2019, in Cincinnati.

AP Photo/John Minchillo

Last month, Henderson County (Nev.) firefighter and paramedic Robbie Pettingill died by suicide. The 35-year-old first responder had suffered from depression that was exacerbated by job-related PTSD. His father, a retired firefighter who had also worked for the Henderson Fire Department, died by suicide four months prior to his son.

Struggling with trauma

Pettingill’s struggles with depression and post-traumatic stress disorder (PTSD) are, unfortunately, not uncommon or unique among firefighters, paramedics and other first responders. Depression and PTSD affect an estimated 30% of our nation’s first responders – compared to 20% of the general population. And while approximately 3.7% of Americans have contemplated suicide, that rate jumps to 37% for fire and EMS professionals. Further, 0.5% of Americans attempt suicide vs. 6.6% of fire and EMS professionals.1

Most people experience trauma in their lives. Some incidences are common, such as the death of a close loved one following a stroke or cardiac arrest, while others are (thankfully) rare, such as experiencing physical violence. And when these traumas occur, it’s our country’s police officers, firefighters, paramedics and EMTs who arrive ready, willing and able to care for their fellow citizens at what is in many cases their most desperate hour.

This is the job that firefighter/paramedic Pettingill did day in and day out. Some days are worse than others, like October 1, 2017, when a shooter opened fire on a crowd of country music concertgoers in Las Vegas. Firefighters and paramedics from the Henderson Fire Department as well as many other nearby police, fire and EMS agencies ran toward danger on that night to protect and care for the victims, even before a threat to their own safety could be neutralized. First responders protected many people and saved many lives, while at the same time providing emotional support to those already grieving the loss of a loved one.

Despite the stoic or detached appearance of calm concern often worn on the face of rescuers during a crisis, these events are strenuous and draining for first responders – a hazard of the job that results in sleepless nights or leads them to find comfort in a beer or cocktail. Insomnia and substance use are both symptoms of PTSD. They ultimately do little, if anything, to help people cope and, more often than not, can make a bad situation worse. Researchers have identified both as likely contributors to the high suicide rates of fire and EMS professionals.2,3

Exacerbating PTSD symptoms

Insomnia and other sleep disturbances can result in heightened emotional reactivity and problems with regulating emotions that can increase the risk of depression. Poor sleep due to erratic schedules and long shifts is an unfortunate reality for fire and EMS professionals. Once “just part of the job,” fatigue is finally being acknowledged as a problem in fire and EMS , and efforts are being made by fire chiefs and leaders in EMS to reduce fatigue amongst their ranks.

Alcohol consumption, while not technically part of the job, can be a part of the culture of comradery and brotherhood of that tradition. Gathering for a drink after a shift isn’t a bad thing in and of itself – in fact, a sense of belonging and social support has been shown to protect against the development of PTSD among firefighters.4 Heavy or binge drinking, however, is problematic. In one survey, nearly half of male firefighters reported heavy or binge alcohol use and binge drinking was reported in 39.5% of female firefighters in another study.1

Honoring – and supporting – first responders

In June, the U.S. Senate unanimously voted on a resolution to establish Oct. 28, 2019, as “Honoring the Nation’s First Responders Day,” encouraging Americans to celebrate the contributions of our nation’s 4.6 million career and volunteer firefighters, police, emergency medical technicians, and paramedics. In this spirit, let’s make a commitment to acknowledge the efforts of first responders every day by remaining sensitive to the fact that some may be suffering in silence.

There are two things every one of us can do to help and honor first responders like Pettingill. Both are very easy:

1. Recognize the symptoms of PTSD and offer appropriate support

Symptoms of PTSD may include:

  • insomnia and nightmares

  • uncharacteristic temper

  • irritability

  • difficulty concentrating

  • difficulty managing emotions

  • flashbacks

  • depression

  • suicidal thoughts

  • substance abuse and addiction

These symptoms apply to anyone, not just first responders. If you notice any of these symptoms, don’t probe or pry; be sensitive and kind, and simply offer up an ear to listen. If you are close to the person, you might direct them to the list of resources on The Code Green Campaign’s website. Should a first responder be abusing alcohol or drugs, there are helplines run by American Addiction Centers: one for firefighters/EMS providers (888-731-FIRE) and another for police and law enforcement (855-997-6542).

2. Spread awareness of triggering questions

“What’s the worst thing you’ve seen?”

When people learn I’m an EMT, it’s almost inevitably asked. It’s a seemingly innocent question, but one that may trigger memories of past trauma that are difficult to handle. Spread the message; Don’t be the person that asks for those details. You may or may not hear about the call that shook them to their core, but in asking the question, you may have reopened a psychological wound that runs deeper than you can ever know.

Learning to cope with PTSD and substance abuse

Although PTSD and substance use are both potentially devastating mental health issues (especially when left unaddressed), they are also both treatable issues. Once detected and treated appropriately, a person can expect a vast improvement in their quality of life.

Read: What’s your department’s suicide prevention plan?


  1. Substance Abuse and Mental Health Services Administration. (2018). First Responders: Behavioral Health Concerns, Emergency Response, and Trauma.

  2. Hom, M. A., Stanley, I. H., Rogers, M. L., Tzoneva, M., Bernert, R. A., & Joiner, T. E. (2016). The Association between Sleep Disturbances and Depression among Firefighters: Emotion Dysregulation as an Explanatory Factor. Journal of Clinical Sleep Medicine, 12(2), 235–245.

  3. Martin, C. E., Vujanovic, A. A., Paulus, D. J., Bartlett, B., Gallagher, M. W., & Tran, J. K. (2017). Alcohol use and suicidality in firefighters: Associations with depressive symptoms and posttraumatic stress. Comprehensive Psychiatry, 74, 44–52.

  4. Stanley, I. H., Hom, M. A., Chu, C., Dougherty, S. P., Gallyer, A. J., Spencer-Thomas, S., … Joiner, T. E. (2018). Perceptions of belongingness and social support attenuate PTSD symptom severity among firefighters: A multistudy investigation. Psychological Services, 2018 March 29, [Epub ahead of print.]

Ryan Kelley, NREMT, is a nationally registered emergency medical technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). In his current capacity as medical editor for American Addiction Centers, Ryan works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.