PTSD is a treatable condition marked by intrusive memories, avoidance, negative mood/cognition, and hyperarousal after trauma. It affects up to 30% of first responders, including policemen, firefighters, ambulance drivers, emergency medical technicians, and military veterans.
First-line focused care includes trauma-focused therapies like Accelerated Resolution, EMDR, Cognitive Processing Therapy, and Prolonged Exposure Therapy. Early, evidence-based treatment improves return-to-duty outcomes [1], [2].
Key takeaways
- Trauma-focused therapies work: CPT, PE, and EMDR are first-line, and medications may support therapy when needed.
- Whole-person care matters: Sleep, substance use, TBI assessments, and family support are core to recovery.
- Risk is higher in public safety: Repeated exposure, shift work, and moral injury raise PTSD odds.
- Return-to-duty is doable: Staged reintegration and reasonable accommodations can protect careers and safety.
What is PTSD, and Why are First Responders at Higher Risk?
Post-traumatic stress disorder (PTSD) can follow life-threatening or terrifying events and includes intrusive memories, avoidance, negative shifts in beliefs/mood, and hyperarousal. Symptoms must persist and impair functioning.
First responders are at a higher risk of developing PTSD due to repeated critical incidents, disrupted sleep, organizational stress, and moral injury. SAMHSA reports that nearly 30% of first responders develop a mental health disorder such as PTSD, depression, anxiety, or substance abuse [3].
First responders are constantly put under life-threatening situations, responding to violence such as murder, assault, rape, suicide, and death. These are experiences that the average person in the general public may only be exposed to 1-2 times, if at all in their life. Failing to save someone’s life, or feeling powerless in destructive situations, can cause “moral injury” and increase the risk of PTSD symptoms such as shame and guilt.
Many first responders also struggle to connect with their loved ones and have a lower social support network. Disrupted sleep schedules also play a role, as many first responders rotate 24-hour shifts or are on call for emergencies.
Signs and Symptoms to Watch For
First responders struggling with symptoms of trauma and PTSD often show several symptoms that fall under the following four categories:
- Intrusions: nightmares, flashbacks, distress to reminders.
- Avoidance: people, places, calls, or gear tied to the event.
- Mood/cognition: guilt, blame, detachment, hopelessness.
- Arousal: irritability, hypervigilance, sleep disturbance, startle.
Screening, Diagnosis, and What a Good Evaluation Includes
Diagnosis follows DSM-5 criteria using validated measures and interviews [1] [2]. Screening should look at presentation of symptoms, timeline, impact on functioning, and all factors related to mental health, such as genetics, childhood trauma, family history, and other life stressors outside of work.
Clinicians should screen for suicidality, hazardous drinking, sleep disorders, and traumatic brain injury (TBI) to help shape care plans [4].To start, contact your primary care provider, case manager, or a trauma-informed clinician who can coordinate a confidential, work-safe plan [2].
Mass-Violence Calls: Special Considerations for Emergency Responders
Emergency responders may need extra considerations such as psychological first AID or short-term trauma interventions to help them return to work if duty calls. Witnessing multiple casualties and mass violence, such as school shootings, may also complicate responsiveness to treatment. Moral injury can delay symptoms or cause symptoms to spike around dates or anniversaries.
It’s important to focus first on stabilization. Safety, sleep, routines, and quick access to trauma-informed care outperform one-size-fits-all “debriefs”.
Treatments That Work (and How They Fit Real Schedules)
Treatment should address all factors of mental health and be flexible to fit with the chaotic schedules of many first responders. First-line, evidence-based therapies, medication, and holistic support can help relieve trauma symptoms in first responders and help them more easily return to duty with more resilience.
First-line psychotherapies: Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and EMDR show the strongest evidence for reducing PTSD symptoms in public-safety personnel [1] [2].
Accelerated resolution therapy (ART): ART is also showing promising results in the treatment of trauma for short-term interventions that are flexible around first responder schedules. ART also does not require verbal recall, reducing the likelihood of retraumatization.
Adjunct medication: SSRIs/SNRIs may help mood/sleep, so therapy is doable; short-term sleep strategies only under medical supervision [5].
Whole-person supports: Skills groups, fitness, mindfulness, and family education improve outcomes and overall quality of life.
Serving Those Who Serve: Mental Health Solutions Tailored for Utah First Responders
Harper Clinic provides holistic, integrative treatment to address the mental health of first responders. We blend cutting-edge, evidence-based neuroscience with holistic, whole-body approaches and tailored counseling for first responders to address the roots of PTSD, depression, chronic stress, grief, and burnout.
Reach out to Harper Clinic by phone, text, or directly through our booking system to schedule your mental health consultation. Our providers can help you verify insurance benefits and set up a personalized support plan.
FAQs
Is PTSD a career ender?
Usually not. Many responders return to full duty after evidence-based care, and others thrive in modified roles that match strengths and safety needs.
Do I need medication?
Not always. First-line trauma-focused therapies often work alone, but medications can support sleep/mood or serve as bridges when symptoms are severe or therapy access is limited.
What if I feel fine but keep reliving one call weeks later?
Delayed or call-specific symptoms are common after high-threat incidents; targeted therapy can prevent escalation and speed recovery.
How can my family help?
Education, consistent routines, and joining select sessions often help. Family-involved care can improve outcomes, strengthen relationships with spouses, and support return-to-duty goals.
Sources
[1] American Psychiatric Association — “What is PTSD?”: https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
[2] U.S. Department of Veterans Affairs, National Center for PTSD — “PTSD Basics & Treatment”: https://www.ptsd.va.gov/
[3] SAMHSA. 2018. Disaster Technical Assistance Center Supplemental Research Bulletin First Responders: Behavioral Health Concerns, Emergency Response, and Trauma.
[4] Mayo Clinic — “Post-traumatic stress disorder (PTSD)”: https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
[5] Social Security Administration — “PTSD Fact Sheet”: https://www.ssa.gov/disability/Documents/PTSD%20Fact%20Sheet.pdf
[6] Cleveland Clinic — “Post-Traumatic Stress Disorder (PTSD)”: https://my.clevelandclinic.org/health/diseases/9545-post-traumatic-stress-disorder-ptsd