First Responders in Recovery: Emergency Medical Services

Everyone depends on them to help others when they are vulnerable. Emergency Medical Service (EMS) workers have a unique set of skills and often need to employ those skills in fast-paced, high-intensity situations. First responders are expected to make split-second decisions while maintaining a high degree of professionalism.

There is a critical need for EMS workers, but the job can be traumatic. Due to the uniquely difficult nature of their job, EMS professionals may benefit from recovery programs focused on helping them address their specialized work environment.

What Do First Responders Experience?

First responders are often exposed to the aftermath of intense trauma and violence. Understandably, this constant exposure can take a physical and mental toll. According to the National Institute for Occupational Safety and Health (NIOSH), 3,000 of the reported injuries to EMS workers in 2020 were solely related to violence while on the job.

The stress of the job often stays with EMS workers long after their shift is over. Exposure to traumatic situations can cause symptoms for first responders emotionally, cognitively, physically, and behaviorally.

Emotional Impacts

Untrained individuals experience lingering effects from traumatic effects, so continued exposure to these same events can impact these workers significantly. A first responder can be affected by the hazards of their job emotionally and this can have a negative impact on their mental health. They might feel anxiety, guilt, grief, fear, denial, irritability, or depression while trying to process their exposure. First responders can experience a loss of emotional control, a sense of failure, and feeling overwhelmed. They may also blame themselves for what happened. These emotions can be overpowering and affect their mental health.

A 2019 mental health survey for EMS providers reported that, within the past year, 1,831 individuals reported at least 1 negative mental health outcome. These outcomes can include burnout, traumatic stress, PTSD, and suicide contemplation or attempts. Not addressing the emotional and mental health impacts can lead to cognitive, physical, or behavioral manifestations.

Cognitive Impacts

First responders can experience cognitive distortions which can lead to difficulties in job performance. Individuals in an EMS role may experience the following stressful experiences:

• confusion
• disorientation
• trouble concentrating
• poor problem-solving skills
• memory problems
• nightmares

Cognitive distortions can also include a heightened or lowered level of alertness and difficulty identifying familiar objects or people. Obviously, these impairments can cause problems on the job due to the necessity for first responders to think clearly, make on-the-spot decisions, or the ability to recall important information.

Physical Impacts

The on-the-job trauma experienced by first responders can manifest as physical ailments as well as behavioral changes. The NIOSH released data from 2020 with findings that a total of 16,900 individuals were injured on the job when working as EMS workers. Physical symptoms of trauma include:

• fatigue
• nausea
• vomiting
• dizziness
• excess sweating
• thirst
• headaches
• difficulty with sight
• jaw clenching
• other non-specified aches and pains

Some symptoms are so severe that they require immediate medical attention: chest pain, difficulty breathing, severe pain, and symptoms of shock. Physical symptoms can limit the individual on and off the job. Physical impacts of the emergency work can create challenges in addressing the task at hand and managing one’s own physiological response.

Behavioral Impacts

The physical symptoms of trauma extend beyond biochemical responses or aches and pains; behavioral changes may occur as well. Behavioral changes can include intense anger, emotional outbursts, changes in appetite, inability to rest, pacing, and even substance use. First responders may not know their behavior is changing as it can start as slight shifts in mood or eating habits. Left unchecked and untreated, it can develop into more problematic behavior including the misuse of drugs or alcohol to manage the mental, emotional, cognitive, and physical effects.

Experiencing trauma on the job can cause an individual to adopt unhealthy coping methods to manage their symptoms.  One unhealthy habit that could develop is the use of substances to suppress negative thoughts and feelings. A person may use substances to numb themselves, find the energy to meet the needs of their demanding job, reduce anxiety, and manage pain from injuries they may have sustained while working. Multiple substances are commonly used because of the physiological effects they have on the body.

For example, alcohol is a central nervous system depressant. Therefore, excess drinking can cause a numbing effect where inhibitions are lowered and thoughts may be less focused on the trauma. Alcohol can be utilized to help individuals sleep, as the same depressant component causes the body to slowly shut down and eventually pass out.

The Repercussions of Substance Use

Using substances initially may seem positive as it can mitigate the symptoms, but the behavior has significant immediate dangers and the benefits are not long-lasting. For drugs or alcohol to have the same initial effect, a person will have to engage in substance use more frequently and in higher doses or start using different substances.

Prolonged use of drugs and alcohol is dangerous because there are no true benefits and it can lead to even more challenges. Being aware of the signs and symptoms of exposure to traumatic events on the job can help identify when additional resources are needed.