• Sara Gilman

First Responder Stress — Are we supporting our First Responders, so they can continue to support us?

Sara Gilman, LMFT, CEO Coherence Associates, Inc.

Fellow, American Academy of Experts In Traumatic Stress, Former Fire Fighter/EMT

Sara has worked in the area of First Responder Stress for over 25 years. As a counselor who is CISM & EMDR certified, and a former fire fighter, she has facilitated debriefings, helped develop Peer Support Programs, and helped 100’s of First Responders recover from the negative effects of their unique work related stress.

It’s no big deal, it’s the nature of the job, this is what I’ve trained for

First Responder Stress — IS a BIG Deal!

First Responders include a long list of individuals in a variety jobs; Firefighters, Paramedics, Emergency Medical Technicians, Dispatchers, Police Officers, Military Personnel, Forensic Investigators, Medical Examiners, FBI Agents, Emergency Room Staff, Social Workers, and even Therapists. In day-to-day life, when the average person senses danger, through the primitive fear mechanism we all possess, they run to safety, away from danger. The First Responder overrides this warning, runs towards the dangerous situation, putting themselves at risk, to protect those in a life-threatening crisis. In their day-to-day work life, these men and woman are repeatedly exposed to catastrophes of all kinds. They are expected to be a compassionate aide to a scared child, injured victim, or disoriented elderly person, and a fast-acting lifesaver in emergency medical incidents, then in a split-second, they may be required to chase down a perpetrator, respond to gunfire, dodge a falling ceiling, or struggle to breathe in a smoke filled environment. While they train tactically for these varied situations, they are forced to learn to disregard their psychological and physiological responses while on duty. Their left-brain, or cognitive selves become their leader, and the right-brain, emotional selves, takes a back seat.

First Responders spend countless hours training in their chosen profession, obtaining qualifying certifications, being tested and retested throughout their careers, to ensure consistent performance under extreme situations. Yet, training in psychological coping strategies is either minimal, or nonexistent. In the past, it may have been assumed that proper tactical training will ensure proper psychological coping. The statistics on the effects of stress in First Responders shows us this is not true. What we are learning, through the advances in neuroscience, and stress research, is that repeated exposure to traumatic stress, critical incidents, and the cumulative nature of duty-related stressors, puts First Responders at greater risk for a host of physiological and psychological problems over time. Even these highly trained, tough-minded, and resilient individuals, are impacted by this level of stress.

Research has shown us that this persistent stress exposure results in the person’s nervous system being in a state of hyper-arousal, which just seems ‘normal’ to the First Responder, however it can lead to symptoms such as outburst of anger, hyper-vigilance, exaggerated startle response, and emotional dysregulation. Many will begin to suffer from somatic complaints including headaches, stomach aches, skin irritations, a long with depression, social withdrawal, substance abuse, chronic fatigue, sleep disorders, and cardiovascular problems.

In the United Sates alone, it is estimated there may be well over a quarter of a million first responders who likely meet criteria for partial Post-traumatic Stress Disorder (PTSD). Most of these folks will be left untreated, and often not aware of the long-term effects on their over all health, and the quality of their life. Evidence shows the need for effective interventions to respond to this stress in our First Responders. Due to the fact they continue to work in the environments that re-expose them to continual traumatic triggers, care must be given to provide proper education, enabling them to recognize symptoms, and seek effective treatment interventions. Effective interventions will help to restore their health and sense of well being, over the course of their career. Proper education, training, and treatment, is an integral part of personal resilience and productive job performance.

The recommendations for types of effective interventions that have come out of the research include;

  • Stress Management Training (8 hours minimum).

  • On-site educational materials on stress related risk factors, sleep hygiene, nutrition, exercise, etc.

  • Critical Incident Stress Management (CISM) — Debriefings

  • Short-term counseling providing evidence-based intervention

  • Peer Support Programs

More and more agencies, departments, and hospitals, are adopting positive and proactive Peer Support & Wellness programs for their personnel. We are moving in the right direction, and much more support needs to be in place for our First Responders and their families to live out happy and healthy careers. The health and well being of First Responders has an impact on all of us as individuals, and as communities, who in a moments notice, call upon these extraordinary individuals to run towards our emergency to bring us to safety.

In my next blog article, I will discuss the effectiveness of EMDR treatment for First Responders, and why we use it as a front-line intervention.

The clinical staff at Coherence Associates Inc. are EMDR & CISM trained, and are available to answer your questions about First Responder Stress & what you can do about it.

Sara Gilman, PsyD, LMFT, CEO

Coherence Associates Inc.


(760) 942–8663

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