When Helping Hurts: Trauma’s Effects on First Responders

Three rescue workers talkingFred is a 40-year-old firefighter who has been working as a first responder for more than 15 years. In his first year as a firefighter, he arrived at a car accident in which three children were killed. Since then, he has been among the first to respond to the scenes of countless injuries and dozens of deaths.

Although he tries not to think about the fatalities, he remembers each one. When asked how he and his colleagues cope with the trauma of witnessing such horrific events, he looks away, chuckles, and says, shaking his head, “We joke around and pretend it doesn’t bother us. You don’t want to be the one going to counseling. Everyone would call you a wimp.”

First responders such as firefighters, EMTs, and police officers face horrors in their work that most of us can’t imagine. In helping everyday people in the worst of times, they witness death, destruction, and much of the worst of what humans can do to hurt one another. A recent article from The Police Chief discusses the importance of seeking professional help for law enforcement officers. Physicians, physician’s assistants, nurse practitioners, nurses, and other medical professionals are also typically exposed to more human suffering than anyone should have to see.

The Boston Globe published an article a few months after the Boston Marathon bombings. It describes the experiences of several first responders whose lives were irrevocably changed by what happened that day. And this article in Counseling Today, aptly titled “First to Respond, Last to Seek Help,” lists the effects of traumatic experiences on first responders and the many barriers to seeking help these individuals face.

Christine, 35, has been a hospital nurse in a children’s cancer unit for 10 years. While she can tell joyful stories of the children whose treatment succeeds in overcoming the cancer cells, there are many stories she doesn’t share. While she doesn’t speak about the pain and suffering she has seen, these memories haunt her at night when she tries to sleep. She is beginning to question her faith as she struggles to understand why children and their families have to experience such pain. Most days she cries in her car on the way to work, but she can’t stand the thought of leaving her job. Her supervisor has suggested she go to counseling and she views this recommendation as an insult to her professional skills.

Part of the problem is the environment in which firefighters, EMTs, police, and medical personnel do their heroic work. The fast-paced nature of their work settings limits opportunity for expressing feelings about what they see. Maintaining a clinical distance between patients and themselves helps first responders and medical professionals maintain their composure in the worst situations.

But there is a reason those of us who are helpers seek out helping work. We are caring people by nature, and it hurts to see others in pain. While most employers offer counseling through employee assistance programs, first responders and health care providers often feel, as Fred mentioned, that asking for help is a sign of weakness.

Exposure to trauma is an occupational hazard for first responders and medical professionals, and as such, it is necessary to practice self-care and know the signs that trauma is taking a toll. According to the Trauma Center of the Justice Resource Institute, the effects of exposure to trauma are cumulative. The longer one has worked as a first responder, the more likely he or she is to have a reaction to trauma.

What You Can Do about It

There are several great books available to help people who have experienced trauma firsthand. Two I recommend are Trauma Stewardship by Laura van Dernoot Lipsky and Compassion Fatigue by Charles Figley. Taking time away from work and seeking social support can be helpful. If needed, find a therapist or counselor who is specially trained in trauma to help you recover.

When to Consider Seeking Professional Help

According to the Trauma Center at the Justice Resource Institute, a first responder who is experiencing the following symptoms should seek professional help to assess and treat the effects of their traumatic experiences:

If trauma symptoms are interfering with your enjoyment of things you used to love, if you’re starting to hate your job and question why you went into the field, or if the way you look at the world has changed, counseling can help. Asking for help is a sign of strength.


  1. First responders and traumatic events: normal distress and stress disorders. (n.d.) Retrieved from http://www.traumacenter.org/resources/pdf_files/First_Responders.pdf
  2. Gupton, H.M., et al. Support and Sustain: Psychological Intervention for Law Enforcement Personnel. The Police Chief 78 (August 2011): 92–97.
  3. Shallcross, L. (2013, August 1). First to respond, last to seek help. Counseling Today. Retrieved from http://ct.counseling.org/2013/08/first-to-respond-last-to-seek-help/

© Copyright 2015 GoodTherapy.org. All rights reserved. Permission to publish granted by Laura J. Reagan, LCSW-C, therapist in Severna Park, Maryland

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Melva


    February 12th, 2015 at 9:07 AM

    I have never quite thought about it in this way, that those who help so many could be the ones who hurt the most and we don’t do enough to recognize that.

  • pete


    February 12th, 2015 at 10:46 AM

    My dad is a firefighter and I can’t tell you how many times he would come home from a call sobbing because there was nothing that could be done to save a home, a family, a pet, whatever. You don’t think about the things that they have to witness that they try to keep inside because they never want their family to understand the pain that they have had to witness first hand.

  • Laura Reagan, LCSW-C

    Laura Reagan, LCSW-C

    February 12th, 2015 at 10:58 AM

    Hi Melva, thank you for your comment! Truly, helpers aren’t immune to the pain of witnessing others in pain. The important thing is to recognize the signs that the helper is suffering, to ensure that he or she is able to continue doing such important work for many years!

  • Laura Reagan, LCSW-C

    Laura Reagan, LCSW-C

    February 12th, 2015 at 1:27 PM

    Pete, thank you for sharing your family’s experience. Such a great reminder that while firefighters are heroes, they are human like everyone else.

  • Zara


    February 12th, 2015 at 3:59 PM

    I think that most people who are in one of the helping professions can feel this tremendous amount of pressure to serve others and to never be in a situation where they feel as if they are letting someone down. Can you imagine always having to perform to these types of standards, living in fear that you won’t be able to save the next person who comes along and needs your help? That has to be terribly difficult to live with at times.

  • Catherine Boyer, MA, LCSW

    Catherine Boyer, MA, LCSW

    February 13th, 2015 at 6:53 AM

    Great heads up article which I hope will motivate a lot of people to seek help. I’d just add that neurofeedback can be very helpful with PTSD and can be an easier access point for men and women with the “tough guy” mentality who may have trouble with the idea of talking about feelings, etc.

  • Laura Reagan, LCSW-C

    Laura Reagan, LCSW-C

    February 13th, 2015 at 10:04 AM

    Zara, you’re right! People can feel responsible to save people even though it is not always possible. The very same desire to help can lead to such pain when it is impossible to rescue someone. We are all human. It’s so important to get professional help to deal with feelings of guilt about what we are unable to do, when those feelings become overwhelming.

  • Laura Reagan, LCSW-C

    Laura Reagan, LCSW-C

    February 13th, 2015 at 10:07 AM

    Catherine, thanks for that comment! I don’t know a lot about neurofeedback, but it’s great to know that there are a variety of options for helping professionals who are dealing with overwhelming reactions to trauma and stress.

  • beth anne

    beth anne

    February 13th, 2015 at 11:08 AM

    Let me just talk for a moment about what the family members of these first responders feel too. Everything that they go through I would suspect that for most of us we go through all of that with them too. There is no avoiding it, no hiding it, and it can take a toll on the whole family.

    There is always this fear of what if he doesn’t make it home? Or what if he sees this night damages him and he can’t get over it? I am not diminishing what these brave men and women do every day, but it is also important to remember that their families have to be brave for them too.

  • Sherry Cardinal, LCSW, DAAETS

    Sherry Cardinal, LCSW, DAAETS

    February 13th, 2015 at 11:40 AM

    One of the biggest obstacles first responders face in getting help is attitude of their administrators and peers about mental health issues and it being a sign of weakness. They also legitimately fear for their jobs and careers if it is found out that they are having problems. It’s only been in the past couple years that Critical Incidence Stress Management has been sanctioned for events in the line of duty. It is still not widely accepted, despite the growing body of evidence that it immensely helpful in building post traumatic growth, resilience and preventing cumulative stress, especially for police. Another obstacle is that first responders generally don’t trust mental health professionals. There are many good reason why this is so. If you are interested in working with police, you better be prepared to ride along, wear a bullet proof vest and share in risks and scenarios that arer part of their everyday jobs. It would also be helpful to have your concealed handgun license, if your State allows, be able to qualify as officers do in the proficiency and willingness to use deadly force should the need arise. If you have any judgments or negative feelings about the later, you shouldn’t be working with police. It is very much a specialty, much like brain surgery is to a family doctor.

    Good reads on the issue are Cop Shock, by Kates, Emotional Survival for Law Enforcement by Gilmartin and Counseling Cops: What Clinicians Need to Know, by Kirschman et al.

  • Ryan


    February 14th, 2015 at 9:11 AM

    I agree with you Sherry. There are still just too many people out there who see this as a weakness, something that they have to be ashamed of and it isn’t

  • Laura Reagan, LCSW-C

    Laura Reagan, LCSW-C

    February 15th, 2015 at 7:54 AM

    Sherry, you raise some great points. It can be difficult for first responders to feel that mental health professionals understand their stories. That is why it is so important to find a therapist you can really connect with, and if the first person you find isn’t the right one, keep going! Help is out there and the right therapist is there for anyone who needs help.

  • Laura Reagan, LCSW-C

    Laura Reagan, LCSW-C

    February 15th, 2015 at 7:55 AM

    Ryan, thanks for your comment! There is no shame in asking for help!

  • Estelle


    February 16th, 2015 at 5:20 AM

    This is kind of like the whole military atmosphere, where people for too long have been made to think that it is not cool to ask for help and that they will be shunned if they do ask.

    Let’s all take a stand and say that not asking for help or better yet being made to feel like you shouldn’t have to ask, that’s what is wrong, not the admitting that you do need some support.

    When any of us go too long without feeling that love and support that is when we tend to break. Our first responders deserve so much better than that!

  • Laura Reagan, LCSW-C

    Laura Reagan, LCSW-C

    February 16th, 2015 at 4:55 PM

    Estelle, I agree that the supervision received at the job is an important factor in how likely the employee is to seek help when needed. If I ask my supervisor for help and I’m told that I should deal with it on my own, or that maybe I’m not cut out for the job after all, of course I’m going to feel uncomfortable going to counseling and I will certainly think twice before going to that supervisor for help again. Often supervisors are unsupportive because they’re burned out after years of trying to hold their feelings in. Personally, I have learned that a work environment which is unsupportive doesn’t fit my needs. And when I supervise others, I make sure to talk about what type of support they need at work, and emphasize the importance of work/life balance and self care. None of us can be superhuman, and we don’t have to be! Like you said, first responders and other helping professionals deserve better!

  • Estelle


    February 17th, 2015 at 6:41 AM

    They do deserve better because they are out there risking their own lives day and night to ensure the safety of ours.

  • Lisa


    November 21st, 2016 at 11:42 AM

    Trust is something that you earn. As a first responder, and as a woman in a male dominated profession, trauma isn’t just about what you experience on scene. In addition, those in the counseling world have limited experience navigating the real, and self-imposed pressures of the job. They are also unwilling to learn. As a graduate student in Psychology, my experiences have been ignored, mocked, and passed off as fiction. One male PhD, actually insinuated that his “male dominated life” trumped whatever real experiences that I’d had as a female navigating a male dominated profession. You wonder why first responders don’t trust counseling professionals? I could give you an entire list of the attitudes that I have experienced by those who are shaping the minds and attitudes of future counselors. Here is my list: 1) They think that social justice means teaching students that police officers, and other first responders are racist. 2) They are require patent compliance with their attitudes and discourage raising questions about anything. 3) They are arrogant, and consider themselves experts on everything. God forbid you actually have personal experience that challenges their expert opinion. You want to help first responders? Listen to them. Accept that you can’t understand what it is like to do their job. Have the humility to accept that you aren’t the expert on surviving day to day life as a first responder, or who they are as individuals; and while you might be able to speculate, you can never know the deep sense of responsibility first responders feel for the community they serve, for their profession, for those they serve with, and for their families.

Leave a Comment

By commenting you acknowledge acceptance of GoodTherapy.org's Terms and Conditions of Use.



* Indicates required field.

Therapist   Treatment Center

Advanced Search

Search Our Blog

Title   Content   Author
GoodTherapy.org is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.org.