Should Mental Health Counseling Be Required For All EMT/Paramedics?

By: Sarah Fader

Updated February 04, 2021

Medically Reviewed By: Wendy Boring-Bray, DBH, LPC

Any first responder will tell you that they've seen some terrible things in their line of work, and this isn't a job that's for the faint of heart. One of the reasons why is the sheer psychological resilience it takes to compartmentalize the horrors as well as the emotional highs and lows of emergency calls. Many who experience life-changing events do so only once in a lifetime, but for emergency first responders these experiences are weekly, daily, and sometimes even hourly. In times of a major crisis, most departments will offer or require professional counseling, but what about those day-to-day stressors that simply build up over time?

The average public safety employee does not like talking about traumatic events because talking about a call again can mean having to relive the event in full detail or emotional anguish. Therefore, many professionals will bottle up their feelings. This leads to increasing stress over time and can become a serious problem if left unchecked.

Most professionals deal with the stress of the job in their own particular way. A study by Northwest Public Health determined that approximately 20% of emergency medical services (EMS) personnel have post-traumatic stress disorder (PTSD) from repeated exposure to emotionally unpleasant calls. This type of stress in counseling is often called secondary trauma because the EMS professional isn't experiencing the trauma firsthand but witnessing the aftermath of the event. Also, the worker is often attempting to determine a solution to the consequence of the crisis, which adds additional stress.

Therefore, many first responders develop various ways to cope with the ordeals of their work. Some coping methods are healthier than others. Whether it's a healthy coping method or developing an internal barrier that separates the calls, they either learn to cope or they get out; there is no in-between option.


Source: pexels.com

Unhealthy Coping Methods

When dealing with trauma, the body goes through physical and emotional reactions. Things that might seem unrelated, like diarrhea or a cold, may be related to the stressful experience. Experiencing trauma can impact a person's immune system. In other cases, sleeplessness, hypervigilance, disorientation, and an insatiable need for control often develop over time. This is how the body and mind deal with this intense stress because trauma is an abnormal event and should only cause temporary side effects.

However, when repeatedly exposed to horrific situations, it's easy for EMTs to become numb, to stop empathizing with others, and to simply block memories out to cope with the stress. This forgetting becomes normalized over time. For many, this works initially, but over time, events cannot be completely forgotten. The issue is that this doesn't fix the fact that the responder isn't dealing with the emotions of the trauma that may eventually lead to deterioration of their health.

First responders recognize a common scenario - after the call, everyone sits around a table in silence. No one wants to talk about what has just happened other than the occasional nod to short discussions about how bad the event was. When they are alone or at home, they may remember or relive the event, but still keep everything inside.

Some EMTs turn to alcohol to forget difficult calls and numb their psychic pain. Repeated use of this type of coping mechanism can lead to both medical issues and on-the-job performance problems. They may turn to other addictive behaviors as well, such as gambling and hypersexuality in order to cope with their stress and keep themselves occupied. All of these behaviors are done to keep themselves from having to relive what happened. (If you’re struggling with substance use, you can reach out to the SAMHSA National Helpline at (800)662-4357.)


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Healthy Coping Methods

The healthiest methods tend to use whatever support system the department already has in place (if there is any). Talking about the trauma, even repeated trauma, with an empathetic listener means that it will no longer be internalized and would help to break this cycle. Some public safety departments even have specially trained staff called peer support representatives who are trained in active listening skills. Other departments have chaplains on staff who can provide spiritual guidance and support. These volunteers help their co-workers healthily work through work-related trauma.

In addition to processing their thoughts and feelings to a trained coworker, other activities can be helpful to reduce traumatic stress. Physical activities such as exercise and yoga can help professionals cope by allowing their bodies to remove the effects of stress. Psychiatric research has shown that traumatic stress can be carried in the body for long periods. Through prolonged and consistent physical movement, this type of stressor can be greatly reduced.

Besides physical movement, daily meditation can help EMTs move past work-related trauma. It can be uncomfortable and even painful at first. But meditation has been shown to reduce the intensity and frequency of flashbacks caused by exposure to work-related trauma. However, this type of intervention should only be done with a meditation teacher who has experience in working with professionals who suffer from this type of issue.


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For many who work in public safety, the worst calls stay with them for the rest of their lives. The stress of certain calls can overburden many, leading to serious burnout. Imagine each emergency call as a rock that must be carried; over time some of these rocks can be dropped as the event is forgotten about over time. But some rocks will always stay with the person, never leaving. The new rocks are added as the EMT becomes more experienced. Those rocks can become heavy and burdensome. Eventually, some people will not want to carry them anymore.

Feelings of powerlessness, lowered self-esteem, and self-blame can overwhelm some EMTs after years of working in the field. This is one of the reasons why first responder suicide rates are also so high. They cannot carry the memories of these terrible events any longer and look for a way out. This does not have to happen. Public safety managers can become more aware of what services are available for their staff. (If you are struggling with thoughts of suicide, know that you are not alone. The National Suicide Prevention Lifeline: 1-800-273-TALK (8255) is available and confidential, 24/7.)

Who to turn to?


Source: counselors.workable.com.com

Most large departments offer free services like grief or trauma counseling. However, they're often only available after particularly traumatic events rather than consistent professional counseling. While no single situation works for everyone, having easy access to an experienced professional counselor on a regular basis is the best way to help deal with the repeated stress of trauma on the job for EMTs.

BetterHelp can match you with trained specialists who can help EMTs and other public safety personnel manage their stress and emotional well-being, to perform properly in their jobs, and feel better about themselves. It's often said that you can't help others if you can't help yourself. This should also be applied to your own mental health needs as well if you want to be a successful lifesaver.

If you’re thinking about taking this step, you likely want to know if online therapy works. PTSD is among the most studied disorders for online treatment. U.S. Veterans Affairs clinics have been looking into seeing whether remote therapy is as effective as in-person therapy for veterans with PTSD. There have been several studies, and one recent one broke some veterans into two groups. One group did online therapy and the other in person. At six months, they both groups had similar signs of improvement.

If you’re a first responder, you probably don’t have a flexible schedule. Luckily, BetterHelp makes that easier. You can reach out from wherever you’re comfortable as long as you have a secure, reliable internet connection. There’s no setting aside time to travel to an office. And while you may be put on a waitlist if you contact a traditional office, BetterHelp connects most people with a counselor within 24 hours.

To help you make a more informed decision, here are some reviews by recent BetterHelp users about working with their counselors:

“Kristen has been a wonderful guide and a caring soundboard for me on countless occasions. Non judgemental, but also not so neutral that I’m no better off than when I started. Well worth the time and investment, especially for a busy full time front line worker, parent, and plain old human being.” Read more on Kristen Hardin.

“Kalene has probably been the most supportive in my journey of rediscovering myself outside of my trauma. I’ve been learning so much about how my brain has set to see the world and allowing myself the safety to learn how to heal those wounds. My counseling has been a strong self improvement and self discovery journey for me and I don’t believe I would have made the progress that I did without Kalene being so supportive and understanding. She’s treated me with so much patience and kindness, as well as she also reminds me to treat myself with that patience and kindness as I maneuver my own healing process.” Read more on Kalene McSwain-Faulkner.


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