It’s the worst day of your life.
You’ve been in an emergency. Something traumatic has happened, and you don’t know what to do next. There’s confusion, worry, fear, maybe even a little panic. And then someone arrives who does know what to do. They assess the situation, take action, and start helping.
Mr. Rogers once famously encouraged children to “look for the helpers” during scary or confusing situations. The helpers are the people who run toward the problem when everyone else is understandably thinking, “Maybe we should go the other direction.”
First responders are those helpers.
Police officers, firefighters, EMTs, paramedics, dispatchers, and other emergency personnel routinely walk into situations that most of us spend our lives hoping never happen. They see people on some of the worst days of their lives and are expected to remain calm, make decisions, and help everyone else get through the crisis.
That bravery and stoicism can be equal parts reassuring and awe-inspiring.
But what happens to the heroes when they go home? What happens when the threat has been neutralized, the crisis has been averted, and someone finally gets to sit down? Because underneath the helmet, badge, uniform, or radio is still a human being.
First responders are a vital part of making the world safer and less scary. At the same time, it’s difficult to imagine repeatedly witnessing death, injury, violence, suffering, and human vulnerability without it taking some type of toll. This month, the Wellness Institute of Michigan is recognizing this sacrifice, but also normalizing the naturally human toll this takes on our heroes (many of whom are probably already objecting to being called that).
Indeed, trauma is an unavoidable occupational hazard for many first responders. As part of the job, compartmentalizing emotions and continuing to function in the middle of horrific circumstances is necessary. In an emergency, you don’t necessarily have the luxury of stopping to process how you feel. Someone needs help, and you’re the person who needs to help them.
That ability to put emotions aside can be incredibly useful.
The tricky part is that the brain doesn’t always get the memo that the shift is over.
Research suggests that approximately one in seven first responders may experience probable PTSD associated with routine occupational exposure. A 2025 systematic review and meta-analysis examining 138 studies found a prevalence of about 14.3% among first responders exposed to routine occupational trauma. Interestingly, that estimate was higher than the PTSD prevalence associated with large-scale disasters in the studies reviewed. Take a second to think about that. We tend to picture PTSD as something that happens after the call—the terrible accident, the mass casualty event, the shooting, the fire.
But trauma doesn’t always arrive as one giant event. I always emphasize that trauma is cumulative and builds up, one traumatic experience after another. There’s one limp body, and then one dreadful call, and then one mangled car. One difficult image after another that doesn’t quite leave your head. Indeed, the cumulative nature of the work may be just as important as any single event.
Posttraumatic Stress vs. Posttraumatic Stress Disorder
A common misconception about post-traumatic stress is that experiencing symptoms after trauma automatically means someone has PTSD. It doesn’t. Instead, post-traumatic stress reactions can be a completely normal response to an abnormal experience. After something frightening or traumatic, a person might experience nightmares, intrusive memories, anxiety, irritability, difficulty sleeping, emotional numbness, being easily startled, or feeling disconnected from what happened.
In other words, your brain may spend some time saying, “Hey, remember that incredibly terrible thing that happened? Let’s make sure we’re REALLY prepared in case it happens again.”
Very helpful. Also potentially exhausting.
The good news is that having a stress reaction doesn’t mean someone has PTSD. In fact, most people who experience trauma do not develop PTSD. According to the National Institute of Mental Health, about half of U.S. adults experience at least one traumatic event during their lifetime, while about 6% experience PTSD at some point in their lives. There is an important distinction between post-traumatic stress and post-traumatic stress disorder.
Posttraumatic stress describes the collection of reactions that can occur following trauma. PTSD is a diagnosable mental health condition in which symptoms persist and cause significant distress or impairment.
Symptoms of PTSD generally fall into four categories:
- Re-experiencing: nightmares, intrusive memories, flashbacks, or distress when reminded of the trauma.
- Avoidance: trying not to think about, talk about, or encounter reminders of what happened.
- Changes in thoughts and mood: guilt, shame, negative beliefs, emotional numbness, or difficulty experiencing positive emotions.
- Changes in arousal and reactivity: irritability, hypervigilance, difficulty sleeping, exaggerated startle responses, or feeling constantly on guard.
And this is where things can become particularly complicated for first responders. Being hypervigilant can be a pretty useful occupational skill. Being hypervigilant while sitting on your couch because your spouse dropped something in the kitchen? Less useful. Being prepared for danger can save lives. Still, feeling as though danger is everywhere can make it very difficult to sleep, relax, connect with family, or simply enjoy an ordinary Tuesday night.
Avoidance can also be tricky. Avoiding a reminder of trauma can provide immediate relief. Unfortunately, that relief can teach the brain, “Good thing we avoided that. It must have been dangerous.” And so the cycle continues. None of this means that every nightmare, bad day, or difficult call represents PTSD. It is important not to pathologize normal reactions to extraordinary circumstances. But it is equally important not to dismiss significant symptoms with, “That’s just part of the job.” Sometimes it is part of the job. That doesn’t mean you have to suffer from it indefinitely.
Trauma Lives in the Body – The Neuroscience of Trauma
One of the most important things we have learned about trauma is that it isn’t simply something that happens in our thoughts. Trauma happens in our bodies, too. Allow me to geek out for a second to talk about how incredible the brain is. When the brain perceives serious danger, the body’s threat-response system mobilizes rapidly. Heart rate increases, our muscles prepare for action, our attention narrows, stress hormones are released. The brain is doing its job, prioritizing information helps us survive. This is the fight-flight-freeze response, and it is not a sign of weakness, but a protective mechanism.
The amygdala plays an important role in detecting and responding to potential threats, while other brain systems involved in memory, attention, reasoning, and context interact with the stress response. During extreme stress, the way memories are encoded and later retrieved can be affected. This helps explain one of the strange things about traumatic memories: people can sometimes remember certain pieces of an event with utter clarity while having difficulty remembering other details. However, triggers can make the memories flood back:
Someone may vividly remember the smell of smoke.
The sound of a siren.
The expression on someone’s face.
The feeling in their stomach.
But they may have difficulty putting the entire event into a neat chronological story. In short, traumatic memories don’t always behave like ordinary memories.
A person can also intellectually understand that something happened in the past while their body reacts as though it is happening again. A loud bang can produce an immediate startle response; a particular smell can trigger anxiety before the person even realizes why; a location can suddenly feel unsafe. The nervous system has learned: Pay attention. This could be dangerous. For first responders, that learning happens repeatedly.
This is one reason the phrase “trauma lives in the body” is more than just a catchy therapeutic expression. The effects of trauma can involve changes in arousal, sleep, muscle tension, attention, startle responses, and other physical experiences. And this is also why telling someone to “just stop thinking about it” isn’t really that helpful. If we could just turn the whole “thought faucet” off, most of us would have already turned the handle on at least three embarrassing moments from high school.
Unfortunately, the brain doesn’t work that way. Instead, healing often involves helping the brain and body learn something different: The danger happened then. It is not happening now.
Treating Post-traumatic Stress and PTSD
Here is the part that I really don’t want to get lost in a conversation about first responder trauma:
There is hope. Experiencing posttraumatic stress does not mean someone is permanently “damaged” and it’s crucial to remember PTSD is a side-effect of our brain doing its job. Moreover, PTSD is treatable, and there are several evidence-based treatments that can significantly reduce symptoms.
Two well-established trauma-focused treatments are Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE).
Cognitive Processing Therapy
Cognitive Processing Therapy, or CPT, focuses on the thoughts and beliefs that can develop following trauma.
Traumatic experiences can sometimes leave people with conclusions (or stuck points) such as:
“I should have been able to save them.”
“If I had just done one thing differently, this wouldn’t have happened.”
“The world isn’t safe.”
“If I let myself feel this, I’ll fall apart.”
CPT doesn’t ask someone to pretend the trauma wasn’t terrible. Instead, it helps the person examine whether the conclusions they’ve drawn from the experience are accurate and helpful. This can be particularly relevant for first responders because responsibility and professional identity can become closely connected to traumatic experiences. Sometimes the most painful part of trauma isn’t just what happened. It’s what we believe what happened means. CPT helps people examine those beliefs and develop a more balanced understanding of the event and themselves.
Prolonged Exposure
Prolonged Exposure, or PE, approaches PTSD from a somewhat different direction. One of the most common responses to trauma is avoidance.
Don’t think about it. Don’t talk about it. Don’t feel that.
And honestly, avoidance makes perfect sense in the short term. Again, it is an adaptive response. If something hurts, our instinct is generally to move away from it. The problem is that avoidance can teach the brain that whatever we’re avoiding must still be dangerous.
PE uses gradual, structured exposure to trauma memories and reminders in a safe therapeutic environment. With the guidance of a trained clinician, the person learns that remembering something frightening is not the same thing as being in danger.
The goal isn’t to overwhelm someone or force them to relive a traumatic experience. The goal is to help the nervous system learn: That happened then. This is now.
Both CPT and PE are recommended trauma-focused psychotherapies for PTSD. Other evidence-based approaches, including Eye Movement Desensitization and Reprocessing (EMDR), may also be appropriate depending on the individual.
And perhaps most importantly, seeking treatment isn’t an admission that someone isn’t tough enough for the job. First responders are trained to identify problems, assess risk, and take action. Mental health deserves the same approach.
Conclusion
Although the point of this blog post is far away from advertising counseling, it is important for me to emphasize that trauma lives in the body, and there are effective treatments to help manage the natural consequences of being exposed to traumatic experiences. Prioritizing taking care of your own needs typically takes a back seat for many first responders; however, it’s important to recognize that taking care of yourself is part of the job.
I often draw a comparison to an airplane crisis. When the plane is going down, what is the first thing you’re told to do? Put on your own oxygen mask. This isn’t because the airline industry has decided that self-care is trendy. It’s because you can’t help someone else breathe if you can’t breathe yourself. The same principle applies to mental health. Taking care of yourself isn’t selfish. It doesn’t mean you’re weak.And it certainly doesn’t mean you aren’t the person everyone else can count on.
Sometimes, taking care of yourself is exactly what allows you to continue being there for everyone else.
First responders spend their careers running toward emergencies. They deserve permission to recognize when they need to stop, take a breath, and take care of the person underneath the uniform. Because the helper is a person, too.