🚧 Website Maintenance in Progress: Thank you for visiting! We are currently in the process of enhancing our website to serve you better. Please check back soon for our new and improved website.

Editor's note: ISTSS helped develop the Vicarious Trauma Toolkit, which provides resources to help professional organizations move beyond focus on individual self-care through trauma-informed policies, practices and programs.



Because of the nature of their work, emergency first responders (EFRs) are particularly at risk of developing operational stress injuries (OSIs) (Public Safety Canada, 2017). EFRs are front-line workers who ensure the safety of citizens; the label refers to paramedics, emergency medical technicians, police officers and firefighters. The most common OSIs reported by first responders include post-traumatic stress disorder (PTSD), depression, anxiety disorders, substance abuse and suicidal risk (Carleton & al., 2018). In many cases, the repeated traumatic events experienced at work are the likely cause of these difficulties. Indeed, recent meta-analysis conducted in North America indicated that approximately 12% of first responders on duty were suffering from PTSD (Berger & al., 2012).

Several factors contribute to EFRs’ vulnerability. First, these populations are exposed more frequently to traumatic events than the general population (Public Safety Canada, 2017). Emergencies are both unpredictable and recurrent in their line of work, increasing the risk that EFRs will interpret them as disruptive or threatening. The constant anticipation of potentially traumatic events can also increase the risk for developing PTSD (Papazoglou, 2013). In such a scenario, anticipation would place EFRs in a vulnerable state even before they are exposed to a traumatic event. Faced with these alarming statistics and numerous accounts of attempted and completed suicide among EFRs in recent years, the idea of specialized psychological care has been received with growing interest by both the scientific community and decision-makers. Unfortunately, the lack of accurate data on the prevalence, prevention and treatment of OSIs among EFRs slows progress in the field.

First responders are still reluctant to seek help for psychological difficulties after being exposed to a traumatic event (Haugen, McCrillis, Smid & Nijdam, 2017). The possible existence of an oppressive culture labeling mental health difficulties as a sign of vulnerability or failure could explain why some EFRs hesitate to ask for help. In fact, professions traditionally associated with manhood and toughness generally do not encourage the expression of distress or emotions (Mitchell &  Dorian, 2017 ; Papazoglou, 2013). Negative emotions continue to be perceived as running contrary to emergency environments because the perceived job requirements of a high tolerance for stress, action and need for control fall in opposition to the “emotional world.” Consequently, first responders tend to use emotional regulation strategies that are either poorly adapted or harmful; these include avoidance, substance use or isolation (Skeffington, Rees & Mazzucchelli, 2017). These strategies provide temporary relief but also increase the risk of developing serious psychological difficulties and rendering help-seeking less likely. Not all aspects the work culture are likely harmful, however. For example, deep-rooted camaraderie, values of solidarity and fraternity among first responders can be seen as protective factors when they result in peer support but also as risk factors if they create a climate of ostracism (Mitchell &  Dorian, 2017). Indeed, stigma and the trivialization of violence constitute the most frequently identified barriers to mental health care. A recent meta-analysis indicated that one-third of first responders felt stigmatized because of their mental health difficulties and 9% encountered barriers in accessing care (Haugen, McCrillis, Smid & Nijdam, 2017). On this note, perceiving a taboo associated experiencing workplace violence is often linked to negative psychological consequences. These results suggest that reducing the stigma associated with help seeking is an essential step for organizations to support their workers.

In addition, the designation of OSIs as work-related illnesses can be a long and complex procedure, unlike physical injuries. This process has been made easier over the years thanks to the efforts of advocates, but progress is still needed. Specifically, the mental health professionals evaluating first responders are not always trained in the specifics of posttraumatic symptomatology, which can lead to ineffective treatment. Receiving inadequate care can act as a strong disincentive to seek additional help.

Finally, initial training as well as continuing education for EFRs should add components on the prevention of traumatic events and understanding their consequences on mental health. The early identification of OSIs could help promote help-seeking. Indeed, it is difficult to ask for help when you do not understand the signs.

Public authorities, scientists and decisions-makers are increasingly recognizing the importance and the plurality of OSIs and developing new prevention and treatment programs (House of Commons of Canada, 2006; Forbes & al., 2011; Public Safety Canada, 2017). Receiving adequate psychological care, however, remains difficult. Many EFRs experience delays in care, a known risk factor for the worsening and chronicity of psychopathology. Additional efforts need to be deployed to ensure the timely, effective and complete care of traumatized first responders. 

About the Authors:

Mrs. Marine Tessier, MPs, is pursuing her doctorate in clinical psychology at the UniversitĂ© de MontrĂ©al. She holds a master’s degree in clinical psychology from France and has benefited from multiple clinical experiences with various populations including victims of crime and those detained in the criminal system. Her doctoral research project is on posttraumatic stress injuries among paramedics and emergency dispatchers.

Josianne Lamothe, MSW, is a doctoral student in criminology at the UniversitĂ© de MontrĂ©al. Her research focuses on the youth protection workers’ experiences with client violence.


Berger, W., Coutinho, E. S. F., Figueira, I., Marques-Portella, C., Luz, M. P., Neylan, T. C., … Mendlowicz, M. V. (2012). Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Social Psychiatry and Psychiatric Epidemiology, 47(6), 1001–1011. http://doi.org/10.1007/s00127-011-0408-2

Carleton, R. N., Afifi, T. O., Turner, S., Taillieu, T., Duranceau, S., LeBouthillier, D. M., Sareen, J., ... Asmundson, G. J. G. (2018). Mental Disorder Symptoms among Public Safety Personnel in Canada. Canadian Journal of Psychiatry, 63(1), 54-64.

Forbes, D., Lewis, V., Varker, T., Phelps, A., O’Donnell, M., Wade, D. J., Ruzek, J.I., Watson, P., Bryant, R.A. & Creamer, M. (2011). Psychological first aid following trauma: implementation and evaluation framework for high-risk organizations. Psychiatry, 74(3), 224-239.

Haugen, P. T., McCrillis, A. M., Smid, G. E. & Nijdam, M. J. (2017). Mental health stigma and barriers to mental health care for first responders: A systematic review and meta-analysis. Journal of Psychiatric Research, 94, 218-229.

House of Commons of Canada. (2006). Committee Report No. 5 - SECU (42-1): Healthy minds, safe communities: supporting our public safety officers through a national strategy for operational stress injuries. Repéré à http://www.ourcommons.ca/DocumentViewer/en/42-1/SECU/report-5.

Mitchell, C. L. &  Dorian, E. H. (2017). Police Psychology and Its Growing Impact on Modern Law Enforcement. Hershey, PA : IGI Global.

Papazoglou, K. (2013). Conceptualizing Police Complex Spiral Trauma and its applications in the police field. Traumatology, 19(3), 196-209. Doi:10.1177/1534765612466151

Public Safety Canada. (2017). Post-Traumatic Stress Injuries and Support for Public Safety Officers. Government of Canada,. RetrouvĂ© Ă  : https://www.publicsafety.gc.ca/cnt/mrgnc-mngmnt/mrgnc-prprdnss/ptsi-en.aspx.

Skeffington, P. M., Rees, C. S. et Mazzucchelli, T. (2017). Trauma exposure and post-traumatic stress disorder within fire and emergency services in Western Australia. Autralian Journal of Psychology, 69(1), 20-28.