As Americans, we have grown accustomed to calling 911 when we are in trouble. We pick up the phone, talk to an operator, and fully expect first responders to appear as if by magic and save us. However, there is a darker side to this privilege. The hidden problem of what happens to the mental health of first responders when they answer calls for accidents involving kids or, god forbid, a school shooting.

The constant exposure to death and destruction takes an enormous toll on the mental health of first responders. Yet, many of them will not acknowledge their pain. If a first responder has a history of child abuse, the effects on their mental health by responding to calls for help can lead to many complications, including death by suicide.

This article will examine complex post-traumatic stress disorder (CPTSD) in first responders and how their vital work harms these brave souls.

The Mental Health of First Responders

The public has ignored for far too long the mental health of those who care for and rescue them. We have overlooked the fact that they are people first, people who can become depressed and stressed like anyone else.

First responders have an image in public, and among each other that they are tough, rugged, and ready for any emergency. But, what if that paramedic, fireman, or nurse is also a survivor of childhood trauma and lives with the effects of complex post-traumatic stress disorder?

The sturdy and unbreakable façade that many of those who are on the front lines of defending our lives leave them open for ridicule should they need to admit and seek help. They need to seek advice for stress, depression, or any of the myriad other mental health problems they may face.

A Refreshment About CPTSD

Complex post-traumatic stress disorder is a mental health condition caused by childhood maltreatment perpetrated by the people children should be able to trust the most. CPTSD is a life-altering and life-long disorder that affects adults and produces a variety of dysfunctions, including the following:

  • Flashbacks to childhood traumatic events
  • Avoidance behaviors
  • Hyperarousal (hyperawareness)
  • Difficulty controlling or expressing emotion
  • Negative self-image
  • Trouble forming and keeping relationships
  • Depersonalization
  • Derealization
  • Losing one’s core beliefs, values, religious faith, and hope in other people

To be clear, people, including first responders who live with CPTSD, may exhibit a few or all of the above symptoms. However, keep in mind that some of the adaptive living styles learned by first responders while surviving as children are crucial for making a great ER doctor, fireman, or paramedic.

Complex Post-Traumatic Stress Disorder and First Responders

Being a fireman or a police officer is tough. They risk their lives and changing their family’s lives every time they go to work and face tremendous stress on the job. A paramedic or nurse never knows when a patient will present with severe trauma, rape, or today, victims of COVID 19. In essence, they are always waiting for the next shoe to fall.

For many, who have survived an abusive past and have CPTSD; as a result, these emergencies can force them to relive what they endured as children through flashbacks and emotional turmoil. They will be present, aware, and damn good at their job when a crisis arises. Later, after the emergency has subsided, they find themselves weeping uncontrollably, or pushing their turmoil deep down where they believe it will be hidden from everyone.

However, turmoil like those first responders who live with complex post-traumatic stress disorder endure is not ever forgotten. Their body and mind remember and because it equates with what they suffered as a child will come back to haunt them.

COVID 19, CPTSD, and First Responders

Most of us are aware that the hard-working people on the front lines, doctors, nurses, nurses aides, and other personnel, to name a few. These folks are working extended hours to care for the sick and dying from the COVID 19 pandemic. How horrible it must be for them to fight so hard to save someone only to have their lungs and other organs fail, and their patients die.

Imagine, though, that you are a survivor of trauma yourself and have never begun treatment to reverse the damages done when you were a child. The pressure and anxiety leveled upon your person every day in the combat zone of COVID 19 would take a massive toll on your mental and physical health.

According to the Substance Abuse and Mental Health Services Administration (SAMSHA), it is estimated that 30% of first responders develop mental health conditions. These include depression and post-traumatic stress disorder. The general population figure is 20%. Add the proclivity for developing PTSD on top of an already existing condition of CPTSD, and you have a recipe for disaster.

The Danger of Death by Suicide to First Responders

Those on the front lines of the COVID 19 crisis are awash with different emotions and physical discomforts such as anger, hypervigilance, and chronic exhaustion. Even during “normal” days, the stress takes a toll on not only the first responder’s personal health but that of those around them, leading to divorces and illness.

It is no wonder that the death toll of those who first respond to our physical and legal needs are dying in record numbers by suicide. Often those who protect and help us find themselves addicted to alcohol, depressed, and avoiding finding mental health treatment because of the tremendous stigma involved in doing so.

In one paper, it was written that studies have found that in 2017 alone, at least 103 firefighters or EMS workers across the United States died by suicide. They also reported that more police officers die by suicide than in the line of duty every year (Heyman et al. 2018).

Ways First Responders Can Help Themselves

All is not lost as there are plenty of ways that first responders can be effective in improving their lives by good self-care. According to The National Center for PTSD, below are only a few of these methods quoted from their site.

First responders working shift work should:

  • Practice self-monitoring and pacing
  • Regularly check-in with colleagues, family, and friends
  • Working with partnerships or teams
  • Practice relaxation techniques and stress management breaks
  • Periodically check in with a peer for consultation and their supervisor
  • Make sure to time-outs for primary bodily care and refreshment
  • Keeping anxieties conscribed to actual threats
  • Do their best to maintain helpful self-talk
  • Focusing their efforts on what is within their power
  • Accept situations they cannot change
  • Foster a spirit of endurance, patience, tolerance, and hope

While doing all of the above first responders should avoid the following:

  • Working too long by themselves without checking in with colleagues
  • Working “round the clock” with few breaks
  • Feeling that they are not doing enough
  • Excessive intake of sweets and caffeine
  • Engaging in self-talk and attitudinal obstacles to self-care

Only by practicing good self-care first responders, especially those who live with CPTSD, hope to conquer the mental crisis caused by COVID 19.

Ways the Public Can Help

The public need not stand by and allow our brave nurses, doctors, firemen, police officers, and other first responders to take their own lives.  There are many ways we can help.

Provide Support. Allow first responders to talk about what they have seen in their work within the confines of the HIPPA law. Offer these brave men and women follow-up treatment and support from mental health professionals and the public alike to shore up their depleted supply of encouragement.

Shout out their worth. Many communities have begun ringing bells, honking horns, and otherwise acknowledging the bravery and courage of first responders during the COVID 19 pandemic. The public must keep telling our brave men and women on the front lines of caring for our health and welfare how valuable they are to us and how much we appreciate and love them. A kind word may be the catalyst to help a police officer not die by suicide or assist a nurse in having a better attitude at home saving her marriage.

In Closing

First responders are a vital part of our society and play a fantastic role in keeping us safe and healing us when we are sick. There is no reason we the public cannot reach out to nurses, doctors, policemen, aids, firemen, and all the other people involved in our care. They are all that stands between us and death by COVID 19.

They need us, and we need them.

It is time to stand up and recognize the pain that those first responders who lived through childhood trauma their struggles and their courage.

“You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ‘I lived through this horror. I can take the next thing that comes along.’” ~ Eleanor Roosevelt

“One isn’t necessarily born with courage, but one is born with potential. Without courage, we cannot practice any other virtue with consistency. We can’t be kind, true, merciful, generous, or honest.” ~ Maya Angelou

If you or a loved one are living in the despair and isolation that comes with complex post-traumatic stress disorder, please, come to us for help. The CPTSD Foundation offers a wide range of services including:

Daily Calls

The Healing Book Club

Mindfulness, Prayer, and Meditation Circle

Support Groups

Our Blog

The Trauma-Informed Newsletter

Daily Encouragement Texts

All our services are reasonably priced, and some are even free. So, to gain more insight into how complex post-traumatic stress disorder is altering your life and how you can overcome it, sign-up, we will be glad to help you.


Giourou, E., Skokou, M., Andrew, S. P., Alexopoulou, K., Gourzis, P., & Jelastopulu, E. (2018). Complex post-traumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?. World journal of psychiatry, 8(1), 12.

Heyman, M., Dill, J., & Douglas, R. (2018). The Ruderman white paper on mental health and suicide of first responders. Ruderman Family Foundation.


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