Assaulted by back-to-back-to-back calls, first responders are paying a huge price while serving.  The cost will linger for years – much like our national debt that continues to rise as families, businesses and entire communities struggle to survive.  As a former firefighter/paramedic I know the price we all pay for the constant onslaught while serving and the lingering feelings of guilt, repressive threats to the psyche and the heavy impressions placed upon our families and friends.

According to the NFPA, our great nation is protected by over 1.4 million firefighters – 70% volunteers.  Another 800,000 are credentialed EMS providers.  The vast majority (95%) of the volunteers serve communities with populations of less than 25,000.  Of this study conducted in 2017, 68% of those surveyed had experienced at least one incidence of violence aimed at them within the last year.

Our culture represents many truisms that make up the basis of who we are as responders: honor, duty, tradition, risk, dedication, bravery, heroism and the list goes on. Those attributes form what we are – a highly reliable organization dedicated to the safety and well-being of those we have sworn to protect, the least of which are our partners, colleagues and team mates.  This very culture and the experiences responders witness daily result in higher risk of depression, anxiety, stress and suicide.  Another recent study of US firefighters revealed 46% experienced suicide ideation; while 19% participated in suicide planning; with 15% attempting suicide. Post-traumatic stress symptoms and illness are common among firefighters, and PTSD rates among emergency services is significantly higher than the general population.

Those who have become more resilient are: 1) more observant of their surroundings; 2) know their limitations; 3) prepare for the need to decompress; 4) admit when they need to reach-out; and 5) build self-care habits.  Others who may not be as resilient miss the physical, behavioral and psychological signs and symptoms of depression:


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Mental Health First Aid for First Responders

Mental Health First Aid for Fire and EMS© lists several risk factors for depression:  distressing and uncontrollable events, stressful and traumatic events, ongoing stress and anxiety and several others.  By definition of being a first responder; those risk factors are present almost daily.  The solution is to be cognizant of those factors and develop coping mechanisms as well as outside helpful releases.  Given the right formula of stressors, personal situational factors and perhaps pre-existing impacts such as family-history or behavioral challenges the first responder possesses an enormous task to seek and maintain mental and behavioral health.

Should the aforementioned risk factors begin to pile up, a real and significant danger of suicidality may begin to arise.  Suicide risk assessment(s) consist of several attributes or factors: gender, age, chronic illness, mental illness, alcohol and other substance abuse, reduced or less social interaction and support, a previous attempt and/or an organized plan.    

Warning Signs of Suicide

Responders interacting with potential patients (or colleagues) should take note of warning signs. Those threatening to hurt or kill oneself must be taken seriously. If during your workup or assessment you discover the patient is or has been seeking access to suicidal means, talking or writing about taking their life, expressing feelings of hopelessness, worthlessness or lack of purpose should be placed in the suicide potential column and further discovery attempted.  Interestingly, the questions to ask a potential suicide patient are quite direct. 

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Talking to the Suicidal Person

Directly ask, “Are you having thoughts of suicide?” Or: “Are you thinking about killing yourself?”  It’s surprising how many responders feel uncomfortable asking direct questions when dealing with suicidal patients.  Many have stated they felt asking directly might cause the patient to carry out their plans.  Mental behavioral practitioners confirm this is not the case.  If the answer to one of these questions is yes, ask if the person has a plan: “Have you decided how you are going to kill yourself?”; “Have you decided when you would do this?” and/or “Have you collected the things you need to carry out your plan?”

At this point in your interaction let the person know you are concerned about them and willing to help.  Ask questions non-judgmentally.  Make the person feel respected with genuine empathy.  Maintain your neutral facial expression(s) and avoid making any negative statements.  This is your time to be confident and build as positive setting as appropriate to ensure the patient receives the care necessary to manage the crisis.

Controlling the Scene

In addition to the patient experiencing the behavioral crisis it is integral to a successful outcome to maintain a sufficient level of safety and security for the patient, yourself, other responders and the scene in general.  Responders may consider safety and security the function of law enforcement, but remember safety is a team effort.  Watch and control the patient.  Ensure lethal weapons are secured. All patients threatening to kill themselves with a weapon should be searched for their safety as well as everyone at the scene.  Never put yourself in a position whereby the patient could harm you should the scene become unstable.

As America’s first responders continue to react to our Nation’s crisis, they must continue to take care of themselves in order to continue serving.  When face-to-face training resumes, leaders should seek additional mental health training. 

Taking Care of Number One

You are like a machine when it comes to personal maintenance.  If you neglect it, it will fail you.  Behavioral self-care is critical in making sure the noggin doesn’t fail you when you need it most.  According to the National Council on Behavioral Health, consider these questions: 1) Have I decided what I will do for self-care?; 2) When I feel upset or distressed, who can I call?; and 3) Does my family or I need a break?

When we take note of the early warning signs of stress and trauma rapid recovery results.  An open and honest pathway to discuss needs with family members and colleagues can be the difference between tragedy and a long, rewarding career.  Balance is the answer:  career, family and self is the key.

About The Author

F. R. Montes de Oca is a former firefighter and paramedic having served communities in Florida, Ohio and North Carolina for over 40 years.  He is the former Emergency Services Director of Orange County, North Carolina and is a certified trainer and consultant for Mental Health First Aid©.  Chief Montes de Oca is actively engaged in fire, rescue, pre-hospital care, emergency management and leadership training for agencies and institutions: National Fire Academy, Occupational Safety and Health Administration, The EMS Leadership Academy© and the Environmental Protection Agency. He can be reached at