Friday, April 19, 2024

Cumulative Trauma: The Hidden Toll of Caring Professions


Caring for others is a noble calling, but it comes with its own set of challenges. For those working in health and safety positions like first responders or mental and/or healthcare workers, the toll of repeated exposure to traumatic events can have devastating effects on their well-being.

Known as cumulative trauma, this term describes the psychological, emotional, and physical strain that builds up over time from constantly being exposed to traumatic situations. These individuals may not even realize the weight they carry until it becomes too much to bear.

First responders, in particular, must maintain emotional control in order to effectively help those in need. However, this means they may not have the chance to fully process their own reactions and emotions while caring for others. This can lead to long-term distress and difficulty coping with the cumulative stress.

Many who work in caring professions suffer in silence, believing that experiencing trauma is just part of the job. But as their careers progress, each new traumatic event adds another heavy rock to their already heavy mental load. Unfortunately, signs of cumulative trauma often go unnoticed or unaddressed.

The ongoing exposure to traumatic stress can have serious consequences for these individuals. Unresolved trauma can manifest in symptoms such as irritability, sleep disruption, fatigue, anger, detachment, isolation, increased alcohol use, hypervigilance, startling easily, physical pain and headaches, and anxiety. It can also greatly diminish their overall quality of life and increase the risk of developing conditions like PTSD.

It's vital for those in caring professions to recognize when exposure to stress and trauma has taken a toll and seek support and professional help. Just like carrying a backpack full of rocks, eventually the weight can become too much to bear. Let's break the stigma surrounding mental health in these professions and ensure that our caregivers receive the care they need to continue doing their important work with strength and resilience. 


If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSDThe Soldier's Workbook

or Acknowledge & Heal, A Women's-Focused Guide to PTSD

Friday, April 12, 2024

First Responders' Mental Health Stigma, & Barriers to Help


First responders are often seen as the heroes who charge into extreme situations to save lives. But what happens when they have to face the aftermath of these traumatic events? While they may have been trained to handle the physical aspect of their job, many are not prepared for the toll it takes on their mental health. The constant exposure to trauma can lead to long-term effects, but unfortunately, resources for mental health support are not always readily available for first responders.

One coping mechanism that is common among first responders is self-medication. This refers to using drugs or alcohol as a way to cope with overwhelming emotions and feelings that they may not be ready or able to confront. According to the National Center for Injury Prevention and Control at the CDC, the high levels of mental stress in first responder jobs can contribute to substance abuse and alcoholism. In fact, studies show that first responders are more likely to engage in heavy or binge drinking compared to the general population.

The pressure to remain composed during one crisis after another can become too much to bear, leading some first responders to turn to alcohol or other substances as an easy escape at the end of a tough day. Along with alcohol, tobacco use and excessive painkiller usage are also common forms of self-medication among this group.

But these habits can quickly spiral out of control and lead to Substance Use Disorder (SUD). Many first responders may not even realize they have a problem until they try to cut back or face negative consequences from their self-medicating behavior. Asking for help with SUD can be challenging and stigmatized, especially for first responders who may feel embarrassed or ashamed about their struggle.

The culture of being a first responder is one that values strength, self-reliance, and always saving others. While this mentality can be beneficial in the line of duty, it also leads many first responders to consider stress and trauma as just part of their job, making it difficult for them to admit when they are struggling and reach out for help. Seeking help for these issues may not only go against societal expectations but also put their career at risk.

Unfortunately, this fear may of repercussion is partially legitimate. Mental health is a requirement for being a first responder. There have been cases where first responders have faced consequences for seeking treatment for mental health challenges. This can include losing access to their weapons or being assigned to desk duty, which can ultimately impact their job performance and opportunities for advancement.

The stigma surrounding mental health in the first responder community leads many individuals to under-report symptoms and avoid seeking help in order to dodge negative judgments or repercussions at work. On average, about one third of first responders experience stigma regarding mental health issues.

While shame and stigma are often the biggest obstacles preventing first responders from seeking mental health services, practical barriers also play a significant role, such as access to convenient services and compatibility with work schedules.

Surveys conducted among law enforcement officers and firefighters have revealed how widespread these practical barriers are. 525 firefighters throughout the United States were surveyed. Cost and availability were highlighted as major challenges when it came to accessing mental health services. This is especially problematic for volunteer firefighters, who may face even more difficulty in obtaining the necessary support compared to career first responders. Law enforcement officers, particularly those employed by smaller departments outside of urban areas, also encounter similar obstacles in accessing mental health services. For many, Employee Assistance Programs (EAPs) are contracted to provide mental healthcare services, effectively outsourcing the problem to people who do not understand the specific needs these first responders have.

This leads to one of the biggest problems. The lack of accessible therapists who are specifically trained to handle trauma. Often, the only option is a general mental health practitioner, who may not have the necessary expertise or understanding of the unique experiences of first responders. This can be discouraging for first responders who finally decide to seek treatment, and that negative or potentially unhelpful encounter could prevent them from seeking further help in the future.

It’s important to know that those who have mental health conditions or experience symptoms can still have positive outcomes with the right support.

The removal of the stigma associated with experiencing emotional distress, access to trauma-trained clinicians, and education about good mental health being just as important as good physical health are all important parts of the healing process. They should be easily accessible to all first responders. After all, these superheroes deserve the best care possible for all they do for our communities.



If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSDThe Soldier's Workbook

or Acknowledge & Heal, A Women's-Focused Guide to PTSD

Friday, April 5, 2024

Psychological Challenges of being an Emergency Medical Service Provider


The job of an Emergency Medical Service (EMS) provider is inherently stressful, involving constant exposure to human suffering and trauma. This can lead to psychological challenges such as depression, anxiety, and posttraumatic stress disorder (PTSD) among EMS providers. Shifts as an EMS provider can vary drastically in terms of call volume, and providers are often working outside in harsh weather conditions at all hours of the day. Emergencies can occur anywhere, from public locations like streets and shopping centers to intimate settings like private residences or nursing homes. Additionally, EMS providers may encounter violent or traumatic situations while on the job, making their work even more challenging. Repeated Exposure Trauma, the severity of the incidents that EMS providers are involved in, and the emotional skills needed to cope with Cumulative Trauma can lead to Compassion Fatigue, Secondary Traumatic Stress, Vicarious Trauma, Burnout, and PTSD. Cumulative trauma refers to the psychological, emotional, and physical distress associated with repeated exposure to traumatic events, either directly or indirectly. Every individual's experience and risk of developing PTSD is unique; some may go through years of service before displaying symptoms, while others may not have an immediate impact, just additional cumulative trauma.

A study from 2018 found that paramedics have the highest rate of PTSD. This is likely due to the top three stressors universally associated with poor mental health, include career challenges, financial struggles, and lack of sleep. Considering the long shifts, standard pay rates, and exposure to traumatic events, it's not surprising that EMS providers are considered high-risk for developing mental illness.

Shift lengths and rotations vary depending on each EMS agency's policies. Typically, shifts can last 12, 16, or 24 hours. Working irregular schedules disrupts providers' natural sleep patterns and can lead to exhaustion. Many providers also work overtime or hold multiple jobs to make ends meet, resulting in back-to-back shifts and further fatigue. While lack of sleep and financial concerns are common issues for EMS providers, the nature of their occupation is the biggest contributor to an increased risk of mental illness.

With the increase in disasters around the world, the demand for EMS providers is higher than ever as they play a crucial role in disaster management systems. However, an estimated 69% of EMS providers report not having enough recovery time between traumatic incidents. Most EMS providers are expected to be on duty for strenuous amounts of time—up to and beyond 24 hours. The duration and intensity of being on call, engaging in extremely stressful situations, and having little opportunity for rest in between incidents can lead to burnout.

Although EMTs and paramedics are often the first responders, they are not the only ones in the EMS chain suffering from burnout. Reports show that other EMS personnel are also experiencing increasing levels of burnout within the industry. Nurses who face moral distress have reported feelings of emotional exhaustion and depersonalization - two key components of burnout. The job of an emergency dispatcher may not require them to physically enter a scene, but they still face daily challenges and trauma that can take a toll on their mental health. Emergency Dispatchers, who act as the vital link between individuals in crisis and first responders, are responsible for dispatching assistance to both emergency and non-emergency situations. They must remain levelheaded and composed while handling multiple tasks and finding solutions on the spot amidst dangerous and heartbreaking situations such as home invasions, domestic violence incidents, fires, car accidents, and even murders.

According to recent findings from the Pulse of 9-1-1 State of the Industry Survey, 74% of respondents reported staff burnout at their 9-1-1 centers, with many displaying symptoms of anxiety, fatigue, and low energy levels.

Moral distress is a major issue within the medical community and it comes as no surprise that it contributes to mental health problems among EMS providers. Despite the patient's decision, EMS providers must respect their choice, even if it may result in their death. One common ethical challenge arises when competent patients refuse assistance that could benefit them. In fact, a study revealed that 27% of ethical conflicts during paramedic responses were due to issues with informed consent. EMS providers may feel a sense of duty to respond and may struggle with moral responsibility to provide care, even if the patient denies treatment or transport- regardless of medical advice. This can lead to moral distress for EMS providers who have good intentions but cannot act upon them. The consequences of moral distress can be significant, such as burnout, job dissatisfaction, high turnover rates, and emotional detachment from patients - all of which ultimately impact patient care.

The effects of burnout, moral distress, and cumulative trauma are not limited to EMS providers; they also affect Emergency Department (ED) nurses and physicians.

Unfortunately, EMS personnel, like other first responders we’ve discussed, are often the last to admit they need help, as it goes against their role as providers of support rather than recipients. Seeking help is often stigmatized or seen as a weakness in this community, where toughness is essential. However, it is crucial for first responders to know how and where to find help.

Support mechanisms, the removal of the stigma associated with experiencing emotional distress, and education about good mental health being just as important as good physical health need to be available and easily accessible to all first responders.


If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSDThe Soldier's Workbook

or Acknowledge & Heal, A Women's-Focused Guide to PTSD