Treat Yourself Before Treating Others

Editor's Note: For a background on First Responders Day click here.

“They run into burning buildings!” “They chase after dangerous criminals!” “They bring people back to life!”

These are all amazing feats that first responders do as part of their everyday job. It’s hard work.

While the work of first responders should be appreciated every day, today we celebrate National First Responders Day by thanking them for something else: shouldering the emotional and mental burdens that come along with a job that requires both empathy and compassion, not just heroics and courage.

I know it’s not easy. I’ve had several firefighter/paramedic friends tell me about calls that weigh heavily on their psyche; one friend even confided in me that he had suicidal thoughts. Research tells us too:

• Police and firefighters are at heightened risk of depression, post-traumatic stress disorder and suicide, and both are more likely to die by suicide than in the line of duty.¹
• Two-thirds of EMTs and paramedics report they’ve experienced at least one form of violence in the previous 12 months, and EMS personnel in the U.S. sustain injuries as a result of occupational violence about 22 times more frequently than the average for all workers.²
• National survey data indicates a higher rate of suicidal ideation and attempted suicide among firefighters and EMS personnel. National death record data shows a significantly higher proportion of completed suicides in firefighters ages 18–90 and EMTs ages 18–64 compared to the general U.S. working population.³
• Over one-half of all EMS workers report inadequate sleep, poor sleep quality, and/or poor recovery between shifts.^4,5

Research suggests that first responders are likely more vulnerable to suicidal thoughts and behaviors in the same way that they are more vulnerable to the mental health disorders that are commonly associated with suicide, specifically, depression, anxiety, and PTSD as well as misuse of alcohol and other substances.^1,3,6,7

And while this can be mitigated to a certain extent by systemic change, it’s well known that kind of change doesn’t happen at all at once.¹ Indeed, change starts with you, and perhaps more accurately, within you.

What can you do to keep yourself afloat when the career you love risks pulling you under? Here are a few suggestions.

Social support. Something you give as well as something you receive from others; compassion is similar. Compassion for others is likely a trait you already possess; empathy and a genuine concern for and desire to help others are common traits among many first responders.

Compassion for others is, to some extent, moderated by compassion for oneself. Research in this area has suggested that while compassionate love for others is generally healthy, for first responders a greater self-compassion is associated with better mental health outcomes and predicts a greater sense of personal accomplishment and satisfaction.⁸ In other words, waning empathy, or emotional burnout, sometimes referred to as “compassion fatigue,” may be alleviated by directing compassion away from others and more toward oneself.

Self-compassion. This can be fostered in several ways, and for first responders can include: being kind toward yourself under challenging conditions, recognizing that your experiences are shared by others, and allowing yourself to feel and process painful experiences—also recognizing when you require time and space (and perhaps help) to do that.⁸

Living a healthy lifestyle. This promotes overall well-being (i.e., good nutrition, exercise, and plenty of rest) and is easier said than done for many of us. First responders often find that one main aspect of a healthy lifestyle is particularly elusive: rest. Research has shown that even non-disordered sleep problems (i.e., sleepiness or minor sleep deficits) are associated with three factors that lead to burnout: emotional exhaustion, depersonalization, and a low sense of accomplishment.

Poor sleep may develop from any number of factors that are likely familiar to many first responders, some easier to modify than others, including: shift work (particularly 24-hour shifts), alcohol consumption, stress, anxiety, lack of exercise, and poor nutrition.

Being aware of the risk and protective factors that influence your mental health as a first responder. This is a good first step. Taking individual action will require effort, but you can start small. Plan a few minutes out of each day for self-reflection, for example. Or track your moods or alcohol intake in a journal.

One study showed that sleep tracking alone can lead to better sleep and reduced stress levels.¹⁰ You might explore some digital options by trying one of the many mental health smartphone apps. Research suggests they may be effective in improving depressive symptoms, reducing symptoms of generalized and social anxiety, reducing stress levels and general psychiatric distress, and promoting positive affect.¹¹ Studies point to using these apps regularly in short bursts, and that the most effective apps allow for self-tracking, goal-setting, and education (e.g., learning coping skills).¹² Learning about the risks that can lead to deficits in mental health and well-being is a first step toward mitigating those risks.

The next step is familiarizing yourself with how your behavior and thoughts contribute negatively or positively and then making the necessary changes. It takes work, but you’re not afraid of hard work—after all, you do it every day on the job.

References

1. Heyman M, Dill J, Douglas R. The Ruderman White Paper on mental health and suicide of first responders. Ruderman Foundation. April 2018.
2. Maguire BJ, Browne M, O'Neill BJ, Dealy MT, Clare D, O'Meara P. International Survey of Violence Against EMS Personnel: Physical Violence Report. Prehosp Disaster Med. 2018;33(5):526-531.
3. Vigil NH, Beger S, Gochenour KS, Frazier WH, Vadeboncoeur TF, Bobrow BJ. Suicide Among the Emergency Medical Systems Occupation in the United States. West J Emerg Med. 2021;22(2):326-332.
4. Gregg A, Tutek J, Leatherwood MD, Crawford W, Friend R, Crowther M, McKinney R. Systematic Review of Community Paramedicine and EMS Mobile Integrated Health Care Interventions in the United States. Popul Health Manag. 2019 Jun;22(3):213-222.
5. Jeruzal JN, Boland LL, Frazer MS, Kamrud JW, Myers RN, Lick CJ, Stevens AC. Emergency Medical Services Provider Perspectives on Pediatric Calls: A Qualitative Study. Prehosp Emerg Care. 2019 Jul-Aug;23(4):501-509.
6. Martin CE, Tran JK, Buser SJ. Correlates of suicidality in firefighter/EMS personnel. J Affect Disord. 2017;208:177-183.
7. Lewis-Schroeder NF, Kieran K, Murphy BL, Wolff JD, Robinson MA, Kaufman ML. Conceptualization, Assessment, and Treatment of Traumatic Stress in First Responders: A Review of Critical Issues. Harv Rev Psychiatry. 2018;26(4):216-227.
8. McDonald MA, Meckes SJ, Lancaster CL. Compassion for Oneself and Others Protects the Mental Health of First Responders. Mindfulness (N Y). Nov. 13, 2020, [epub ahead of print].
9. Wolkow AP, Barger LK, O'Brien CS, et al. Associations between sleep disturbances, mental health outcomes and burnout in firefighters, and the mediating role of sleep during overnight work: A cross-sectional study. J Sleep Res. 2019;28(6):e12869.
10. Weber S, Lorenz C, Hemmings N. Improving Stress and Positive Mental Health at Work via an App-Based Intervention: A Large-Scale Multi-Center Randomized Control Trial. Front Psychol. 2019;10:2745.
11. Linardon J, Cuijpers P, Carlbring P, Messer M, Fuller-Tyszkiewicz M. The efficacy of app-supported smartphone interventions for mental health problems: A meta-analysis of randomized controlled trials. World Psychiatry. 2019;18(3):325-336.
12. Zhang R, Nicholas J, Knapp AA, et al. Clinically Meaningful Use of Mental Health Apps and its Effects on Depression: Mixed Methods Study. J Med Internet Res. 2019;21(12):e15644.

Ryan Kelley is a nationally registered emergency medical technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). He is currently a medical editor at American Addiction Centers.