Grief and the First Responder

How denying grief can affect the first responder.

Reviewed by Lybi Ma

Key points

• Being a first responder means being constantly exposed to trauma and loss.
• When seeking support, the first responder prefers to talk to a peer.
• Not acknowledging emotions can lead to unhealthy coping choices.

When we think of a first responder, we think of someone brave who comes to our aid during our time of greatest need. First responders include the police, firefighters, and emergency medical technicians (EMT). Perhaps few of us think about how their often life-threatening experiences affect the first responder. These individuals go places and see things that we do not want to imagine. Their work is intense and unpredictable. They can be sound asleep and have to wake up immediately to respond to some emergency. How do they cope with the death and destruction that they encounter often daily and even multiple times a day?

Being a first responder can take a toll on one's physical and emotional well-being. It is estimated that there are 100 to 200 suicides by first responders a year, which is double the rate in the general population. Research has also shown that firefighters and law enforcement officers are more likely to die by suicide than in the line of duty, while EMS clinicians are more likely to take their lives than members of the public.^[1]

First responders are constantly exposed to death and trauma. Sometimes this is the result of the deaths of those they are trying to rescue and at other times it is the unexpected loss of one of their own, another responder. We know that grief is a part of all our lives. It is the emotion most associated with loss. However, for first responders there is often not enough time to grieve one death before there is another. Multiple deaths when unprocessed are referred to as cumulative grief and unprocessed grief. Traumatic grief is also common in first responders and is related to deaths that are unexpected or violent. First responders need to allow themselves the time to grieve the loss of life and destruction. Allowing oneself the time to grieve is a necessity to maintain emotional and physical health. Indeed, some sources believe that training responders to deal with trauma, stress, and grief is just as necessary as the training they get for their jobs.^[2]

I was able to speak with a local first responder. I asked him how loss and grief are dealt with at his firehouse. He stated that when there was an event with heavy casualties, the first responders were given contact information for someone who could help them if they felt the need. This first responder felt that most things could be handled within their crew. He talked about the camaraderie among the members and how events of the day were processed over meals they themselves prepared. Research has found that camaraderie is the best buffer against the negative effects of the emotional demands placed on emergency responders.^[3] But some choose a different path by using alcohol. Many first responders use alcohol as a way of coping with the emotional trauma, the physical strain of their work, the long hours, and the lack of sleep. There is a higher rate of alcoholism in first responders than in the general population, with firefighters also having the highest risk of binge drinking.^[4]

Some of the most difficult and traumatic experiences the first responders experience are related to finding children who have died as a result of a fire or violence. The images can haunt them for a long time. It is especially hard for those who have children of their own. Given the nature of their work, being constantly exposed to death and trauma, there is a high percentage of first responders who also develop post-traumatic stress disorder. It seems that many of the emotional issues related to being a first responder can have their roots in unresolved or unprocessed grief. Allowing oneself to grieve is essential to our overall well-being. It does not mean the person is weak or too emotional or is somehow unable to do their job. There is still a stigma associated with seeking outside help for a problem. Regardless, the first responders can allow themselves to mourn the death and destruction that happens around them.

There is a movement now toward peer mental health support for responders. Some are reluctant to see a professional therapist and therefore do not seek out help. The peer program is based on the premise that most responders prefer to speak with someone who truly can understand what they have experienced. Those who are chosen to go through the training for peer support then are available to listen, counsel, and facilitate any additional help that might be needed. Responders report feeling more comfortable talking with their peers as they are acutely aware of what the work entails.^[5]

Introducing the peer support program is a very positive move to make talking about mental health care more acceptable and available. First responders need to understand that given the nature of their work, they are susceptible to a host of mental health issues and that sharing their thoughts and feelings with someone can truly help.