Stress and Mental Health: Take Care of You

The inherent stress associated with firefighting is well known, widespread and comprehensive. It's the physical stress of working in extreme conditions in heavy gear. It's the emotional response to witnessing trauma and human suffering. It's the mental grind of middle of the night calls and lifesaving responsibilities. Rookies and new recruits know it comes with the territory, similar to the bunker gear issued to them at the start of their careers. Veterans know it's responsible for the overabundance of gray hair. All of them prepared to face it head on–like opening the front door to a burning house. Stress, unlike a fire, isn't easily contained with water and proper venting. It is much more similar to carbon monoxide, a silent toxin spreading everywhere in the life of the firefighter–unknown until it begins to cause damage. Damage such as interrupting sleep, settling on waistlines, increasing substance use, fracturing marriages, and truncating lives.

While once a taboo subject in the fire house, stress and its toll on mental health is slowly becoming a topic of conversation, especially as more about the topic is being understood. Firefighters are up to five times more likely to suffer from depression and PTSD.3 In 2017, more firefighters died by suicide than in the line of duty.3 Repeated exposure to trauma affects personal and family relationships as firefighters become more cynical and negative.4 These effects make a lasting impression, and highlighting the impact of extreme events on firefighters is important as they add additional stress.

Natural disasters, pandemics and epidemics, and man-made tragedies add a layer of uncertainty for those already in a career filled by the unknown. Stress associated with these unanticipated, wide-spread events impact firefighters in previously unconsidered ways and tax an already overwhelmed nervous system. Firefighters on duty during natural disasters (hurricanes, tornados, floods and derechos) must respond to an influx of calls as the public requires assistance while trying to determine if their own family and friends are safe, creating an internal struggle between service to community and service to family. The stress of increased workloads, intense debris cleanup and drawn out community rebuilding results in increased rates of both substance use and depression.6,7

Working during the COVID-19 pandemic led to a heightened fear of contracting and spreading the virus, a fear that greatly impacted families as spouses and children stayed away from firefighters to ensure their own health.8 Increased stress levels coincide with epidemics, including AIDS and H1N1; however, the effects during the COVID-19 pandemic have reached epic proportions. Sleep disorders have developed as the brain tries to process the increased number of patients related to the virus.8 Post-traumatic stress associated with COVID-19 has become a specific reason for first responder suicide.

Perhaps the most horrific extreme events are man-made tragedies, given their intentional nature. Personnel working during events like active-shooter incidents or tragedies like 9/11 experience the most extreme form of stress as they fear for their lives and juggle their own life safety while tending to patients. Sleep is often interrupted with horrific images of victims, making it even more difficult to process and heal from the experience. Firefighters who are parents often project their children's faces onto young victims, making sleep even more elusive. Job burnout, substance use, depression and PTSD all increase as a result. Privacy to cope is often scarce as constant media attention regarding these events magnifies the emotional toll, making it difficult for firefighters to escape trigger points.1

These mental health outcomes are examples of the damage caused by unchecked extreme stress. While it may be simple enough for firefighters to brush the mental strain off as part of the job, too many brothers and sisters have experienced declining mental and physical health, and have lost relationships and lives to the silent toxin. Firefighters recommend homes have a carbon monoxide detector to ensure the safety of the residents before the gas has caused damage. The need for a stress detector to ensure the mental wellbeing of firefighters is proving to be just as necessary. The impact of social support cannot be overstated, especially during times of social distancing.5 Firefighting is the ultimate team environment. The job can't be done alone. Healing from the job can't be done alone either.

by Maria D.H. Koeppell, Ph.D. and Sara A. Jahnke, Ph.D.
Center for Fire, Rescue, and EMS Health Research, NDRI-USA, Inc.


  1. DeMarco, H. (2018, July 4). The other victims: First responders to violent disasters often suffer alone. Retrieved January 28, 2021.
  2. Edelman, S. (2020, June 20). FDNY EMS lieutenant dead in apparent suicide may be due to coronavirus PTSD: Union. Retrieved January 28, 2021.
  3. Heyman, M., Dill, J., & Douglas, R. (2018). The Ruderman white paper on mental health and suicide of first responders. Ruderman Family Foundation.
  4. Jahnke, S., Poston, W., Haddock, C., & Murphy, B. (2016). Firefighting and mental health: Experiences of repeated exposure to trauma. Work, 53, 737-744.
  5. Lamplugh, M. (2020, July 10). Covid-19 and its psychological effects on firefighters and first responders. Retrieved January 27, 2021.
  6. Mohney, G. (2016, October 13). Natural disasters may increase substance abuse risk, study finds. Retrieved January 27, 2021.
  7. Osofsky, H., Osofsky, J., Arey, J., Kronenberg, M., Hasel, T., & Many, M. (2011). Hurricane Katrina’s first responders: the struggle to protect and serve in the aftermath of the disaster. Disaster medicine and public health preparedness, 5 Suppl 2, 2012;62(8):661-664. doi:10.1093/occmed/kqs162
  8. Wang, H. (2020, April 23). ‘I Hear The Agony’: Coronavirus Crisis Takes Toll On NYC’s First Responders. Retrieved January 28, 2021.

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