The Unseen Burden: Mental Health in the Firefighting and EMS Profession

Stress Timbomb - Paul Combs

Throughout my career, I’ve heard the phrases countless times: “Suck it up,” “Man up,” and “Stop being a baby.” As first responders, we’re often expected to be invincible, impervious to the trauma we witness daily. For years, I believed that nothing could truly hurt me, that I could push through the most difficult situations without being affected. But there was a turning point—a day when I realized that I no longer felt like myself.

For 28 years, I answered calls, responding to emergencies with the mindset that if I ignored the trauma I encountered, it wouldn’t affect me. I thought I could compartmentalize my experiences, but eventually, the weight of it all caught up to me in ways I never anticipated.

My first experience with trauma came early, in 1997. I was a 16-year-old EMT, just two months into my career, when I was dispatched to a cardiac arrest involving a 13-year-old. It was Valentine’s Day, and the snow was falling as we fought to save this child’s life. For over an hour, we worked tirelessly—shocking, administering medication, performing CPR—never giving up hope. But in the end, she didn’t survive. I vividly remember attending a Critical Incident Stress Debriefing (CISD) the following night and meeting her parents. Her mother’s words still echo in my mind: “Thank you for letting me say goodbye.”

I can’t help but wonder: Why do I still remember this moment so clearly? Why did I choose this profession in the first place?

Fast forward 28 years. I’m now a Firefighter/Paramedic with a wife and two daughters who mean the world to me. Yet, they don’t truly know what I’ve experienced during my career. My wife often says, “You never talk about work,” and my response is always the same: “You don’t need to know the things I’ve seen.” How could I possibly explain to her that I’ve witnessed people at their worst, or worse still, in their final moments?

Over time, I began to recognize that something wasn’t right. I became frustrated, angry, and increasingly distant from my family. The question lingered: Why was I feeling like this? After all these years, why was it suddenly affecting me? The truth is, there is only so much we can endure before it becomes too much. Mental health is real, and it affects us all.

As first responders, we often view ourselves as invincible, as people who can take on the world’s most harrowing situations without being affected. But we are human, and we are not immune to the emotional toll that comes with our job. It’s crucial to acknowledge that it’s okay not to be okay. We don’t have to shoulder this burden alone, and there are resources available to help us decompress when the weight becomes overwhelming.

I recently experienced a call that served as a reminder of the importance of mental health awareness. We responded to a cardiac arrest involving a five-month-old infant. By the time we arrived on scene, there was nothing we could do. The impact of that call was immense, and our supervisor, recognizing the emotional toll, pulled our units out of service and checked in on us for the remainder of the shift. Later that day, I reached out to a close friend for support. At 6:00 AM, I called him, needing to talk about the call and how I was feeling.  Later that night when I called him again about work (this blog as a matter of fact), his first words to me were: “Stop. First things first, how are you doing?”

In the past, I would never have spoken about the emotional impact of a call. But now, just having someone to talk to has made a world of difference. The simple act of being heard lifted a weight off my shoulders, helping me feel grounded again. Our profession demands a great deal from us both physically and mentally, but it’s vital that we take steps to prioritize our own well-being.

This is, without a doubt, the greatest job in the world, but it’s essential to recognize our limits. Our health—both mental and physical—and the well-being of our families should be our top priority. As we give our all to help others in times of need, we must also remember to take time for ourselves. Supporting one another is key. When we see a fellow first responder struggling, sometimes the most powerful thing we can do is simply be there to listen. You’d be surprised at how much just offering a listening ear can help someone from reaching their breaking point.