We all know that the Emergency Services are there at the end of the telephone to help us in our time of need. Whether we’ve broken a bone and need a paramedic, have been assaulted and need the police, have an oven fire raging through our house and require a fire fighter, can see a dinghy with a child in it getting swept out to sea and need a coast guard, or need the Mountain Rescue teams or Air Ambulance services, there’s always someone there to help.

However, what isn’t considered quite so often at the dial of 999, is the impact that seeing such traumatic events can have on those responding. While it is their job and certainly what they set themselves up for doing in life, no amount of money or training can change the fact they will experience emotional (and sometimes physical) trauma in their line of work – there’s some parts that aren’t included in the emergency services job description – and that includes all emergency services which includes occupations such as Police Officers, Firefighters, Paramedics and Ambulance Technicians, Coastguard and Lifeboat crews, Mountain Rescue teams, Search and Rescue teams, National Health Service (NHS) 111 and 999 call handlers, HM Coastguard helicopter pilots and crew, Emergency Planning and Response officers, Hazardous Material Response teams, Prison Officers, Royal National Lifeboat Institution (RNLI) workers, and Bomb Disposal experts amongst others. 

PTSD and C-PTSD in emergency workers

PTSD & C-PTSD prevalence across different occupational groups, including firefighters, police officers, ambulance personnel, and other rescue teams is much higher than the average rate in the population. Research shows that ambulance personnel exhibit higher rates of PTSD and C-PTSD than other emergency service workers. “Similar professions, such as emergency and psychiatric nurses, have a comparable high risk of trauma exposure and thus show higher prevalence rates of PTSD.”

• Approximately 20% of police officers and staff in the UK exhibit symptoms that align with PTSD or C-PTSD. However, more than two-thirds of those individuals who are experiencing such symptoms are unaware of their condition.
• Studies have identified a prevalence of PTSD of between 20% and 21% in emergency ambulance personnel.
• One study showed C-PTSD criteria was met by 18.23% of firefighters and PTSD criteria were met by 5.62% of them. 

It’s also been reported that one in four emergency ‘blue light’ workers have thought about ending their life. That’s 27% of an online poll of 1,600 staff and volunteers, who found they weren’t being adequately supported and were experiencing stress and poor mental health. In addition to this, nearly 63% had considered leaving their job or voluntary position as a direct result of poor mental health or stress.

The reality is, emergency service workers are at high-risk of developing Post Traumatic Stress Disorder (PTSD) and particularly Complex Post Traumatic Stress Disorder (C-PTSD). People who experience PTSD or C-PTSD have often experienced some kind of life-changing trauma, either where their life has been threatened or they have witnessed someone’s life in danger. However, these brave Paramedics, Police Force, Fire Fighters and other emergency workers are often encountering  these stressful and traumatic situations multiple times within their everyday line of work, without any real advance warning of what they’re headed into.

Tim Tittensor shared his story with Blue Light Together, a charity collaboration to support Emergency Service Workers. “The role of being a police officer has had a continuous effect on my mental wellbeing. We see things that the general public don’t. When we attend incidents like sudden deaths, we are expected to deal with the deceased as well as the family on scene. Violent incidents, such as stabbings and shootings also have an impact. You do rely on your colleagues for the camaraderie to get you through, although that isn’t always enough.

After a few days, I realised that this event had affected me. I spoke to my colleagues after the incident like I had many times before, but it wasn’t helping. I began to experience night terrors and sleepwalking. I struggled to get in the train where the crash was and suffered from flash backs.

I decided that the lack of sleep and bad dreams was a phase and self-medicated to help myself sleep with scotch. This didn’t help. I know colleagues that after a ‘rough day’ also do this, and although it may get you to sleep it doesn’t address the issues behind it. The alcohol probably made things worse as my sleep walking increased and I was constantly getting up more tired than I had the night before.

In November 2019 I decided I needed to speak to someone about what was going on, so made an appointment with a doctor. This was the most difficult talk I’ve ever had.

In the police it is still believed that it is best to bottle things up and rely on your colleagues to get you through. Unfortunately, on this occasion it was not enough. Talking to my doctor was the best decision I made. I was supported, listened to and understood. I was advised to take a step back from active duty to get my mental health back on track. I was then referred to the mental health teams through the NHS and then through work.

In January 2020 I began to see a therapist to get EMDR (Eye movement desensitization and reprocessing) therapy. This helped and with time with the counsellor taught me new techniques for future issues and finally cleared me to go back to work full time.

My advice is always the same to colleagues now. If you need help, then go and ask for it. No one will think any less of you. It shows great courage to speak to someone about what’s going on in your head. I also advise them not to drink to cover the issue. It doesn’t help and actually makes things worse on the long run.

I made the difficult decision to speak to my doctor, even though it felt as it was frowned upon as I needed help. I got the help I needed and I was able to return to full duties to do a job I love and I now feel stronger and able to deal with much more since I opened up.”

Why do emergency workers develop PTSD and C-PTSD?

Adrenaline starts pumping, blue lights flashing, sirens screaming and their brain whirrs into action as they go through everything they need to do to save someone’s life. Sometimes they make a life-changing difference. Other times there’s nothing they can do. Sometimes it may feel personal; could they have done more? What if they had driven quicker? Did they take the right steps? And many report there’s a level of guilt sometimes too. It’s hard to switch off from witnessing something so traumatic – stepping into the worst possible moment in someone’s life – and then leaving again, to just move on to the next ‘job’. They have little time to pause and reflect before moving onto the next call – no time to process what they’ve just been part of. 

When you experience something really traumatic your body suspends ‘normal operations’ and so temporarily shuts down some bodily functions such as digestion, skin repair and crucially, memory processing. So if they experience this multiple times, there becomes a lot of traumatic memories stored in your body and mind ‘waiting’ to be processed – this can manifest as a multitude of symptoms if PTSD or C-PTSD then develops. Find out more about how PTSD is caused here. 

Symptoms of PTSD & C-PTSD

From sleepless nights to palpitations, cold sweats to nightmares, emotional detachment to nausea, hyper-vigilance to panic attacks; there’s many ways in which PTSD or C-PTSD can manifest itself. Sometimes it isn’t immediate, and can appear after many years. Sometimes it isn’t obvious and requires a conversation with a trained professional to identify the root cause of the problem. Find out more about the physical, mental and emotional symptoms here. 

Early interventions in the workplace

It’s still not clear why some people develop PTSD or C-PTSD and others don’t – but early interventions have been shown to help, and can be particularly useful in identifying and treating trauma symptoms early on. Employers and colleagues being aware of the high level of stress that staff are under, being offered counselling after particularly traumatic cases, being encouraged to talk out more, and  to being allowed to have a break from work after a big trauma, are all interventions that are shown to have helped.

Ultimately, it is about reducing the stigma and showing that there is no shame so people know it’s ok to ask for help. No matter how brave or strong or invincible some people feel, no one is exempt from PTSD or C-PTSD.

If any of these symptoms or stories feel familiar, we hope you’ll share it with colleagues, friends or family to help us spread awareness – and to encourage colleagues to seek help when they need it.

For more support

Blue Light Together is the place for UK emergency services staff, volunteers, retirees and friends and family to find information, ideas and support to help look after your mental health. It is brought to you in partnership with The Royal Foundation, The Ambulance Staff Charity, Police Care UK and The Fire Fighters Charity.