First Responder Stress and Mental Health

FieldBrief Issue 1
Published March 24, 2026

First Responder Stress and Mental Health

MetroHealth works side by side with EMS professionals every day. That partnership doesn’t end at the hospital doors—it includes supporting the mental health of the responders who make trauma care possible.

“The job is hard, the hours are long, and you’re never guaranteed a break,” says MetroHealth EMS Coordinator David Sirl, EMT-P, who has more than 40 years of military, fire service and SWAT medic experience. “We need to talk about the hard stuff.”

This includes:

• Burnout: Over 50% of certified EMS professionals report personal and work-related burnout.
• Depression & anxiety: 15% to 24% of dispatchers experience symptoms of PTSD and depression.
• Suicide: Firefighters are more likely to die by suicide than in the line of duty.
• Stigma: 80% of first responders report stigma as a major mental healthcare barrier.
• Career concerns: 74% fear that seeking help would have a negative impact on their career or that leadership would treat them differently.

“Divorce rates among first responders are higher than the general population,” says Jeremiah Escajeda, MD, Medical Director of Cleveland Department of Public Safety and a MetroHealth emergency medicine physician. “Substance use disorder and obesity rates are higher. These are all markers of how stressful this job can be. Every first responder knows somebody who has had suicidal thoughts or who has died by suicide.”

Throughout your career, you may experience as many as 800 critical incidents. Here are Sirl’s recommendations for stress management:

• Get outside
• Sleep at least six to eight hours at night
• Exercise
• Be mindful of what you eat
• Watch your alcohol consumption
• Enjoy healthy hobbies
• Practice mindfulness—be present in the moment without judgment
• Guard your mental health
• Don’t journey on your own

Cleveland offers a powerful example of what first responders face—and why the first 48 hours after a critical incident matter. What you do in the first 48 hours after a critical incident can determine how well you recover.

Here’s what to do, courtesy of the Westshore Critical Incident Response Service (CIRS):

• Don’t make any big life changes.
• Get plenty of rest.
• Eat regular meals.
• Don’t abuse alcohol or drugs.
• Maintain a normal schedule, structure your time and keep busy.
• Do things that feel good.
• Alternate strenuous exercise with relaxation.
• Talk and spend time with other people.
• Remember—how you’re feeling is normal.
• Check in with your coworkers. They, too, are under stress.
• Give yourself permission to not feel OK.
• Write down your feelings when you can’t sleep.
• Try not to fight recurring thoughts, dreams and flashbacks—these will lessen over time.
• Make small, daily decisions to help you feel more in control.

Stress reactions to critical incidents can appear immediately or months later. They can last a few days or much longer.

Click here to download and print a list of stress-related symptoms to watch out for.

“There is a stigma that pursuing help or talking about it is a demonstration of weakness,” Sirl says. But talking about it is how you get help:

• Office of First Responder Wellness | Department of Public Safety
• Ohio Assist | Ohio State Highway Patrol
• IAFF Center of Excellence
• Ohio Suicide Prevention Foundation

Now, Sirl is working with a group to develop a MetroHealth peer support team.

MetroHealth is proud to stand alongside the EMS professionals who form the backbone of emergency care in Northeast Ohio. Taking care of yourself isn’t a weakness—it’s part of staying mission-ready. When EMS professionals are supported, the entire trauma system performs better.

To claim EMS Continuing Education for this edition of FieldBrief, please visit metrohealth.org/fieldbrief and complete a brief survey. The survey link is located below the list of articles.

MetroHealth Medical Center is a State of Ohio Approved Continuing Education Site #1202