First responders can have many difficult experiences in their jobs, and the public wonders how they deal with it all. Too many exhibit signs of traumatic stress but don't get help. Many often fail to deal with what they've seen in a healthy manner and many have traumatic stress issues that they try to keep quiet.

Oftentimes, the stress manifests itself at home, affecting family relationships. The divorce rate for law enforcement personnel is around 75 percent. More than 80 percent of firefighters experience symptoms of mental health issues. Almost 25 percent of dispatchers have symptoms of post-traumatic stress disorder.

Much of the time, first responders feel they can't reveal their feelings to co-workers or management for fear that they might be considered weak or lose out on a promotion. Often, there is a code of silence about such issues at work and the fear of reprisal.

"They hear everything and see everything, it's the worst moments in people's lives and they're supposed to be calm and handle it," said Dr. Stephen Odom, CEO of New Vista Behavioral Health. "They compartmentalize it, and you can only do that for so long. Over time, it begins to take its toll."

For many reasons, first responders hold it in, don't ask for help and only when they get home, it seems they let off steam, often to the detriment of the family. "That's the only safe place there is," Odom said. "It's tough to be a first responder's family."

First responders also feel they should be strong and be able to take it. They think they are or should be built differently than the rest of us and that if they can't handle the stress, it's a personal failing.

"They only come through our doors a couple of ways," Odom said. "Either something really bad happens or they have been told they need to come get help." Oftentimes, it's the family that can't take it anymore, he said. "The spouse can't take the drinking, or they have that thousand-yard stare all the time."

It's also difficult for first responders to share their problems with the rest of the public. And there are now specialized 12-step meetings for first responders, part of the change that Odom says he's beginning to see that addresses the issue.

"Coming up with a world in which they can talk about mental health issues among their peers seems to work better," he said. "More and more, they are beginning to talk about mental wellness now and not mental illness. Departments need to acknowledge the issue."

An important step in getting first responders to seek help or stay healthy is to get people to understand that it's one of the consequences of the job. "And that everyone who experiences these kinds of things will have these consequences," Odom said. "We are working hard to normalize it; to say this is what happens when you're a firefighter or a police officer and it's part of the job."

He said agencies have the resources, but they have to acknowledge the issue and lead the charge.

"There are employee assistance programs, departmental wellness people, but they have to be given permission and clout to put these things out there so people want to be a part of it," Odom said.

There is debriefing that must occur both before and after incidents. First responders can be taught resiliency techniques, such as combat breathing, where they are taught how to breathe in such a manner that tamps down anxiety, helps the coping mechanism.

There's also a treatment known as Eye Movement Desensitization and Reprocessing, which teaches the brain to reprogram memories and puts them in their place and takes away the emotional power they have. There also needs to be debriefing after the fact. "Every time something happens we should talk through it, so you can get it out of your head, because you need to," Odom said.

Odom used the airplane oxygen mask analogy to explain the importance of first responder health. "They tell you if the oxygen mask drops, put it on yourself before you take care of the kids next to you. The same thing needs to be said for first responders. You can't really be the best first responder you can be if you're not taking care of yourself first."

This article was written by Jim McKay and reprinted with permission from Emergency Management by Government Technology.