Every conference has the headline keynote speakers, the packed exhibit halls and the major announcements. But often the sessions that truly stay with attendees are the breakout presentations where someone stands up and delivers something practical, operationally relevant and deeply human.
As part of this new Rob on the Road series, as I go about my travels to EMS, fire and public safety conferences across the country, I will highlight the standout sessions, speakers and conversations shaping our profession. These articles are designed to bring readers inside the room, not simply to summarize agendas, but to capture the ideas, lessons, leadership insights and real-world discussions that crews will still be talking about on the flight home.
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The emotional and physiological toll of the job
This first stop takes us to the California Fire, EMS and Disaster Conference (CFED) in Indian Wells, California, where leaders from across EMS, the fire service, healthcare and emergency management gathered to discuss the evolving challenges facing public safety. Among a strong educational lineup, one session in particular stood out for both its honesty and operational relevance.
Dr. Joelle Donofrio-Odmann, pediatric emergency physician at Rady Children’s Hospital, EMS medical director for San Diego Fire-Rescue and associate professor at UC San Diego, delivered a presentation that moved well beyond a traditional pediatric EMS lecture. Instead, she tackled something many in EMS recognize but few openly discuss: the cumulative emotional and physiological toll of the job.
Her session, The run that becomes a marathon, focused on the calls that never truly end when the unit clears the scene. Throughout the presentation, she blended science, operational experience and deeply personal stories to explain how traumatic calls affect responders long after the event itself is over.
What made the session particularly powerful was her willingness to use her own experiences as examples. She described becoming the unexpected first responder to a fatal shooting outside her own home, stepping into patient care while still mentally operating as a private citizen preparing for bed. She spoke candidly about pediatric calls that mirrored her own family life, including a drowning resuscitation that occurred on the same day she and her husband had been looking at houses with swimming pools for their children.
She also described the emotional impact of repeated quality assurance reviews following difficult pediatric arrests. In pediatric emergency medicine, critical cases are often reviewed multiple times through trauma, airway, cardiac arrest and quality improvement committees. While clinically valuable, she explained how repeatedly revisiting traumatic events can extend the emotional burden on providers long after the patient encounter ends.
Central to her message was the idea that EMS and emergency medicine are highly effective at clinically debriefing difficult calls but far less effective at debriefing the people involved in them. She emphasized that many of the reactions responders experience after traumatic incidents are not signs of weakness or failure, but predictable physiologic responses.
Donofrio-Odmann walked attendees through the neurobiology of stress, discussing cortisol release, adrenaline surges, disrupted REM sleep, hypervigilance and the concept of “allostatic load” — the cumulative wear and tear on the body and brain caused by repeated stress exposure without adequate recovery. She explained how these physiologic changes can affect memory, relationships, decision-making, emotional regulation and long-term health.
Strategies for recovering after difficult calls
Importantly, the session moved beyond simply identifying the problem. Donofrio-Odmann provided practical and immediately applicable strategies responders can use after difficult calls. These included hydration, exercise, breathing techniques, progressive muscle relaxation and limiting alcohol use following traumatic incidents because of its impact on sleep and memory processing.
She also discussed evidence-based interventions including EMDR, cognitive processing therapy and peer support programs, while strongly advocating for robust agency wellness systems. San Diego Fire-Rescue’s wellness infrastructure — including confidential counseling, chaplaincy services and peer support resources — was repeatedly highlighted as an example of how organizations can proactively support personnel.
What resonated throughout the room was the authenticity of the presentation. This was not a generic wellness talk built around slogans and buzzwords. It was a frank discussion from a physician and EMS leader openly acknowledging that emergency responders routinely experience events most civilians will never encounter in a lifetime, and that carrying the weight of those experiences has real consequences.
Her closing message challenged attendees to rethink how they approach stress, recovery and long-term health. The difficult calls may be unavoidable, she said, but ignoring their impact does not have to be part of the culture.
