Self-care tips to recover from a traumatic EMS incident

Responding to an active shooter incident can be career ending, but self-care and after-care can prevent problems and preserve your career

Responding to a mass shooting incident can have serious and lasting effects on the mental health of the emergency responders involved. Practicing self-care can help reduce the effects of the trauma and stress experienced. It is also important for EMS providers to be able to recognize the signs of post-incident stress, know how to take care of themselves and be ready to support others during the recovery period.

Self-care tips

Self-care is deliberate activities that are done to improve your mental or physical well-being. Some self-care tips for dealing with stress and trauma include:

  1. During or right after the incident take a moment to do 'The Pause'. This technique was developed by a trauma nurse after observing that his team seemed to handle losing a patient better when they all paused immediately after and acknowledged what they had just experienced.
  2. Avoid using drugs and alcohol to cope with the stress.
  3. Don't isolate yourself from friends, family or co-workers.
  4. Talk to somebody; a friend, a family member, a coworker, a priest, or members of a support group. The specific person doesn't matter. You can even talk to yourself.
  5. Write about the stress. Some people find they are able to process their thoughts and emotions by blogging or keeping a journal.
  6. Take care of yourself. Eat, sleep, shower and put on real clothes.
  7. Don’t read the comments on news stories or social media posts.

Other-care tips

It is also important that we look out for each other after a traumatic event. Exhibiting symptoms of stress immediately after an event is normal and part of the coping process. Look for ongoing symptoms or symptoms of stress that do not improve with time. We are best able to recognize the signs of stress in ourselves and our co-workers. Common symptoms of stress include:

  1. Being irritable or quick to anger.
  2. Being withdrawn or not participating in group activities.
  3. Sloppiness or poor work performance.
  4. Increased alcohol consumption.
  5. Nightmares, flashbacks, difficulty sleeping. Sleep issues can also exacerbate stress, anxiety, and depression.
  6. Physical symptoms such as headaches, nausea, and loss of appetite.

Agency managers need to know how to respond to people that are showing signs of stress after a traumatic incident. However, it is critical that management does not force personnel to take part in any sort of emotional/psychological debriefing process. Each of us processes trauma and stress differently and at our own pace. Forcing somebody to go through a debrief when they're not ready can exacerbate the trauma and increase stress.

Offer a variety of options so personnel can select the method that best suits them. Those options might include a chaplain, peer support team, a psychologist, or a CISM team.

Make sure emergency responders know that even if they don’t want to talk to someone now, help will be available at any time, no matter how long it has been since the traumatic incident.

EMS leaders need to be aware that personnel who were not on the scene of the initial incident may also need as much support as those who were. In a small community everyone knows everyone. EMS providers may have had friends and loved ones that were on the scene, either as emergency responders, bystanders or victims. Not being able to help or know if loved ones are OK can cause feelings of helplessness, anger and fear along with significant stress.

Responding to active shooter incidents and other types of mass casualty incidents can be career ending, but they don't have to be. Practicing good self-care and after-care can prevent mental health problems, addiction, and family issues later on; preserving the careers of the responders involved.


  1. The Pause Crit Care Nurse February 2014 34:74-75; doi:10.4037/ccn2014962
  3. "What Is Self Care." What Is Self Care. International Self Care Foundation, n.d. Web. 
  4. Bledsoe, Bryan, DO. "EMS Myth #3: Critical Incident Stress Management (CISM) Is Effective in Managing EMS-related Stress." EMSWorld, 1 Dec. 2003. Web. 

About the author

Ann Marie Farina is a NR-P in Washington state. She has been in EMS since 2003 and has worked in a variety of positions in Alaska and Washington since then. Over the years her jobs have included working as a wildland fire medic, a dual-role firefighter/paramedic, a 911 transport medic, and as an educator. In March of 2014 Ann founded The Code Green Campaign, a mental health awareness campaign that raises awareness about mental health conditions and suicide in first responders. Through Code Green, Ann has worked as an educator, researcher and consultant in order to assist agencies in improving their mental health programs. Ann is a member of the EMS1 Editorial Advisory Board.

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