“The sounds of the sirens still make me cringe. I was an EMT for four years, then a medic for four more … I’ve suffered from depression on and off for as long as I can remember and yet I always managed to get by, to fight. Now I’m just exhausted. I don’t want to fight anymore. I don’t want to do anything except sleep, yet still there the nightmares come … ” — Diana, paramedic, eight years in EMS

EMTs and other first responders can’t unsee some of the tragic scenes they are called out to. The first and easiest way to keep such incidents from disrupting one’s psyche and leading to detrimental behavior is to talk about how the memory is affecting you — either with coworkers and management, or with a mental health professional. (Shutterstock photo)

Ann Marie Farina, president of The Code Green Campaign, and Fiona Campbell, secretary, increase awareness of the risks to good mental health that are inherent to the EMT profession by promoting the campaign at first responder conferences. (Photo provided)

Campbell and Annie the goat promote tactics for coping with the stress and trauma of EMT work at a recent event. (Photo provided)

These words are from one of hundreds of stories collected and published by The Code Green Campaign, a national nonprofit organization dedicated to raising public awareness of the high rates of mental health issues, substance abuse and suicide among emergency medical services, firefighting and law enforcement personnel.

The campaign’s storytelling project provides first responders with the opportunity to relay personal struggles they have experienced on or because of the job. The stories are published anonymously so that other responders will read them and understand that they are not alone in their own struggles. They also help responders who have not experienced the issues firsthand to understand what their colleagues are experiencing.

A new story is published every Monday, Wednesday and Friday on the campaign’s website and Facebook page. Over 300 stories are currently available, and new submissions from first responders looking to share their experiences are welcome.

Ann Marie Farina is a paramedic in Spokane, Wash., and president of The Code Green Campaign. In 2014, one of her coworkers committed suicide. The Code Green Campaign was founded later that year by Farina and other EMS professionals who were concerned about the high rates of post-traumatic stress disorder and suicide among their peers. The name “Code Green” was created by combining the color of the green awareness ribbon used by mental health advocates with the code alerts used to designate an emergency patient. Code Green is a call to action on the mental health of first responders.

While studies have been conducted on the mental health of police officers and first responders following large-scale disasters such as Hurricane Katrina and the Oklahoma City bombing, no similar large-scale studies have been conducted on EMS and firefighting teams engaged in everyday operations. Yet the campaign estimates that 15–25 percent of first responders have been diagnosed with PTSD. The rate of suicide among first responders is suspected to be as high as two to three times that of the general population. Substance abuse is also common.

While it started as a storytelling project, The Code Green Campaign quickly expanded to include education and advocacy.

“Our original plan was to do the storytelling project on social media … and use that to help reduce stigma,” said Farina. “I think we existed for about 48 hours before it just absolutely blew up and we realized that we had something much bigger on our hands. We were not going to be just a storytelling project.”

The campaign’s volunteers, first responders themselves, aim to teach other public safety employees how to care for their mental health and how to recognize mental health issues in their peers. They offer a two-hour continuing education course for public safety departments. The course is offered in-person or online and teaches ways to develop resiliency and recognize the signs of a peer in crisis, and how to initiate helping conversations.

“A lot of people just aren’t comfortable having that conversation,” Farina said. “They’re afraid they’re going to make things worse. They’re afraid they’re overstepping their bounds. They don’t know how to start. So we teach people the steps of how to sit down, have that talk — to prepare them so that they can go in with a plan, which tends to make people much more comfortable being able to do that.”

The campaign also lobbies for systemic change in how mental health issues are addressed by public safety agencies.

“We would really like to see more education,” said Farina. “One of the things we just recently advocated for is adding mental health, mental wellness and resiliency education to the initial EMS training requirements and  the recertification requirements. But that’s one of those changes that takes time. In the meantime, we would really like to see more agencies providing education for their people: either creating peer support teams or mental health first aid, anything that really gets it out there, reduces the stigma and improves the atmosphere for people to communicate with each other when they are having problems.”

Western Berks Ambulance Association, Berks County, Pa., has utilized resources from the Code Green Campaign. It has placed Code Green Campaign posters in the workplace, and the keys for every vehicle in their fleet are on a Code Green keyring to communicate the department’s commitment to caring for its own.

“It helps bring awareness,” said Chief Ed Moreland. “We’re in that tough-guy culture, and although you can’t unsee what you’ve seen, none of us wants to admit that we really have any problems. So this is kind of the ‘Hey, let’s pull the shade off of that tough guy image’ — it’s costing some people their careers. In some cases, self-destructive behavior pushes them out of this line of work.”

One of the greatest obstacles to providing mental health services to first responders is the stigma against asking for help.

“Part of the culture of EMS is that we are the helpers, we don’t seek help,” Farina said. “People are worried that they will lose respect or that their job will be threatened if they ask for mental health resources.

“One of the things we run into is the attitude of ‘Well, if you can’t handle it, just get out,’ but that doesn’t actually solve the problem,” she said. When public safety agencies provide their employees with training and resources to maintain their mental wellness and resiliency, first responders and the public benefit. “It is worth spending the money on the education to keep your people on the job. We promise.”

Chief Moreland agreed. “If we don’t take care of our staff, we’re not going to be here to take care of the public. It’s OK to have a problem, and it’s OK to ask for help.”

The website of The Code Green Campaign offers a database of national and local crisis resources such as crisis hotlines, treatment centers and retreats. For public safety employees experiencing crisis, the campaign suggests calling Safe Call Now, a 24-hour crisis referral hotline for emergency services personnel, at (206) 459-3020.