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First In, Last Out - Resources for First Responders

The U.S. DOJ’s Office of Justice for Victims of Overseas Terrorism created this page for all of the first responders who help the victims and survivors of terrorism and other crimes.  We acknowledge your sacrifices, respect your challenges, and are grateful for all the work that you do.   We hope this page is useful to you and helps you through what may be difficult times.

First responders are often the overlooked survivors of terrorist attacks and mass casualty events.  In the course of their duties, police officers, fire fighters, paramedics, medical personnel and victims' assistance providers are exposed to traumatic crime scenes and difficult stories from victims and survivors.  This exposure may lead to “vicarious trauma”.

According to DOJ’s Office for Victims of Crime, “Vicarious trauma is an occupational challenge for people working and volunteering in the fields of victim services, law enforcement, emergency medical services, fire services, and other allied professions, due to their continuous exposure to victims of trauma and violence. Exposure to the trauma of others has been shown to change the world-view of these responders and can put people and organizations at risk for a range of negative consequences.” (The Vicarious Trauma Toolkit, Glossary of Terms, see below)

These experiences can vary and can affect people very differently - and this response can evolve over time.  Below are a few resources for first responders or their loved ones that might be helpful as they address possible issues of vicarious trauma.  Some of these resources may be useful to you, but some may not be.  This is not a comprehensive list, but may help guide efforts to find information.  All of these resources are from other U.S. Government agencies or offices, and a short abbreviation glossary is below:

The Centers for Disease Control (CDC);
Federal Emergency Management Administration (FEMA);
Health and Human Services (HHS);
The National Center for Complementary and Integrative Health (NCCIH);
The National Institutes of Health (NIH);
The National Institute of Mental Health (NIMH);
The National Institute for Occupational Safety and Health (NIOSH);
Office for Victims of Crime (OVC);
Substance Abuse and Mental Health Services Administration (SAMHSA);
U.S. Fire Administration (USFA);
The U.S. Department of Veteran’s Affairs (VA).

If you feel you need further assistance, please reach out to a qualified counselor or psychologist, or your organization’s human resources office for referrals. 



The Vicarious Trauma Toolkit - DOJ’s OVC – OVC’s toolkit makes a major contribution to the field by providing the Vicarious Trauma–Organizational Readiness Guide (VT–ORG) to help guide organizations' efforts to become more vicarious trauma-informed.

Responder Safety and Health – HHS – A collection of various resources and trainings directed at assisting first responders, including:

Tips for Retaining and Caring for Staff after a Disaster;

Tips for Disaster Responders: Preventing and Managing Stress; and

Individual Resilience: Factsheet for Responders

SAMHSA's Disaster Kit, – SAMHSA/HHS, a comprehensive resource which includes:

A Guide to Managing Stress in Crisis Response Professions;

Tips for Health Care Practitioners and Responders; Helping Survivors Cope with Grief After a Disaster or Traumatic Event;

Tips for Disaster Responders - Understanding Compassion Fatigue; and

Tips for Managing and Preventing Stress - A Guide for Emergency Response and Public Safety Workers. (Many resources also in Spanish.)

Crisis Counseling Assistance and Training Program (CCP) Toolkit - SAMHSA/HHS - The Crisis Counseling Assistance and Training Program (CCP) helps individuals and communities recover from natural and human-caused disasters through community outreach and access to mental health services. This toolkit includes numerous resources, including the First Responders and Disaster Responders Resource Portal. This website includes online trainings, webcasts, tip sheets, and other online disaster behavioral health trainings.

Tip sheets, Brochures, and Publications:

Traumatic Incident Stress - NIOSH/CDC – A short but comprehensive list of physical, emotional, cognitive and behavioral symptoms and recommendations for actions on-site and after the event.  A summary is at Traumatic Incident Stress - Information for Emergency Response Workers (Fact Sheet).

Coping with Traumatic Events - NIMH/NIH/HHS – General information for anyone who has suffered a traumatic event, including how children may respond.

Self-Care for Disaster Behavioral Health Responders - SAMHSA/HHS – A visual presentation about the stressors facing first responders and best practices to address them.

Psychological First Aid for First Responders – SAMHSA/HHS – A quick reference pamphlet about how to communicate with traumatized people during or just after a traumatic event, including how to deescalate with an agitated person.

Tips for Disaster Responders - Identifying Substance Misuse in the Responder Community – SAMHSA/HHS - A tip sheet to provide information on the warning signs of misusing alcohol, prescription medication, or other substances, and includes treatment resource information.

Resources for Health Care Providers – NCCIH/NIH/HHS – Complementary health approaches for health care providers to utilize personally or in their practices.

Tips for Supervisors of Disaster Responders - Helping Staff Manage Stress When Returning to Work – SAMHSA/HHS - This tip sheet can help supervisors ease the transition for disaster responders returning to work, recognize and reduce potential difficulties in the workplace, and enhance positive consequences for all of their staff.

Disaster Technical Assistance Center Supplemental Research Bulletin - First Responders: Behavioral Health Concerns, Emergency Response, and Trauma - SAMHSA/HHS - The purpose of this publication is to discuss the challenges encountered by first responders during regular duty as well as following disasters; shed more light on the risks and behavioral health consequences (such as PTSD, stress, and depression) of serving as a first responder; and present steps that can be taken to reduce these risks either on the individual or institutional levels.

Preventing suicide among first responders – USFA/FEMA – An infogram with links to various firefighter and law enforcement organizations to address suicide prevention.

Online Trainings and Videos:

Online Disaster Behavioral Health Trainings – SAMHSA/HHS – The trainings  cover a range of topics, including crisis intervention, Psychological First Aid, preparedness and response, resilience-building, and psychological responses to disasters. The trainings listed are free to the public; however, they may require you to register with a training website in order to take them. Some of the trainings also offer continuing education unit credits.

Online DTAC Training Courses – SAMHSA/HHS – The following free online trainings are designed to help participants improve their awareness and understanding of the behavioral health effects of disasters and disaster and emergency response. Includes Shield of Resilience, a 1-hour, online course provides law enforcement officers with a foundational skill set to better understand and address the behavioral health stressors that are unique to law enforcement and Service to Self, a 1-hour online course is specifically for fire and emergency medical services personnel which addresses occupational stressors; mental health and substance use issues including depression, posttraumatic stress disorder, suicidality, and alcohol use; individual and organizational resilience; and healthy coping mechanisms including demonstrations of stress management techniques.

Stress Management Techniques, Healthy Coping Strategies, Breathing Exercise - Video – SAMHSA/HHS – A YouTube video meant to help staff understand the personal impact of working with disaster survivors. It also covers the importance of practicing self-care and demonstrates a breathing exercise that may help staff reduce stress.

Provider Strategies for Coping with Burnout and Secondary Traumatic Stress – VA – The VA has numerous resources through their National Center for PTSD (Posttraumatic Stress Disorder) to address the needs of first responders. This one-hour interactive course is designed to provide brief education and dynamic intervention strategies to help address provider burnout and STS. Highlights include informational provider vignettes, interactive features, and instruction on physical, cognitive, and meaning-based coping strategies. All are designed to improve personal health and resilience. Continuing education credits are offered for this free course.