Interventions for post-traumatic stress disorder among first responders: implications for public health response and system resilience.
International Journal of Emergency Medicine · 2026-07-01 · Systematic review
Abstract
INTRODUCTION: First responders, including Emergency Medical Services (EMS) personnel, police officers, firefighters, and disaster responders, are at increased risk of developing post-traumatic stress disorder (PTSD) due to repeated exposure to traumatic events. Although EMS personnel face unique occupational stressors, much of the available evidence on PTSD interventions is derived from broader first-responder populations. This study aimed to synthesize evidence on the effectiveness, feasibility, and sustainability of psychological interventions for PTSD among first responders, with particular attention to their relevance for EMS personnel. METHODS: A systematic review was conducted following PRISMA guidelines. Randomized controlled trials and quasi-experimental studies were included. Eligible studies involved first responders, including EMS personnel, police officers, firefighters, disaster workers, and emergency service personnel. Psychological interventions analyzed included trauma-focused therapies (e.g., eye movement desensitization and reprocessing [EMDR] and cognitive behavioral therapy [CBT]), group-based approaches (e.g., critical incident stress debriefing [CISD]), and resilience- or mindfulness-based programs. Primary outcomes were PTSD symptoms measured using validated instruments, while secondary outcomes included psychological distress, resilience, and related mental health indicators. RESULTS: Fifteen studies with varying sample sizes were included. Trauma-focused interventions, particularly EMDR and CBT, demonstrated the most consistent effectiveness in reducing PTSD symptoms across first-responder populations. Group-based interventions showed mixed findings, with some studies reporting short-term benefits and others demonstrating limited or no effect on PTSD outcomes. Resilience- and mindfulness-based programs were generally associated with improvements in short-term psychological well-being but showed limited evidence of sustained long-term benefits. Seven studies were assessed as having a low risk of bias, while the remaining studies presented methodological limitations of varying severity. CONCLUSIONS: EMDR and CBT appear to be the most promising interventions for reducing PTSD symptoms among first responders. However, the evidence specific to EMS personnel remains limited, as many available studies involve broader first-responder populations. Further high-quality, EMS-specific research with standardized outcome measures and long-term follow-up is needed to strengthen the evidence base and inform occupational mental health practice.
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