Firefighters, paramedics and dispatchers care for strangers for a living, and research on how they get hurt holds a lesson for anyone caring for someone at home. Support layered on top of an unchanged workload does little. Changing the load does more.
What the research on first responders found
Megan Edgelow, an occupational therapy researcher at Queen’s University in Ontario, studies what happens to the people whose job is to show up when something goes wrong. In a study published in December 2025, her team examined ten years of approved workers’ compensation claims for psychological injury, including PTSD, filed by Ontario dispatchers, correctional workers, firefighters, paramedics and police. Only about a third of the injured workers (35.7 percent) had a documented return to work. In a 2026 summary of the research for The Conversation, Edgelow reported that these claims rose 400 percent between 2014 and 2018 and have stayed at that level since, across a dataset of more than 11,000 workers.
The pattern extends beyond Canada. A Ruderman Family Foundation white paper found that in 2017 more US police officers and firefighters died by suicide than in the line of duty.
Over the same decade, employers did respond. They added employee assistance programs (counseling lines and short-term therapy an employer contracts out), resilience trainings and pamphlets. When Edgelow’s team surveyed 644 Ontario public safety workers about those supports, many said they did not trust internal programs to keep what they shared confidential. One firefighter described the employee assistance program as a single hour of counseling with no follow-up. Edgelow sums up how many participants saw the offerings: as “tick box” exercises.
The stresses workers named came from the job itself: chronic understaffing that left no time for breaks, leaders out of touch with conditions on the front line, and harassment policies that existed mainly on paper. A worker could finish every resilience module and walk back into the same short-staffed shift.
What works better
Edgelow points to a 2023 overview of 52 systematic reviews of changes made at the level of the workplace, covering nearly 1,000 studies. The strongest evidence was for changing working hours and schedules. There was moderate evidence for giving workers more say over how their tasks are organized and for improving the social climate at work, and the clearest gains showed up in burnout. Her reading of that evidence is that changing the conditions of the work does more for people than programs aimed at making each person tougher. Her recommendations follow from it: adequate staffing, a culture that allows rest, harassment rules that are enforced, health benefits good enough that workers can get confidential care outside the workplace, and leaders trained to notice when someone is struggling.
Individual support still matters. The order matters more. When support sits on top of conditions that keep injuring people, it mostly records that something was offered.
The families who carry it home
First responders go home to someone. A 2022 systematic review of 43 studies on the spouses, partners and children of emergency responders found signs that the job’s stress spills into the household. Partners described worrying about their spouse’s safety, living with a spouse who withdrew, and holding their own feelings in check to keep the peace. The authors caution that the evidence is still limited, and they found little support for these families from the organizations their partners worked for.
That makes many first-responder families caregivers in their own right, absorbing strain that starts in a workplace they have no say over.
The same mistake, at home
Family caregivers will recognize the shape of the tick-box problem. According to the 2025 Caregiving in the US report from AARP and the National Alliance for Caregiving, caregivers spend an average of 27 hours a week providing care, and 24 percent provide 40 hours or more. What many are handed is a self-care handout, a breathing exercise, or a reminder to look after themselves. The 27 hours stay the same.
The help that changes the load is harder to get. The same report found that nearly 4 in 10 caregivers say respite care (someone else taking over so you get a break) would help, and only 13 percent use it.
The first-responder research suggests where to put your effort. Advice about coping has its place, and the bigger gains come from changing the conditions of the work. For a caregiver, that can look like this:
- Ask for hours of help, in so many words. Ask a doctor, hospital social worker or your local Area Agency on Aging about respite care, adult day programs and in-home help. The federal Eldercare Locator (1-800-677-1116) will connect you to the agency near you.
- Split the work. Write down every task you do in a week, then ask relatives to take specific ones on a set schedule.
- Read your exhaustion as information about the workload. After months of 40-hour weeks of care, the hours are the problem to solve.
What programs don’t reach
Even when the conditions improve, the people who did the work carry what they saw and felt. The public safety workers in Edgelow’s survey wanted support they could trust to stay confidential, outside the chain of command. Caregivers often need something similar: a place to talk honestly about resentment, grief or exhaustion with people who have done the same work, without any of it getting back to the family.
A fellowship of other caregivers can offer that kind of room.
If you or someone you care for is in crisis, call or text 988 to reach the Suicide and Crisis Lifeline.
