The Silent Epidemic: Suicide Among Firefighters and EMTs

Firefighters and Emergency Medical Technicians (EMTs) are often characterized as being resilient, tough, and fearless. Yet, beneath the surface of this bravery lies a growing crisis that claims more of these first responders than the fires, accidents, or emergencies they face on duty: suicide. The average layperson needs to understand that in addition to potentially sacrificing their lives, they oftentimes sacrifice their marriages, their mental health, and their bodies. This silent epidemic has reached alarming proportions, and it’s time we shine a light on the statistics, the contributing factors, and the steps we can take to prevent it.

The Stark Statistics

The numbers paint a grim picture. According to the Firefighter Behavioral Health Alliance (FBHA), an estimated 100 to 200 firefighters die by suicide each year in the United States—double the rate of the general population. In 2017 alone, a Ruderman Family Foundation study reported 103 firefighter suicides compared to 93 line-of-duty deaths, a trend that has persisted for years. When EMTs are included, the National Fire Protection Association (NFPA) documented 127 suicides among firefighters and EMTs in 2020, slightly up from 126 in 2017. Meanwhile, research from the National Violent Death Reporting System (NVDRS) between 2015 and 2017 found that first responders, including firefighters and EMS clinicians, accounted for 1% of all suicides, with firefighters making up 21% and EMS providers 18% of that subset.

Perhaps even more troubling are the rates of suicidal ideation and attempts. A study of U.S. firefighters revealed that 46.8% had contemplated suicide at some point in their lives, 19.2% had made a plan, and 15.5% had attempted it—figures far exceeding the general population’s lifetime rates of 14.3%, 3.9%, and 1.9–8.7%, respectively. For EMTs, the odds of dying by suicide are 1.39 times higher than the general public. These statistics underscore a harsh reality: for too many firefighters and EMTs, the greatest threat isn’t the emergencies they respond to, but the internal battles they fight long after the sirens fade.

Factors Leading to Firefighter Suicide

So why are these brave men and women so vulnerable? The factors driving firefighter and EMT suicides are complex, rooted in both the nature of their work and the culture surrounding it.

1. Repeated Trauma Exposure: Firefighters and EMTs witness the worst of human suffering—car accidents, house fires, overdoses, and violent deaths—sometimes daily. The cumulative toll of these traumatic events can lead to post-traumatic stress disorder (PTSD), which affects approximately 20% of firefighters and paramedics over their careers, compared to 6.8% of the general population. Studies show that 61% of firefighters have responded to incidents resulting in death, amplifying this risk.

2. Burnout and Moral Injury: Beyond trauma, the relentless pace of the job—long shifts, unpredictable calls, and high stakes—can lead to burnout, characterized by emotional exhaustion and a loss of purpose. Moral injury, a lesser-discussed but potent factor, arises when firefighters feel they’ve failed to save someone or witnessed events that clash with their values, wounding their moral compass.

3. Occupational Stress and Lifestyle Strain: The job doesn’t end at the station. Strained relationships with spouses and children due to irregular hours, coupled with sleep disturbances from night calls, compound the stress. Alcohol use, often a coping mechanism, is another risk factor, with some studies linking it to increased suicidal behavior among first responders.

4. Stigma and Silence: Perhaps the most insidious factor is the culture of stoicism within the fire service. Firefighters are expected to be tough, invincible—modern-day superheroes. Admitting to mental health struggles is often seen as weakness, and fear of being labeled “unfit for duty” keeps many from seeking help. This stigma means that warning signs—like withdrawal, irritability, or talk of hopelessness—go unnoticed or unaddressed.

5. Access to Means: Firefighters often have ready access to firearms, a common method of suicide among first responders (69% compared to 44% in the general population, per NVDRS data). This availability can turn a fleeting moment of despair into a fatal act.

   
   

Getting Ahead of the Problem: Solutions and Support

This epidemic isn’t inevitable. We can—and must—take proactive steps to save our firefighters and EMTs from this silent killer. Here are some actionable strategies:

1. Break the Stigma: Cultural change starts with open conversation. Departments should normalize mental health discussions, encouraging leaders to share their own struggles and framing help-seeking as a sign of strength, not weakness. Campaigns like “The Yellow Rose” in Muskegon County, Michigan, where firefighters wear shirts to promote mental well-being, are a powerful step in this direction.

2. Universal Screening and Early Intervention: Routine mental health screenings for all first responders, especially after traumatic calls, can catch suicidal ideation early. A full assessment—evaluating risk factors, plans, and intent—should follow any positive screen, with safety plans or hospitalization for those at imminent risk.

3. Peer Support Programs: Firefighters often trust their “brothers and sisters” more than anyone else. Formal peer support teams, trained to recognize warning signs and offer a listening ear, can bridge the gap to professional help. Critical incident stress debriefings, after a bad, disturbing call, are also vital.

4. Access to Tailored Treatment: Evidence-based therapies like Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) are gold standards for treating PTSD and reducing suicide risk. Departments should partner with culturally competent mental health providers who understand the unique stresses of first responder life, rather than relying on generic Employee Assistance Programs.

5. Reduce Access to Lethal Means: Safe storage of firearms and medications, along with education on their risks, can prevent impulsive acts. This is especially critical given the high firearm use in first responder suicides.

6. Legislative and Research Support: The Helping Emergency Responders Overcome (HERO) Act, which mandates a national suicide reporting system for public safety officers, is a start. But we need more funding for research to pinpoint trends and protective factors, and policies to ensure mental health resources reach even the smallest volunteer departments.

7. Community and Family Involvement: Spouses, friends, and community members can be trained to spot warning signs—sudden mood changes, giving away possessions, or talk of being a burden—and encourage help-seeking. Programs like First Responders’ Bridge, which offers retreats for those struggling, show the power of external support.

8. Education and Training: Continuous education in topics such as mental health, addiction, and marriage/divorce.

   
   

A Call to Action

Firefighters and EMTs spend their careers saving us; it’s time we save them. The suicide epidemic among these first responders is a public health crisis that demands urgency, compassion, and action. By confronting the statistics, understanding the factors, and implementing real solutions, we can honor their sacrifice not just with words, but with lives preserved. If you know a firefighter or EMT, check in on them today. This is so important- Ask the question... "Are you ok?" If you are one, know this: you are not alone, and help is available—call or text 988, the National Suicide Prevention Lifeline, anytime. Or reach out to Rise Up & Fight Ministries at www.riseupfight.org Together, we can turn the tide on this tragedy.

Stay safe out there.