Liz Frings

EMDR for Emergency Services Staff and First Responders: Trauma Therapy for Police, Ambulance, Fire and 999 Control Rooms

For most people a critical incident is a rare event that stands out for the rest of their life. For police officers, paramedics, firefighters and 999 control room staff it can be part of an ordinary week, and the effects tend to build up over a career rather than arrive all at once. EMDR (eye movement desensitisation and reprocessing) is one of the two therapies NICE recommends for post-traumatic stress disorder, and clinicians have spent decades adapting it for people in these roles. This guide covers what makes these services different, how the therapy is adapted for it, the routes to help in the UK and who pays, and where to find fuller answers to the questions people in the job ask most.

Who this guide is for

It is written for anyone whose work puts them at, or on the end of the phone to, other people's worst moments:

  • police officers, special constables and police staff, including investigators who review distressing material
  • paramedics, ambulance technicians, emergency care assistants and patient transport crews
  • firefighters, on call and wholetime, and fire control staff
  • 999 call handlers and dispatchers across all three services
  • volunteers, including community first responders, search and rescue teams and coastguard
  • retired staff, whose jobs often catch up with them once the work stops

In the United States these roles are usually called first responders, and much of the research uses that term. In the UK, a first responder more often means a volunteer sent by the ambulance service. Whatever your role, if the job has left its mark, this applies to you. It may also help partners and families who are trying to understand what is going on.

Why the emergency services are different

The jobs add up

Psychologist Robbie Adler-Tapia, a former firefighter and emergency medical technician, describes a "Parade of Faces" in EMDR with First Responders (Luber, ed., 2015). These are the jobs that stay with a person long after the shift ends. In her experience they tend to be the first ones and the worst ones, those involving children, suicides, moments of real danger to the responder, scenes remembered through a smell or human remains, and anything that touches the responder's own life.

No single one of those jobs has to be the "big one". Years of them can do the damage together, and a recent incident can bring older ones back to the surface. UK research fits that pattern. In a 2018 survey of almost 17,000 UK police officers and staff, the largest of its kind at the time, 90% had been exposed to trauma, and one in five of those reported symptoms of some form of PTSD. A 2021 study of 1,300 current and former UK firefighters found 18% met the criteria for the complex form and just under 6% for the standard diagnosis. In both groups, the complex form was more common. PTSD in emergency services workers covers the signs and the figures in more detail.

The job asks you not to be affected

The culture of every emergency service expects people to stay steady. That brings dark humour, compartmentalising, and two states worth naming. Depersonalisation is the feeling that the event is happening to someone else. Derealisation is the feeling that it isn't real. On shift these responses let people keep working in places everyone else runs from. Used out of habit for years, they can mean the impact arrives much later, sometimes as a delayed-onset stress disorder.

Responsibility and second-guessing

Roger Solomon, who has worked with police officers for decades, calls people in these roles "responsibility absorbers". They often hold themselves responsible for how things turned out, with thoughts like "I should have done more". Split-second decisions are later picked apart by the organisation, the courts and the press. In my work with police officers, I've noticed how clearly they remember a careless remark made to them after an incident, and how much a supportive word helps.

Betrayal and moral injury

Adler-Tapia uses the term "betrayal trauma" for the experience of feeling unsupported by the service, the media, the public or family. A related idea is moral injury, a term that grew out of research with military veterans. It describes the harm that follows taking part in, failing to stop, or witnessing acts that clash with a person's own moral code. Leaving a patient waiting because no ambulance is free, or being unable to save someone because of how a job was resourced, can leave this kind of wound. For some, how an incident was handled afterwards hurts as much as the incident itself. What is moral injury? looks at it in more depth, including how counselling can help.

Two families

Many in the emergency services spend more of their waking hours with their crew than with their partner and children. When a colleague is hurt or killed, the whole crew feels it. The strain also reaches home, through poor sleep, irritability, hypervigilance, nightmares, or drinking more than before, and partners can carry some of the weight too. How to help someone with PTSD is written for partners and families.

999 control rooms: what is heard, not seen

Control room staff are often left out of conversations about the mental toll of the job, even though they hear it all. Dispatchers may comfort a child, talk someone through CPR and coordinate the response, all from what they can hear, and then struggle afterwards with the pictures their own mind has created. They rarely find out how an incident ended, so there is no closure.

The strain shows in the figures. A 2025 Unison report found that 27% of NHS ambulance control room staff had left their jobs in the previous three years. In 2023/24, sickness came to more than a month for each handler, against about four days for the average UK worker. A University of Bradford study of 999 ambulance staff in the control room describes them as a hidden and under-researched part of the workforce. I have looked at the risks and the figures in more detail in vicarious trauma in 999 call handlers.

The therapy can work with memories that were never seen, only heard or imagined. The target can be a sound, a voice, the image the mind built, or the moment the line went quiet.

How it is adapted for this work

It follows the same eight phases for everyone, from history taking and preparation through to processing and review. What changes with clients from these services is mostly how the work is planned and paced.

  • Mapping the jobs first. Rather than starting with one incident, the therapist may help you list the ones that still bother you. You then decide together where to begin, whether that is the most recent, the worst, or an older one the recent incident has stirred up.
  • Learning to contain. Before any processing, the preparation phase teaches ways to put distressing material away between sessions and at the end of a shift. Adler-Tapia stresses that a container is meant to be emptied later, ideally as a daily routine, which is the part many responders never get to.
  • Finding the moments that went right. Clinicians working with police often look for moments of effective action or courage within an incident. These can help when processing gets stuck on the worst moment.
  • Recent incidents and older ones. There are specific protocols for recent traumatic events. A therapist may also keep the work narrowly focused on one incident at first, and leave wider associations for later.
  • Not having to tell the story. Some can't describe what they saw, or worry about what hearing it will do to the therapist. The work can be done without sharing the details, and EMDR without talking about the trauma explains how.
  • Pacing around work. Each session is closed carefully so you are steady enough to get on with your day. Side effects and shift work covers the common worries, including the so-called hangover after a session and losing your edge.

For a general explanation of how the method works on traumatic memories, see EMDR for PTSD.

Does it work for people in these jobs?

NICE recommends the therapy for adults with PTSD after an event outside military combat, typically over 8 to 12 sessions, with more after multiple traumas. UK research with police is encouraging. In a 2021 study of a UK police trauma service, officers with standard or complex PTSD who had around 10 hours of EMDR or trauma-focused CBT showed substantial falls in PTSD, depression and anxiety symptoms, though there was no comparison group. Early figures from a Police Care UK intensive service are also promising. The wider research on these occupations is still limited in quality, and it's worth knowing that. Does it work for emergency services staff? sets out each study and where the gaps are.

Getting help in the UK, and who pays

There are several routes, and they differ in who pays and who your therapist answers to. That matters for confidentiality.

Route Who pays Who the therapist answers to Worth knowing
Private therapy you arrange yourself You, or private medical insurance You Nothing goes to your employer. An insurer will hold claim details.
Occupational health or an EAP Your employer Your employer's provider, under its contract Ask what reports go back before you start.
Police Care UK The charity The charity's process Free and independent of the police service. Is piloting a therapist network called NEST.
TASC (The Ambulance Staff Charity) The charity The charity's process For current and former ambulance staff and their families.
The Fire Fighters Charity The charity The charity's process For the UK fire services community.
NHS Talking Therapies The NHS The NHS Free, and you can usually self-refer in England. Waits and availability vary.

Many services also use TRiM (trauma risk management) after an incident. TRiM began in the UK armed forces and is now used by many police, fire and ambulance services. It is a peer-led risk assessment carried out by trained colleagues, usually a few days after the event and again around a month later. It is not therapy, but it can be a route to it.

Choosing between these routes often comes down to trust. Is counselling confidential? looks honestly at what each route means for your privacy and your career.

Eye movement therapy or counselling

Not everyone wants to process specific incidents, and not every difficulty is a stress disorder. Burnout, the weight of years in the job, a decision about leaving the service, or strain on a relationship can all be worked with in person centred counselling, which follows your lead rather than a set protocol. Person centred therapy for trauma describes that approach, and which is right for me? compares the two.

Frequently asked questions

Do I have to talk about the worst of it?

No. This therapy needs far less description than most, and some versions need none at all. The guide to working without talking about the trauma, linked above, explains how.

How soon after an incident can I start?

NICE suggests considering it from one month after a trauma if you prefer it, and offering it from three months. In the first month it favours keeping an eye on how things develop, or trauma-focused CBT where symptoms are clinically important. Specialist early-intervention protocols exist, and Solomon reports working with police officers from 18 hours to several months after an incident, typically once the initial shock has eased. Your therapist will help you judge the timing.

Can I keep working during treatment?

Many do. It takes some planning, and the guide to side effects and shift work covers how.

Do I need a diagnosis first?

No. You don't need a formal diagnosis to see a private therapist, and they will assess what is going on at the start.

Will the therapist understand the job?

It is a fair question to ask before you start. In my experience, earning trust is the biggest hurdle in this work. Find a therapist who will ask about your role rather than assume they know it. Police counselling has a list of questions worth asking first.

Does it help with complex PTSD?

It can, though the work usually takes longer, with more time spent on preparation. The UK police study above found brief therapy helped officers with the complex form as well as the standard one.

Support for emergency services staff in the UK

Each of these charities is independent of the employer:

  • Police Care UK offers free, confidential support for serving and former police officers, staff, volunteers and their families who have been harmed through policing.
  • The Ambulance Staff Charity (TASC) supports the mental health, physical rehabilitation and financial wellbeing of current and former ambulance staff and their families.
  • The Fire Fighters Charity supports the UK fire services community with mental health, physical health, wellbeing and practical support.

If you are in crisis now, ring 999, ring NHS 111 and choose the mental health option, or ring Samaritans free on 116 123.

Working with me

I'm a BACP registered counsellor offering EMDR therapy and person centred counselling in Nottingham and online. In my experience, clients can experience a considerable reduction in distress levels, and increased resilience and coping skills. I've worked with police officers who have been exposed to many traumatic incidents over their careers, and I'm happy to work with sessions funded by Police Care UK, TASC, the Fire Fighters Charity, occupational health or an EAP, where the funder agrees. You can get in touch to ask whether it might suit you before committing to anything.

Sources

More about EMDR therapy