What is Cumulative Trauma in First Responders?

What is Cumulative Trauma in First Responders?

You never thought the job would change you… but somehow it did. The change was not because of a major call, OIS, or line of duty death, it just slowly happened. You are not sure where it started, but you know that you are not the same person you once were, or who you want to be at your core.

You are not the only first responder to feel like this. Lots of others have felt this same way throughout the years of their service. In clinical counseling, we call what you are experiencing cumulative trauma. 

Cumulative trauma is more likely to impact first responders due to the frequency of traumatic events they experience while fulfilling their duties. If you think about the general public, most people witness MAYBE one to three traumatic events throughout their lifetime. Now take a first responder who may see that in a day, or a weeks’ time

Let’s talk about what cumulative trauma is, how it happens, what it can look like, and what are some ways to help tackle cumulative trauma


So what is cumulative trauma? How does it happen?

Cumulative trauma is when someone experiences traumatic events repeatedly and may not fully process the reactions or emotions they experienced during those events. What happens when the reactions or emotions are not dealt with is they get shoved in the box (I like to use the backpack analogy as we usually carry these things with us) and they stay in there unless we do something about them. 

Don’t get me wrong, compartmentalizing is an essential function of most people, especially first responders. But there is a difference between compartmentalizing and not addressing the shit we put in our backpack. 

If we do not go back to tackle all that is in our backpack, we start creating a new way of experiencing events and even start thinking in different patterns

Reactions to situations, bad or good, is a natural part of being a human. However, when people start experiencing traumatic or stressful situations frequently without acknowledging or working through the experiences, this is where thinking and reactions patterns can start to change. This is also where the signs of cumulative trauma begin showing up. 

An example would be if you respond to a motorcycle vehicle accident where the motorcyclist had part of their leg amputated on site. Then immediately after, you get called to respond to a domestic at a residence. With all the paperwork and everything else involved, there is really no time for the responder to acknowledge, process, or probably do much of anything other than shove that shit in the backpack and continue on.  


When we never go back to what we put in the backpack, that is what starts to create the change in us.  


One important note to clarify is if a first responder is having reactions that might be cumulative trauma, or anything for that matter, it is not because they are not meant to do the job of a first responder. More likely, they would benefit from working through some of the shit they put in their backpack.


What does cumulative trauma look like?

If someone is having signs of cumulative trauma, it is likely subtle at first. Individuals may even experience just physical symptoms when it starts out. Overtime, if the over-full the backpack is not addressed, and we keep putting more in there, people can experience a wide variety of signs.

Below is a brief list of some different indicators of cumulative trauma:

  1. - Difficulty concentrating
  2. Frequent headaches
  3. Issues with sleep
  4. Irritability or anger concerns
  5. Social withdrawal
  6. Frequent anxious or depressed
  7. Relationship tension/problems reactions/thoughts
  8. Thoughts of self-harm 
  9. Low motivation
  10. Alcohol/drug use problems
  11. Disciplinary problems at work
  12. Communication problems
  13. Weight gain 
  14. Many, many others

The list above is not an all-inclusive list. What is important to be aware of is if you have never before had issues with sleep, relationships, or whatever it is you are experiencing, but now you are, that is a good indicator it might be time to address the backpack


How do you tackle cumulative trauma?

There are a variety of approaches to tackle cumulative trauma. One of the most important pieces to have in place or develop is healthy coping skills and doing self-care. Activities that are healthy and help you establish a sense of routine and control help reduce the effects individuals experience. There are lots of coping skills that are useful to help establish and keep a healthy routine so finding what works for YOU is key.

Sometimes when we have a lot we are carrying around that feels heavy, isolating is SO tempting. Being intentional about connecting with people who you trust and feel safe around is another great way to help work through what is in the backpack. To help support the need for relationships in our life.  

Allowing yourself to recognize and acknowledge your reactions or feelings, when you are in a safe space, can significantly help with processing what we put in our backpack. This is a healthy way to recognize what is going on for you individually and part of addressing what is in your backpack. 

Additionally, seeking support from a mental health counselor can really help rewire the brain after thought patterns and reactions have taken root. If you choose to try counseling, there are many ways to work through cumulative trauma.

Finding a counselor and approach that you feel comfortable with is enormously important. Options can include traditional talk therapy, in addition to methods such as Eye Movement Desensitization and Reprocessing (EMDR), Brainspotting, workshops, or even retreats. 


There are ways to help manage and balance the shit in our backpack. It does not have to change you, your relationships, or the way you want to live life. You still love doing the job. There are ways to continue doing what you love and are called to do. 

Be well and take care!

Liz Durfee


Liz is an Associate Clinical Social Worker in California. She is one of our experienced counselors at Code 3 Counseling. Liz specializes in working with first responder and military trauma. You can contact her through our website. 


If you find that this exercise or these conversations brought up some stuff you are struggling with, either individually or in your relationship, please do not hesitate to reach out to us for help. We are here to support you, and we understand that this can be a challenging issue to face. 


Remember, it may be your battle, but you don’t have to fight it alone.