The Crisis Behind the Badge
In 2024, 112 firefighters and EMS professionals died by suicide. That number, documented by the Firefighter Behavioral Health Alliance, represents confirmed cases — individuals whose deaths were verified through official records and family reporting. The actual number is estimated to be approximately 40% higher, meaning the true toll likely exceeded 150 lives lost to suicide in a single year.
To put this in perspective: more firefighters die by suicide each year than die in all other line-of-duty causes combined.
This is not a new problem. According to data compiled by the FFBHA, there have been 2,142 validated suicide losses among firefighters and EMS personnel between 1880 and 2024. But the rate is accelerating. The numbers are growing. And the fire service — a profession built on saving lives — is losing its own members at a rate that demands immediate, sustained, and unflinching response.
The Data: What We Know
According to a USFA study, the suicide rate among firefighters is approximately 18 per 100,000, compared to 13 per 100,000 in the general population. That 38% elevation is significant on its own, but the real clinical picture is more nuanced and more alarming.
PTSD Prevalence
Research consistently shows that approximately 20% of firefighters meet diagnostic criteria for post-traumatic stress disorder. The general population rate is approximately 6.8%. Firefighters are nearly three times more likely to develop PTSD than the average American.
PTSD in firefighters is not caused by a single traumatic event. It is the result of cumulative exposure — hundreds or thousands of calls over a career, each one depositing another layer of traumatic imagery, emotional weight, and physiological stress response. The pediatric cardiac arrest. The fatal house fire. The multi-vehicle accident with entrapment. The suicide call where the victim reminds you of your brother. Each call is survivable in isolation. Accumulated over 20 or 30 years, they become a clinical burden that the brain was not designed to carry.
Who Is at Risk
Of the 112 confirmed suicides in 2024, approximately 20% were retired members. This data point is critical and often overlooked. Retirement does not end the psychological effects of a firefighting career. In many cases, retirement intensifies them.
Active firefighters have structure. They have a crew. They have a purpose. They have an identity. When a firefighter retires, all of that disappears simultaneously. The camaraderie, the mission, the daily routine — gone. What remains is the accumulated trauma, now without the support system that helped manage it.
This pattern mirrors what we see in military veteran populations, and it demands the same response: transition support, continued mental health access, and peer connection programs that extend beyond the last day of active service.
Understanding the Risk Factors
Suicide is complex. It is never caused by a single factor. But research has identified several risk factors that are disproportionately present in the fire service population.
- Cumulative trauma exposure. The dose-response relationship between traumatic incident exposure and psychological distress is well-established. More calls equals more exposure equals higher risk.
- Sleep disruption. Shift work, particularly 24-hour shifts with interrupted sleep, disrupts circadian rhythms and impairs the brain's ability to process and consolidate emotional experiences. Chronic sleep deprivation is independently associated with increased suicide risk.
- Substance use. Alcohol use in the fire service exceeds general population rates. While cultural attitudes are slowly shifting, alcohol remains a common — and clinically counterproductive — coping mechanism for job-related stress and trauma.
- Relationship strain. The demands of shift work, the emotional toll of the job, and the cultural expectation of stoic self-reliance create significant stress on personal relationships. Relationship dissolution is a known acute risk factor for suicide.
- Access to lethal means. Firefighters have higher rates of firearm ownership and familiarity with lethal methods. Means restriction counseling — a proven suicide prevention strategy — is underutilized in the fire service.
- Stigma. Despite progress, the stigma associated with seeking mental health support remains the single greatest barrier to treatment in the fire service. The fear of being perceived as weak, of losing one's assignment, of being treated differently by the crew — these fears keep firefighters silent when silence is most dangerous.
Breaking the Stigma: The 2025 Safety Stand Down
The 2025 National Safety Stand Down, organized by the National Fallen Firefighters Foundation, focused its theme directly on this crisis: "Break the Stigma: Behavioral Health RESET." The RESET framework provides a structured approach that departments can implement immediately:
- Recognize the signs of behavioral health distress in yourself and in your crew members. Changes in behavior, withdrawal from social interaction, increased substance use, expressions of hopelessness, giving away possessions — these are warning signs, and every firefighter should be trained to recognize them.
- Educate your department on the reality of occupational behavioral health risk. This is not about weakness. It is about exposure. Firefighters develop PTSD and depression for the same reason they develop cancer — because of what the job exposes them to. Frame it as an occupational health issue, not a personal failing.
- Strategies for building resilience before crisis hits. Mindfulness training, stress inoculation, physical fitness, spiritual practices, creative outlets — the evidence base for proactive resilience building is strong and growing.
- Empower firefighters to seek help without fear of professional consequences. This means clear departmental policy that protects confidentiality, peer support programs that operate independently of the chain of command, and leadership that models help-seeking behavior.
- Training for all members on crisis intervention, suicide awareness, and peer support. The Question, Persuade, Refer (QPR) model and the Applied Suicide Intervention Skills Training (ASIST) program are evidence-based trainings that should be standard in every fire academy and every annual refresher cycle.
Peer Support: The Evidence-Based Lifeline
Of all the interventions available, peer support programs have the strongest evidence base for mitigating PTSD symptoms and reducing suicide risk in the fire service. The reason is straightforward: firefighters trust other firefighters.
A peer support program trains active and retired firefighters to provide confidential, nonjudgmental support to their colleagues. Peer supporters are not therapists. They are trained listeners who can recognize distress, provide immediate support, and facilitate referrals to clinical professionals when needed.
The effectiveness of peer support rests on credibility. When a 20-year veteran sits across from you and says "I've been where you are, and I got help, and it made a difference" — that carries a weight that no clinical brochure can match. Lived experience is the currency of trust in the fire service, and peer support leverages that currency for life-saving purposes.
If your department does not have a peer support program, advocate for one. The International Association of Fire Chiefs and the International Association of Fire Fighters both provide resources for establishing and training peer support teams.
Legislative Progress: The First Responders Wellness Act
On the federal level, the First Responders Wellness Act (S. 666) would establish grant programs to support mental health services, peer support programs, and family support resources for fire and EMS personnel. The legislation recognizes that behavioral health support for first responders requires dedicated funding — not an afterthought in the general health budget, but a line item that reflects the scale of the crisis.
State-level action is also advancing. Multiple states have enacted or expanded workers' compensation coverage for PTSD and other psychological injuries sustained in the line of duty. These laws recognize what the clinical literature has established: PTSD is an occupational injury, and treating it as such removes a significant barrier to treatment access.
What You Can Do Today
If you are in crisis right now, reach out. The 988 Suicide and Crisis Lifeline (call or text 988) is available 24/7. The National Volunteer Fire Council's Fire/EMS Helpline at 1-888-731-3473 provides confidential crisis support specifically for fire and EMS personnel. The COPLINE crisis line at 1-800-267-5463 serves all first responders.
If you are not in crisis but want to be part of the solution, here is what I ask of you:
- Check on your crew. Not the "how's it going" check. The real check. Sit down. Make eye contact. Ask the question. "Are you doing okay? Really?" And then listen. Don't fix. Don't minimize. Listen.
- Normalize the conversation. Talk about mental health the same way you talk about physical fitness. It's part of the job. It's not optional. It's not weakness. Every firefighter who seeks help makes it easier for the next one to do the same.
- Advocate for your department. Push for a peer support program. Push for confidential access to licensed clinicians. Push for critical incident stress management after significant calls. These are not luxuries. They are operational necessities.
- Take care of your retirees. Don't let retirement be a cliff. Invite retired members to department events. Check in regularly. Include them in peer support networks. The transition from active service to civilian life is one of the highest-risk periods, and connection is the most effective protective factor.
- Learn the warning signs. Take a QPR or ASIST training. Learn to recognize when someone is moving from distress to danger. Learn to ask the question directly: "Are you thinking about suicide?" Asking the question does not plant the idea. It opens the door. And sometimes an open door is the difference between life and death.
We Can Change This
The fire service has transformed itself before. We changed how we fight fires. We changed how we build apparatus. We changed how we train recruits. We can change how we treat behavioral health.
The 112 firefighters and EMS professionals who died by suicide in 2024 were not statistics. They were engineers and captains and paramedics and volunteers. They had families and hobbies and plans for retirement. They walked into fire stations every shift and did the job. And then, at some point, the weight became too much.
We owe it to them — and to the ones who are struggling right now, silently, behind the badge — to build a fire service where asking for help is as natural as pulling a hoseline. Where behavioral health is part of the annual physical. Where peer support is as available as the Jaws of Life.
We save lives for a living. It's time we got serious about saving our own.
If you're considering a career in the fire service, know that the job is rewarding and challenging in equal measure. Read our guide to becoming a firefighter and explore the full range of fire service careers. And know that taking care of your mental health isn't just permitted — it's expected.