For most of us, our first responders -- police officers, firefighters, emergency medical technicians and paramedics -- are part of our local fabric. We may nod to the cop on the beat, wave to a crew of firefighters as they pass by, or pull over obediently when an ambulance races by us. But we generally take these men and women for granted. We just trust that they will be there to help us through whatever disaster or crisis may befall our home or our community. But who is there to help these helpers?

We got a glimpse of how stressful a first responder's job can be when we watched in awe as brave firefighters climbed the steps of the World Trade Center on September 11, 2001, risking their lives to save others. And we saw the overwhelming plight of New Orleans police officers during the Hurricane Katrina disaster.

But for every traumatized New York firefighter or New Orleans police officer, there are thousands of other first responders in cities and towns big and small who go to work every day not knowing if that day will be calm or calamitous. The constant potential for danger can be stressful in itself, and when actual emergencies do arise, first responders are even more vulnerable to stress-related illnesses and outcomes. Many fire and police departments across the nation are also experiencing budget cuts and staffing shortages, adding to the daily pressures.

One study conducted by the U.S. Department of Justice's National Institute for Justice revealed that police are at higher risk for heart disease, hypertension, alcohol abuse, migraine headaches, and insomnia. According to the National Police Suicide Foundation, the number of deaths due to suicide is two to three times the number of line-of-duty deaths among law enforcement agencies and emergency workers.

Historically, alcohol has been the accepted "stress reliever" among first responders, and studies confirm this group's vulnerability to alcohol abuse. A Chicago Police Department study linked alcohol abuse to 60 percent of police officer suicides.

"There used to be more drinking on the job 40 years ago," said Sgt. Steve Wickelgren, coordinator of the Minneapolis Police Assistance Program and a former patrol officer. "We all heard the stories about the beat cop who poured a little something into his coffee cup. That culture has changed, but 'choir practice' [when officers get together after work to let off steam and have a few drinks] still goes on, and drinking problems -- though significantly less -- are still there."

Addressing the issues of stress and stress management with new recruits is one way to prevent alcohol abuse, says Wickelgren. Toward that end, he offers a stress management presentation at the recruit school and another one-hour class that acquaints recruits with the department's confidential services if any officer wants to discuss an issue, from drinking to domestic or anger problems.

"They come in for different reasons, but communication and control are most often the common denominator," he said. "No big surprise, since cops are used to being in control, and they often suck at communicating."

Wickelgren also volunteers with the Metro Critical Incident Stress Management Team, a group of peer helpers who make themselves available to first responders after a stressful event, such as a gruesome accident scene, a body recovery, or a fellow employee's death. The team uses a peer-driven "defusing and debriefing" model specifically designed for emergency personnel. With the assistance of mental health professionals and chaplains, this confidential process allows first responders to talk freely about an event. Wickelgren says talking about a traumatic event with someone who "has been there and done that" is often very healing and comforting.

Despite the strides that have been made in the area of stress management and alcohol abuse prevention, Wickelgren says there is still a stigma among many emergency workers that prevents them from getting help when problems do arise. "There's the attitude of 'We're the helpers; we're tough; we can handle it.'"

Wickelgren says that many alcoholic first responders who suffer from such "terminal uniqueness" benefit from going to regular Alcoholic Anonymous meetings, where they learn they aren't much different than the other recovering people who gather in mutual-help groups.

Download the U.S. Substance Abuse and Mental Health Services Administration's stress management and prevention guide for emergency workers.

--Published October 2, 2006