By Dr. Hayder Mazin
FROM AWARENESS TO ACTION
They answered the call during the world’s darkest hours. EMS professionals worked through relentless waves of trauma, grief, and exhaustion—often without the time, tools, or support to process what they endured. As detailed in Part One of this series, the psychological toll of that reality has left a lasting imprint: elevated rates of anxiety, depression, PTSD, burnout, and suicidality among frontline responders.1,2,3
Yet understanding the depth of the crisis is only the first step. The true challenge lies in building systems that protect the mental health of those who protect us. It is no longer enough to raise awareness or offer reactive support after a crisis strikes. The next frontier of EMS resilience demands proactive leadership, embedded mental health infrastructure, and culturally competent behavioral health support.
One such leader is Joseph Brigandi, NREMT, MEd, NCC, LPC—an EMS veteran turned licensed psychotherapist, and the founder of the First Responder Behavioral Health Institute (FRBHI). Drawing on decades of field experience and clinical practice, Brigandi has designed a replicable, trusted model for integrating mental health care directly into the culture of emergency services.4
This second installment in our JEMS series shifts the focus from crisis acknowledgment to solution activation, profiling FRBHI as a scalable blueprint for departments ready to make behavioral health a strategic, operational, and ethical priority.
FROM RESPONDER TO REFORMER
Brigandi’s story begins not in a therapy room, but in the back of an ambulance. At just 17 years old, he entered emergency services—rushing toward crises, stabilizing patients, and witnessing the worst of humanity with little to no emotional support. While his technical skill sharpened over the years, one truth became increasingly clear: no one was caring for the caregivers.
The moments of trauma he and his colleagues experienced were routinely met with silence. There were no psychological debriefings, no embedded mental health professionals, and no formal systems for processing emotional fallout. “There were no behavioral health support systems designed for us,” Brigandi recalls. “And there was no training to help us understand what we were carrying home.”
That void—raw and personal—became the catalyst for change. Brigandi pursued licensure as a professional counselor, determined to bridge the gap between emergency services and behavioral health. But instead of leaving EMS behind, he fused both worlds to launch the FRBHI.
His vision was as practical as it was urgent: to build a culturally competent, field-proven model that would offer EMS professionals what he never had—accessible, relevant, and trusted support. Today, FRBHI stands as a mission-driven organization grounded in clinical insight, lived experience, and a single unshakable belief: those who serve on the frontlines deserve more than gratitude—they deserve real care systems.
WHAT REAL CHANGE LOOKS LIKE
At the core of the FRBHI lies a transformative principle: mental health care must be trusted, culturally attuned, and logistically practical for the high-pressure world of emergency services. For Brigandi, that meant designing a system that didn’t just treat the symptoms of burnout, but anticipated and addressed them before they could escalate.
FRBHI’s model is not built around a single intervention, but around a flexible ecosystem of trauma-informed, evidence-based, and field-compatible programs. Each initiative is constructed with the understanding that first responders need support that fits into their schedules, language, and lived experience.
Among its flagship offerings:
- On-Demand Certification Programs that cover trauma resilience, psychological first aid, and emotional regulation. These are crafted to align with unpredictable shifts and high-call-volume environments.
- Specialized Courses such as Breaking Bad News, Crimes Against Children, and Personal Trauma Awareness, which focus on emotionally complex, under-discussed areas of EMS practice.
- Crisis Response Teams, deployed on-site during or immediately after critical incidents to provide real-time psychological support, are often embedded directly within EMS operations.
- Peer Support Integration, which trains frontline responders to identify, approach, and support colleagues in distress, creating safe, internal touchpoints for early intervention.5.6
- Leadership Consultation equips EMS administrators with the tools to build psychologically safe teams, recognize warning signs, and integrate wellness into operational policy.7
What distinguishes these programs is their clinical integrity matched with cultural realism. Unlike many off-the-shelf wellness modules, FRBHI’s offerings are field-tested, shift-adapted, and often free or low-cost, ensuring scalability across departments of all sizes.
“Our trainings don’t sit on a shelf,” Brigandi explains. “They’re built to walk into the firehouse, the ambulance bay, or the shift meeting. Because that’s where the need lives.”
In an industry that has historically leaned on reactive support after traumatic events, FRBHI offers something more rare and radical: a proactive, preventative model of mental health readiness—designed not to respond to crisis, but to build resilience long before crisis occurs.
WHAT’S STOPPING PROGRESS
Despite the rise in national awareness surrounding first responder mental health, access to meaningful care remains uneven, inconsistent, and often inadequate. According to Brigandi, the issue isn’t simply awareness—it’s systemic inertia and a persistent disconnect between the realities of EMS work and the support structures meant to serve it.
One of the most glaring barriers is the overreliance on generic Employee Assistance Programs (EAPs). While these services may exist on paper, they’re rarely tailored to the unique needs of EMS providers. “You can’t just hand someone a hotline number and expect them to trust it,” Brigandi explains. Many responders have learned from experience that these programs are under-resourced, hard to access, or staffed by clinicians who don’t understand the emotional architecture of the job.8
Another structural problem is clinician mismatch. Too often, mental health providers assigned to EMS personnel lack familiarity with field-specific stressors, leading to miscommunication, frustration, and early disengagement from care. “You wouldn’t send a pediatrician to treat a firefighter with PTSD,” Brigandi notes. “So why send a therapist who’s never seen a fatality scene?”
Add to this the educational bottleneck faced by aspiring EMS clinicians. Those who wish to transition into behavioral health roles often encounter licensing requirements that are prohibitively expensive, time-consuming, and poorly aligned with shift work. FRBHI addresses this by mentoring field personnel and creating low-barrier pathways into trauma-informed practice.
And then there’s the cultural barrier—the silent stigma that still equates help-seeking with weakness. Despite national campaigns to normalize behavioral health conversations, many EMS professionals remain reluctant to speak openly, especially within hierarchical structures. The result is a delay in care, or worse, no care at all.
“We have to reframe resilience,” Brigandi says. “It’s not about suppressing pain. It’s about having the systems and language to address it.”
FRBHI was created to dismantle these barriers. By embedding culturally competent clinicians, building trust through peer support, and tailoring education to the real conditions of EMS life, the Institute offers a practical, scalable, and field-honest model of mental health engagement—one that meets responders not where we wish they were, but where they are.
ADVICE FOR EMS AGENCIES
When asked what EMS agencies can do right now to better protect their personnel, Brigandi is both direct and optimistic: “You don’t need a million-dollar grant to start doing the right thing. You need the will to lead.”
Based on his experience working with dozens of departments across the U.S., Brigandi identifies four core pillars that any EMS agency, regardless of size or budget, can implement to build a sustainable culture of psychological safety and support:
- Integrate Mental Health into Training and Policy
Behavioral health should be woven into the operational fabric of EMS, just like CPR recertification or equipment drills. That includes structured education on burnout, trauma exposure, coping skills, and early warning signs.
“If it’s not in your training calendar, it’s not in your culture.”
This integration aligns with national recommendations that promote annual mental health refreshers as a protective measure for high-risk professions.7
- Partner with Culturally Competent Providers
Agencies should proactively identify therapists and organizations, like FRBHI, that specialize in first responder mental health. Building those relationships in advance ensures that support is ready before a crisis occurs.
“Our clinicians speak the language of the field. That’s how trust begins.”
- Empower Peer-Led Support Structures
Peer supporters aren’t a substitute for therapy, but they are a crucial frontline layer. Agencies can train seasoned staff to recognize stress signals, offer emotional triage, and refer colleagues to appropriate resources. These programs increase help-seeking behavior and reduce stigma.5 - Build a Culture of Psychological Safety Through Leadership
Supervisors and training officers shape more than operations—they shape norms. Leaders who speak openly about fatigue, stress, and vulnerability create environments where others feel safe to do the same.
“Leadership isn’t just about the call—it’s about what happens after.”
By building around these four pillars, EMS leaders move from crisis reaction to strategic prevention. As Brigandi emphasizes, resilience doesn’t start after the trauma—it starts long before. The agencies that succeed in this next chapter will be those that lead with both courage and structure.
A VISION FOR THE NEXT DECADE
For Brigandi, the future of EMS mental health support isn’t abstract—it’s visible, attainable, and long overdue. While awareness has grown and small-scale initiatives have emerged, the next decade must deliver comprehensive, systemic reform that treats psychological well-being as a core operational priority.
At the center of his vision is a bold but pragmatic goal: to make mental health education accessible, affordable, and foundational for those entering and advancing in EMS. “We need to dismantle the barriers that keep our own from becoming licensed professionals,” Brigandi says. That’s why FRBHI offers no-cost certifications and mentorships that prepare field personnel to serve not just as responders, but as culturally competent clinicians themselves.
Brigandi also imagines a future where mental health professionals are embedded within EMS agencies—not as external consultants, but as fully integrated members of the operational ecosystem. Much like physical safety officers or training captains, behavioral health specialists would monitor team dynamics, conduct debriefs, and serve as trusted support hubs for responders at all levels.
“Just like we budget for radios or turnout gear, we must budget for behavioral health. It’s equipment for the mind.”
This vision includes structural reforms, too: national policies that promote behavioral health parity, funding that prioritizes preventative mental health models, and leadership benchmarks that incorporate psychological wellness as a metric of success.
Importantly, Brigandi’s vision is not built on idealism—it’s built on what FRBHI is already doing today. The question isn’t whether we can achieve this future—it’s whether we have the will to scale it.
“Let’s stop patching wounds in silence. Let’s build the system we needed yesterday.”
A REPLICABLE MODEL
The story of the FRBHI is not just one of innovation—it is one of replication. What Brigandi has created through FRBHI is more than a single solution; it is a scalable, field-tested blueprint for EMS agencies and leaders nationwide.
This model works because it’s built on lived experience, clinical excellence, and operational insight. It meets EMS providers not with slogans, but with systems—programs, partnerships, training, and trust. These aren’t abstract concepts; they’re actionable strategies that agencies of all sizes can adapt to their contexts.
And now, the challenge belongs to all of us.
This is the next evolution of EMS leadership: not defined solely by rapid response or clinical precision, but by the courage to institutionalize care for the caregiver. That leadership can come from a medical director, a shift captain, a wellness coordinator, or anyone who decides to stop accepting burnout, silence, and turnover as the cost of doing business.
“When we protect our people, we protect the mission,” Brigandi says. “And when we invest in mental health, we invest in operational strength.”
The tools are here. The models are working. The urgency is real.
Now is the time to lead.
ABOUT THE AUTHOR
Dr. Hayder Mazin is a physician, medical writer, and the visionary founder of MedLexis. With expertise in emergency medicine and digital health, he creates medically infallible content that empowers professionals and patients alike. He is committed to bridging science and compassion through transformative writing.
REFERENCES
- Anderson, J. R., & Taylor, R. E. (2022). Mental health and well-being among EMS professionals: A national survey. Journal of Emergency Medical Services, 49(3), 202-208. https://doi.org/10.1177/02770790211050839
- Liu, H., & Zhang, X. Y. (2021). Prevalence of depression and anxiety in EMS workers: A systematic review. Occupational Health Science, 5(4), 489-500. https://doi.org/10.1007/s12199-021-00772-6
- Ruderman Family Foundation. (2021). The mental health crisis in EMS: Rates of suicidality among first responders. https://www.rudermanfoundation.org/reports/ems-suicide-crisis/
- Brigandi, J. (2025). Interview with Dr. Hayder Mazin on EMS mental health infrastructure and FRBHI initiatives [Unpublished interview].
- Cooper, J. L., & Burns, R. E. (2022). Peer support programs for EMS workers: A model for mental health interventions. Journal of Emergency Services, 39(2), 119–124. https://doi.org/10.1097/JES.0000000000000356
- Johnson, L. E., & Weathers, S. C. (2021). The role of peer support in mitigating burnout in EMS: A review of the literature. Journal of Mental Health in Emergency Medical Services, 8(3), 134–140. https://doi.org/10.1016/j.jme.2021.07.004
- Thomas, J. K., & Richards, H. L. (2022). Burnout and its impacts on EMS: A national survey on the emotional toll of the job. Prehospital Emergency Care, 26(2), 123–131. https://doi.org/10.1080/10903127.2021.1914358
- Davis, S. P., & Nash, R. D. (2021). Stigma and mental health barriers in EMS: The cultural challenges of seeking support. Occupational Health Psychology Review, 4(3), 220–229. https://doi.org/10.1080/23801078.2021.1948065
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