The Public Safety Group Blog

While EMS clinicians are taught how to respond to trauma in the field, they may receive less guidance on how exposure to suffering can affect their own well-being over time.  As a result, compassion fatigue in EMS and fire is often misunderstood and is rarely built into training in a meaningful way. This gap creates an important opportunity for educators to help students and first responders build healthier ways to manage the emotional demands of the job. 

Dr. Lisa Correll is a Solutions Consultant at the Public Safety Group with a background in fire and EMS. She began her career as an EMT and paramedic, later serving as a captain at Polk County Fire Rescue in the Safety and Training Division, where she developed a passion for education. After transitioning into academia, she held roles including adjunct instructor, clinical coordinator, program director, and Associate Dean of Health Sciences at Polk State College.  

Dr. Correll holds a PhD in Education with a focus on curriculum and instruction. She sat down with the Public Safety Group to discuss her research on how empathy, resilience, and repeated exposure to trauma shape first responders’ well-being.  

In EMS, most mental health conversations center around PTSD, but compassion fatigue is just as important to understand. Dr. Correll notes that the confusion around the term can make it that much harder for individuals to identify there may be a problem. 

“They hear compassion fatigue and they think it means ‘I’m tired of caring.’ This is not, ‘I’m tired of caring. I’m tired of being empathetic. I’m tired of doing this job.’ It is a mental health result… of being exposed to trauma, being exposed to the suffering of other humans,” she said. 

The difference comes down to the source of trauma. PTSD is typically tied to a traumatic experience that happens directly to the first responder such as being injured. Compassion fatigue, sometimes described as secondary traumatic stress, comes from exposure to other people’s suffering and trauma.  

“Compassion fatigue comes from the chronic exposure to people who are suffering and experiencing trauma. So simply hearing a traumatic story can make someone suffer from compassion fatigue,” Dr. Correll explains. 

What the Research Shows About Empathy, Resilience, and Risk 

In her dissertation, "Empathy, Compassion Fatigue, and Resilience in Central Florida Firefighters and EMS Personnel," Dr. Correll examined Central Florida firefighters and EMS personnel, looking at whether empathy correlated with compassion fatigue and whether resilience could predict levels of compassion fatigue. Her findings reinforced the protective role of resilience.  

“For every one point increase of resilience, it decreases compassion fatigue by 0.58,” Dr. Correll says. “And that shows just how important it is to work on developing resilience.” 

Dr. Correll's findings also pointed to how empathy and resiliency may shift over the course of a career. 

 “Empathy was lowest in the middle of our careers,” she said. “Compassion fatigue was the highest. But then towards the end of our career, resiliency was improving and so was empathy.” 

This fluctuation over time highlights the need for ongoing support throughout a first responder’s career. Compassion fatigue education should not be limited to orientation or initial certification. It should be revisited throughout the clinician’s career, especially during transitions into higher-stress roles or during long periods of high-call volume. 

One overlooked component that plays a major role in how EMS clinicians experience and respond to compassion fatigue is culture. Many are trained, formally or informally, to stay calm under pressure, compartmentalize quickly, and move from one call to the next without much discussion.  

“I think that this population really prides itself on emotional suppression over emotion regulation,” Dr. Correll says. “And those are two very different concepts.” 

Emotional suppression and may help a clinician function during a call, but regulation is what helps them process the experience afterward. Without regulation, emotions can remain unresolved and surface later as irritability, hypervigilance, detachment, or difficulty connecting with patients and colleagues. 

Dr. Correll says the culture of “suck it up” can put first responders at greater risk. 

"That probably still plays a part in it, is that culture of ‘suck it up’ rather than ‘how can we process this and how can we recover from this in a healthy way?’”  

Recognizing Compassion Fatigue in Students and First Responders 

Statistics show that nationwide, 73% of the EMS workforce report experiencing symptoms of compassion fatigue. Only 27% meet CDC recommended guidelines for sleep. Addressing compassion fatigue in training gives EMS students and clinicians the tools to recognize the warning signs early and avoid becoming part of those statistics.   

One of the biggest challenges is identifying compassion fatigue before it escalates. Compassion fatigue may show up in behavior, communication, classroom participation, clinical performance, or how someone responds to patients during stressful scenarios. Students and first responders may not recognize the signs in themselves. Dr. Correll cautions that warning signs may be behavioral before they are clearly verbalized. 

“You start to see maladaptive coping,” she says. “They are irritable. They’re very hypervigilant. They’re easily startled. They are quick to be agitated.” Dr. Correll also notes that the opposite behavior may present instead. A student or clinician who appears completely detached, dismissive, or unwilling to acknowledge any emotional reaction may also be struggling. These signs may indicate that the person has learned to suppress their emotions rather than regulate them in a healthy way. 

Symptoms of compassion fatigue can overlap with those of PTSD and burnout, which is why educators should avoid making assumptions and instead focus on creating space for support when concerning patterns appear. 

While it is part of the job for EMS clinicians to care about their patients and feel empathy for what they are experiencing, Correll says that it is possible to take it too far. Unhealthy empathy can pull responders too deeply into someone else’s trauma and can begin to affect how they process trauma and recover after difficult calls. 

“When you see unhealthy empathy, people are really identifying with the victim,” she says. “They feel like it’s them that’s experiencing it and not being able to pull back and saying, ‘Okay, this is someone else’s trauma. This is not yours.’ Healthy empathy would be showing that same compassion, the same drive to care for people, but also recognizing that it’s not yours.” 

Building Resilience Through Training and Education 

Resilience can be built in EMS education structured practice, realistic expectations, supportive feedback, and repeated opportunities to perform under manageable levels of stress. Dr. Correll says that training should be intentional, rather than treated as an afterthought.  

“I think it's really important that we start in the classroom, gradually increasing pressure, gradually increasing that stress through simulations and scenarios,” she advises. “So that we’re building resilience from day one in our classroom before they even get to clinicals, before they get to the field.” 

Structured practice helps students build confidence before they are expected to manage the pressure of real calls. First responders who feel clinically unprepared may have a harder time recovering from difficult calls, while repeated practice with assessment, communication, and decision-making can help students build both technical competence and emotional readiness. 

Simulation is one way to build that kind of practice into training, and it does not need to be high-tech to be effective. Dr. Correll notes that what matters most is whether the scenario helps students practice before they face those pressures in the field. 

“You don’t have to have all the bells and whistles,” she said. “You can do low-fidelity simulations, but still put your students or your employees in a mock environment that’s controlled stress.” 

Making Debriefing More Effective and Accessible 

Debriefing is where much of the learning and emotional processing happens, but it is also where many instructors feel least comfortable. A strong debrief gives students a way to connect what happened in a scenario with how they made decisions, managed stress, communicated with others, and recovered afterward. 

Language around “emotion” may feel uncomfortable or too personal to some students and clinicians. For instructors who are less comfortable discussing emotion directly, Dr. Correll suggests a simple shift in language to make the topic more approachable. 

“Maybe calling it ‘stress regulation’ and maybe just taking that word ‘emotion’ out of it might help some of them be more willing to approach the debriefing,” she said. 

This shift in language helps instructors address what is happening without triggering resistance. Instead of asking students to talk broadly about feelings, instructors can ask what they noticed in their body, where their stress affected decision-making, how communication changed under pressure, and what strategy they could use next time to reset and refocus. 

“We want to stress our students, but we don’t want to take them to the point of no return, because that’s going to negatively impact their learning,” Dr. Correll says.  

What Educators Should Do Differently 

EMS clinicians need compassion to communicate with patients, support families, and make human connections during some of the most difficult moments of someone’s life. The challenge is helping first responders use empathy in a way that is healthy and sustainable. Dr. Correll says educators and leaders should encourage empathy, not discourage it.  

“It’s our obligation to our employees and our students to teach them healthy empathy, healthy coping, and how to become more resilient through it so that we do better for our patients.” 

The emotional weight of EMS and firefighting work does not begin after graduation, and training should not wait until first responders are struggling to address it. By building empathy, stress regulation, resilience, and thoughtful debriefing into education from the start, instructors can help students enter the field with a more realistic understanding of the work ahead.