Wisconsin Office of Rural Health, September 2025
For more than 30 years, James Small has been the person running toward the flames, sirens, and chaos. A firefighter. A paramedic. A police officer. A Fire & EMS Chief. A Police Chief. And today, the Rural EMS Outreach Manager with the Wisconsin Office of Rural Health.
Like so many first responders, James has seen more than his fair share of trauma. Car wrecks. Fires. Domestic calls gone bad. Overdoses. And the countless “routine” calls that don’t feel routine once you carry them home.
However, James’s story is also about something many first responders are less comfortable talking about: mental health.
Breaking the Silence
“When I started treatment [for Post Traumatic Stress Disorder] in 2016, responder mental health was a taboo topic,” James says. “I hid that I was in treatment for years because it meant weakness. But at the same time, I could tell that treatment was making me more effective at home and at work.”
For a long time, James assumed his decision to get help would lead to stigma or even rejection from his peers. When he began sharing his story, the opposite happened.
“I expected people to react negatively and look down on me,” he remembers. “Instead, I found a lot of people who were having similar things and asking what I did. I have never had an experience that was negative, so my fears were unfounded.”
The realization that speaking up could spark connection instead of isolation changed the way James saw his role.
PTSD in the Ranks
James’s experience isn’t unusual. In fact, research shows that first responders are at significantly higher risk for post-traumatic stress disorder (PTSD) than the general public. From the 2024 WI Fire and EMS Mental Health Survey, 89.4% of the 1,712 respondents indicated they had experienced a job-related critical incident or traumatic event.1 PTSD can result from the cumulative effect of repeated exposures to critical incident stress coupled with other stressors and factors such as sleep deprivation.2 The same mental health survey found that 78.8% of respondents reported at least one sleep problem, with 60% reporting multiple issues, underscoring how deeply critical incident stress disrupts rest.1 With the prevalence of sleep deprivation and chronic stress among first responders, it’s no surprise that 16.5% of them screened positive for probable PTSD in the past year, with nearly 5% showing symptoms in the past month.1
Closer to home, James points to findings from the yet to be published Wisconsin EMS Leadership Study conducted this spring: As many as 1 in 6 Wisconsin EMS Responders reported dangerously low well being measures.
Culture, Connection, and Change
So why does PTSD remain so heavy a burden? James is blunt: culture.3
“The culture in public safety has historically been to ignore these issues and tell people to suck it up,” he says. “This has led to extremely high rates of issues such as turnover, divorce, and suicide in the industry.” Data backs this up, with respondents who experienced a traumatic or critical event and were at full-time status, 13.6% reported thoughts of suicide or self-harm, 38.7% reported family or relationship problems, 16.7% reported substance abuse, and 59.0% reported being easily angered or withdrawn.1 Attempting to hide these struggles to fit in with the dominant culture can lead one to feeling inadequate and isolated.4
For James, one of the most important lessons from his extensive career has been that the role of a responder isn’t only about reacting in the moment, it’s also about being a facilitator of long term outcomes. Part of this is making connections with other resources that provide long term benefit to the people. “We have the ability to have tremendous impacts on people that make communities better,” he explains. That applies inward, too – how responders support themselves and each other, not just the people they serve.
In James’ experience, peer support programs are one of the most effective tools. Earlier this year, WORH sponsored several trainings in north central Wisconsin that prepared 70 responders to be peer supporters. The idea is simple yet powerful: responders are more likely to open up to peers informally before seeking therapy.
James himself is living proof. He first sought treatment after attending a responder mental health class where the instructor, another police officer, shared their own experience and suggested a treatment pathway. “One of the impacts of critical incident stress is being mistrustful of others who aren’t in public safety,” James notes. “Peer support is a good way to help people become aware of the impacts and sometimes get ahead of it before it develops into PTSD.”
Hawk Enters the Picture
This Labor Day, James’s work and journey took an unexpected turn at a Milwaukee Brewers game.
Through the Jefferson County Peer Support Team, where James volunteers, Jay and Vanessa Leonard nominated him to throw the first pitch at the Brewers game. They also connected James with Custom Canines, a service dog training organization. He loved the idea and joined their waiting list. On Labor Day afternoon, in front of a cheering crowd, James was shocked to meet his new companion Hawk, a trained service dog.
“Hawk is trained to help sense stress and help with recognizing when I’m experiencing triggers,” James explains. “He’ll also go with me for peer support volunteering. Dogs are used commonly at debriefings. Overall, I think he will be great at helping advocate for improving responder wellbeing.”
Research backs him up. Studies show that service dogs can significantly reduce PTSD symptoms, improve sleep, and increase emotional regulation for both veterans and first responders.5,6,7 While Hawk will help James directly, his presence will also ripple outward by bringing comfort and opening conversations in the many communities James serves.
The Hard Truths Behind the Medals
James is quick to point out that trauma doesn’t always come from tragedy. Even successful calls: ones where lives are saved, can leave a mark.
“I once could barely bring myself to attend a life-saving award ceremony because the call was very triggering,” James shares. “I was having extreme anxiety prior to the ceremony. At the time I didn’t know this was normal, but since then, I’ve heard other responders talk about it. None of my life-saving awards are displayed. I don’t want to think about those calls.” James’ experience echoes true among other first responders. The Fire and EMS Mental Health Survey revealed that of the respondents that reported having nightmares or unwanted thoughts about critical incidents, 71.9% reported trying to not think about the event(s) or going out of their way to avoid situations that reminded them of the event(s).1
It’s a powerful reminder that even what we see as “good things” may represent terrible memories to those who have been traumatized.
Building a Culture of Care
In his current role as Rural EMS Outreach Manager, James is determined to make wellbeing part of every conversation about system improvements.
“I try to bring responder wellbeing into the discussion when we are working on system improvements and sustainability,” he says. “Recognizing the humanity of the employee is critical. There should never be a situation where an emergency responder has their life ruined because they chose to try a job to help people, but it happens all the time. We have a duty to learn why these impacts happen and correct them.”
A Message to Fellow Responders
When James talks with responders struggling after a critical incident, his first message is simple: what you’re feeling is normal.
“It’s not your fault,” he emphasizes. “But it is your responsibility to do something about it. Don’t keep just sucking it up.”
Sometimes that “something” is a peer conversation. Sometimes it’s professional treatment. And sometimes it’s the steady presence of a dog like Hawk.
A Call to Action
James’s story is deeply personal, and it carries a universal truth: every EMS provider, firefighter, and police officer deserves good mental health.
We can all help by checking in with our friends and family in these lines of work. Ask how they’re doing, not just on the job, but really doing. Be willing to listen. Let’s work together to recognize all wounds received on duty, physical and emotional alike.
Resources for Wisconsin Responders & Their Families
988 Suicide & Crisis Lifeline (Wisconsin)
Call, text, or chat 988 for free, 24/7 confidential support. Operated statewide by Family Services of Northeast Wisconsin. Wisconsin Department of Health Services. https://www.dhs.wisconsin.gov/crisis/988.htm
Wisconsin Statewide Warmline (Peer Support)
Peer-run, confidential emotional support from Certified Peer Specialists. Served over 24,000 Wisconsinites in 2024. mhawisconsin.org
NAMI Wisconsin
Support groups, educational programs, and peer resources across the state. Find your local affiliate online. https://namiwisconsin.org/
SAMHSA National Helpline
Free, confidential referrals to local mental health services. 1‑800‑662‑HELP (4357). More information and other helplines run by SAMHSA: https://www.samhsa.gov/find-help/helplines
State Employee Assistance Program (EAP)
State employees can access six free counseling visits for mental health support. https://etf.wi.gov/
References
1. Rogers Research Center. (2024). 2024 WI Fire and EMS Mental Health Survey – Analysis.
2. Pappas, Stephanie. (2025). PTSD and trauma: New APA guidelines highlight evidence-based treatments. American Psychological Association. 56(5), 44.
3. Small, James. (2025). Supporting our Responders by Developing a Culture of Resilience. EMS Professionals. (2), 37-39. Supporting our Responders by Developing a Culture of Resilience
4. Novotney, Amy. (2019). The risks of social isolation. American Psychological Association. 50(5), 32.
Guardian Angels Medical Service Dogs. How Service Dogs Support First Responders with PTSD and Trauma Recovery.
5. Guardian Angels Medical Service Dogs. How Service Dogs Support First Responders with PTSD and Trauma Recovery.
6. TMS Institute of Arizona. (2025). New Study Links Service Dogs to Better Mental Health in Veterans.
7. Office of Research and Development, Department of Veterans Affairs. (2020). A Randomized Trial of Differential Effectiveness of Service Dog Pairing Versus Emotional Support Dog Pairing to Improve Quality of Life for Veterans with PTSD.