Unique Experience of Off-Duty First Responders When Responding to Cardiac Arrest

What happens when off-duty first responders provide care?

When responding to a cardiac arrest, the experience for first responders can vary significantly depending on whether you are on-duty or off-duty. While on duty, you have access to all the necessary equipment, resources, and support from your team. Whereas off-duty, you may find yourself ill-prepared, lacking proper tools, facing the emotional burden of acting alone, and often assisting a loved one or someone you know. It can also be said that there is an unwritten expectation by those close to you that you can and should act to save a life without an issue and will be better able to process it effectively.

First responders like yourself, whether you are a paramedic, EMS, firefighter, or police officer, undergo extensive training, hone your skills, and gain valuable experience from peers. You are used to working in teams, alongside technology and equipment for monitoring, compressions, and airway management- ensuring a well-coordinated and effective response. This sense of preparedness and the support of your fellow team members can give you the confidence to face challenging situations with a higher level of cognitive readiness.

As an off-duty first responder, you are not in the same advantageous position, working with limited knowledge and resources. Your training, though fundamental and specialized, might not adequately prepare you for the complexities of handling a cardiac arrest without the assistance of a team and proper tools. The concept of CPR is simple – to provide chest compressions, which in theory is simple to follow for an experienced first responder. However, what is missing is the continuous validation in the form of information feedback. As an off-duty first responder, you may have the knowledge of what the cardiac arrest patient needs to survive, but may not have access to the necessary tools, for example, a defibrillator to provide shocks. The knowledge of what is potentially happening, but not being able to correct it can cause a deep sense of moral injury. 

What makes acting to save a life different for first responders off duty compared to the general public is the idea of tunnel vision. A first responder has experience and is less likely to get tunnel vision, and you can be bothered by everything that “is not” happening for the cardiac arrest patient, even second-guessing your own actions because you don’t have validation from your team or technology. Your training will likely have had a minimal emphasis on the reality of acting unprepared and without essential equipment in a life-or-death situation. As a result, you may be burdened by doubts and uncertainties when attempting to save a life off-duty.

Another challenge faced by an off-duty first responder is the lack of access to your full range of equipment and resources. Without technology or other specialized tools, your ability to provide the same level of care as you would on duty becomes compromised. The frustration of being unable to render optimal aid can be disheartening and adds to the burden you may carry during these moments of acting to save a life. There are times that even when acting on duty and equipment fails, there is a level of frustration that is felt. 

The emotional toll on an off-duty first responder can be immense and often not discussed amongst first responders. Responding to a cardiac arrest without the support of your colleagues leaves you feeling isolated and sometimes overwhelmed. In cases where it is a friend or a loved one involved, you are often perceived to be the pillar of strength because you “see it every day,” not allowing you to express your emotions or feelings. You may experience intense stress and trauma, especially if your efforts are not successful. Witnessing a life slip away in such circumstances elicits feelings of helplessness and sadness, impacting your mental well-being and resilience just like any other person. First responders are often encouraged to develop coping mechanisms for work-related stress, but never for off-duty situations.

While an off-duty first responder is driven by a strong moral obligation to help others, you must also consider your personal safety when responding to emergencies while off-duty. Acting without backup or support exposes you to potential danger, risking your own well-being. Striking a delicate balance between your duty to save lives and ensuring your own safety can create inner turmoil and stress. In addition to safety, the vicarious exposure of not being able to assist when you have the knowledge and skills to do so can be emotionally challenging.

First Responder Insight: “I was on a trip, and I saw 2 people being stabbed, and by the time I was able to get over to assist the victims, the area had been sealed off. I watched as the EMTs struggled, and I knew I could help, I saw what they didn’t, I knew what they missed, but all I could do was watch. I felt connected because I saw it happen and felt useless because there was nothing I could do. I don’t know why it bothers me so much…”

It is also important to acknowledge that for a first responder, acting in good faith is a conscious decision because you know what happens behind the scenes, after the call, and the legal elements. Acting to save a life in a public setting, after an incident where criminal activity took place, or charges might be laid after an auto accident, a first responder knows that you may be called as a witness or testify for or on behalf of someone, and you are held to your professional standard when acting selflessly off-duty. 

We need to acknowledge that acting off-duty is sometimes one of the most complicated aspects of being a first responder, and in those critical moments, it’s normal to question yourself: “Do I walk away and do nothing or accept all that I know and act without the resources to potentially change an outcome.” 

Stepping in to assist during emergencies while off-duty can blur the lines between a first responder’s professional and personal life. Navigating these emotions and maintaining a sense of normalcy in their personal relationships can also be challenging.

The difference in responding to life-threatening emergencies like cardiac arrest while on-duty versus off-duty highlights the unique challenges faced by a first responder. The lack of equipment, resources, and support, combined with the emotional toll, can have a profound impact on your well-being. Despite these difficulties, many off-duty first responders continue to answer the call of duty out of a deep sense of responsibility and compassion. As a society, we want to acknowledge that whether you are struggling because you acted to save a life off-duty or choose not to act, we see you and understand the burden it has.

Thank you to our contributors

Paul Snobelen & Curt Mahoney