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The nature of a first responder's occupation continuously puts them in harm's way as well as regularly expose them to others who have been injured or harmed. First responders are normally the first people on the scene and experience difficult situations. They are the first to help survivors and give emotional assistance to people caught in a trauma situation. The responsibilities that first responders have are very important but over time have put their well being and overall health at risk. Trauma is the emotional shock that follows a very stressful event or a physical injury. These occupations subject individuals to a great deal of traumatic events, resulting in a higher risk of developing post-traumatic stress disorder , major depressive disorder , panic disorder , and generalized anxiety disorder. Exposure to multiple traumatic stressors could also exacerbate other pre-existing conditions. The presence of any mental health disorders in these individuals can also be associated with diminished ability to work efficiently, early retirement, substance abuse, and suicide. The term First responders was written in The U.S. Homeland Security Presidential Directive, HSPD-8, defines "The term "first responder" refers to those individuals who in the early stages of an incident are responsible for the protection and preservation of life, property evidence, and the environment, including emergency response providers" The term first responder can refer to Law enforcement, Firefighters, EMT's, Paramedics, Dispatchers, and soldiers.