Moral Injury in First Responders, Understanding the Hidden Wound

There is a quiet wound spreading through the fire service, EMS, policing, and every corner of public safety. It is not always visible, it rarely announces itself, and most people working on the front lines don’t have the language for it. Yet it shapes how they see themselves, their communities, and how they carry the hard moments long after a call is over.

That wound is moral injury.

In this conversation, Dr. Lorraine Smith McDonald, Assistant Professor and long-time researcher at St. Stephen’s College and the University of Alberta, brings more than a decade of research and lived experience supporting military members, veterans, firefighters, paramedics, and police officers. Her work explores the emotional, psychological, and spiritual impact of being exposed to events that violate deeply held beliefs, values, and expectations.

“It’s not just my morals that are injured, but the very core of myself. It’s an injury to selfhood.”

This episode pulls back the curtain on what moral injury truly is and why first responders experience it so often. It is a conversation that every public safety professional should hear, because moral injury is far more common than most people realize.

First responders often assume the heaviest impacts come from the major traumatic calls. But according to Dr. McDonald, the deeper wound is frequently something different, something slower, something more internal. She describes moral injury as “what happens to our humanity in the face of inhumanity,” a line that captures the essence of what so many in public safety feel but struggle to name.

While PTSD (or Operational Stress Injury) is often rooted in fear-based responses, moral injury strikes at the core of identity, meaning, purpose, and selfhood. Firefighters, paramedics, and police officers are repeatedly placed in situations where they cannot act in alignment with their values or must witness harm they cannot fix. Over time, this creates a spiritual, emotional, and psychological wound that erodes one’s sense of self.

And the most surprising part for many listeners is that moral injury does not require a single catastrophic event. It can build slowly, call after call, expectation after expectation, year after year.

Dr. McDonald’s journey into this work began with military chaplains describing a type of guilt and shame they couldn’t name during the Afghanistan war. As she studied veterans, she found that many weren’t just struggling with trauma, but with the impact those events had on their identity and their belief in themselves as moral beings.

When she expanded her research into first responders, the patterns became unmistakable.

Firefighters and paramedics talked about being expected to fix society’s deepest, most chronic problems, even though they knew they couldn’t. Police officers described the “underbelly of society,” a constant exposure to situations that challenge one’s belief in humanity. And across every discipline, organizational betrayal and values misalignment were major contributors to moral injury.

She describes moral injury as an ontological wound, an injury to one’s very being. Not just a moment of guilt, but a profound disruption in how a person understands themselves and the world.

This reflects what countless first responders feel, often without language for it:
• The jadedness
• The loss of compassion
• The dark humour
• The internal conflict
• The erosion of purpose
• The quiet feeling of “I am not who I used to be.”

Moral injury, as Dr. McDonald explains, is not a rare phenomenon. It is everywhere in public safety, often unspoken yet profoundly felt.

Understanding moral injury is not about pathologizing first responders. It is about giving people vocabulary, validation, and a framework for healing.

Dr. McDonald highlights several ideas that lay the foundation for moral repair and resilience. These include knowing your personal values, reconnecting with meaning, practicing forgiveness and self-compassion, expanding your worldview to make sense of difficult experiences, and ensuring your identity is not tied solely to your job.

She also explains what organizations can do, including restoring trust, being transparent, aligning stated values with real behaviour, and acknowledging that moral injury is happening at every level, including leadership.

Most importantly, she emphasizes that moral injury is not a sign of weakness. It is a sign that someone still cares, that their values remain intact even when challenged, and that their humanity is still very much alive.

When first responders understand moral injury, what was once a confusing internal struggle becomes something nameable, workable, and deeply human.

Top Five Takeaways From the Conversation

1. Moral injury is an injury to selfhood, not just emotion.

It affects identity, meaning, purpose, and worldview. It is the “undoing of character,” as early researchers described, and many first responders feel this erosion without knowing its name.

2. Moral injury is far more common than people realize.

In Dr. McDonald’s study, 77 percent of firefighters interviewed had experienced at least one morally injurious event. Many experience it repeatedly throughout their careers.

3. It is not the big traumatic calls that cause the most harm.

The real damage often comes from chronic societal problems, impaired systems, organizational betrayal, and being placed in situations where no good choice exists.

4. The symptoms are emotional, spiritual, and relational.

Loss of compassion, anger, cynicism, regret, shame, isolation, and the sense that one’s humanity is slipping away are all common indicators.

5. Moral resilience is possible.

By understanding values, practicing self-compassion, reconnecting with meaning, nurturing identity beyond the job, and receiving organizational support, first responders can begin to repair these internal wounds.

Moral injury deserves to be part of every conversation about first responder wellbeing. If this episode opened your eyes, challenged your thinking, or helped you find words for experiences you’ve carried alone, please share it with someone who needs it.

Subscribe to Beneath the Helmet, share this episode with your crew, and help bring moral injury into the conversations that matter most.

Stay well.

Arjuna George - Show Host