Polyvagal Theory and emergency responders: How our nervous systems impact our lives

by Rhonda Kelly - Executive Director, All Clear Foundation

Emergency responders frequently face critical incidents and crisis situations. Their bodies and minds are trained to react in the moment. However, most are not trained on how to wind back down after a call, returning to a baseline of calm and safety. Many responders note that they try to do the “right things” to take care of their mental health and well-being. But they find those actions fail to have the desired impact. And they are left wondering why.

The answer might lie in polyvagal theory. Polyvagal theory is a framework that explains how the autonomic nervous system responds to stress and trauma and how it influences our emotions, behaviors, and social interactions. Dr. Stephen Porges introduced the theory in 1994, proposing that the vagus nerve – which connects the brain to various organs, including the heart, lungs and gut – has evolved to support three different states of the nervous system: ventral vagal, sympathetic, and dorsal vagal.

Through the lens of this theory, responders can better understand their own nervous system responses to stress and trauma and develop strategies to regulate their states, promoting safety, healing, and well-being.

The three states of the nervous system

Polyvagal theory proposes that these three states of the nervous system – the ventral vagal, the sympathetic, and the dorsal vagal – correspond to different levels of perceived safety or threat.  

  • The ventral vagal state is the optimal state for health and well-being. It enables connection with others, effective communication, and emotional regulation.  

  • The sympathetic state is activated when danger or challenge is perceived. It increases heart rate, blood pressure, and muscle tension to allow for fight or flight.  

  • The dorsal vagal state is triggered when we feel trapped, hopeless, or helpless. It causes us to collapse or withdraw from the world through immobilization, dissociation or shutdown. 

According to polyvagal theory, these three states are hierarchical. This means that we first try to use the ventral vagal state to cope with stress. If it fails, we use the sympathetic state. And finally, we use the dorsal vagal state if the sympathetic state is ineffective. Our nervous system is constantly scanning the environment for cues of safety or danger, without us being aware of it, according to the theory. This process is called neuroception. Our nervous systems respond to what our neuroception detects. If we become stuck in dorsal vagal or sympathetic inappropriately, the “right things” we do to take care of our health are not effective. We need to shift our states toward ventral to really benefit from them.  

Responding to crisis situations

Emergency responders are exposed frequently to crisis situations. Career or volunteer, they are trained to assess situations, anticipate the worst outcomes, and take actions to mitigate. This focus on prevention of negative outcomes can increase their natural negativity bias, shifting their neuroception toward threat mode even in nonthreatening situations. The resulting negative or crisis-focused thoughts can create internal states that push toward sympathetic or dorsal vagal states, keeping the nervous system from returning to a baseline of safety and calm.  

Frequent exposure to high levels of stress and trauma, if not countered, can affect mental health and well-being. This may explain why research has shown that emergency responders experience higher rates of depression, anxiety, post-traumatic stress injury (PTSI), substance misuse, and suicide than the general population. 

Polyvagal theory can help responders understand how their nervous systems react to stress and trauma and how to recover and enhance performance. Responders may experience frequent shifts between the sympathetic and dorsal vagal states, depending on the nature and intensity of the situations they encounter. They also may have difficulty accessing the ventral vagal state, which is essential for restoring balance and resilience. This can lead to chronic dysregulation of the nervous system, which can manifest as depression, anxiety, PTSI, or other mental health challenges. 

Applying the theory in daily life

One of the practical applications of polyvagal theory for responders is to actively foster being in a ventral vagal state as much as possible, on and off the job. They can do this by engaging in activities that promote feelings of safety, connection, and relaxation, including: 

  • Time with supportive friends and loved ones 

  • Breathing exercises to decrease heart rate and calm the nervous system 

  • Mindfulness practices to help stay present and increase awareness of sensations and emotions 

  • Body movements to release tension and increase flexibility 

  • Music or singing to soothe the brain and stimulate vocal cords 

  • Hobbies to engage the mind constructively and create a flow state 

  • Humor and playfulness to lighten moods and foster connection 

  • Compassion and kindness toward ourselves and others 

For responders who experience persistent or severe symptoms of depression, anxiety, PTSD, or other mental health issues, seeking qualified professional mental health help can decrease suffering and speed recovery. Therapy can help with processing traumatic experiences, managing the nervous system, and strengthening coping skills.  

Some of the therapeutic approaches that are based on or compatible with polyvagal theory include eye movement desensitization and reprocessing (EMDR), cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), sensorimotor psychotherapy (SP), somatic experiencing (SE), neurofeedback (NF), or polyvagal-informed therapy (PIT). 

Polyvagal theory is often called the science of safety. It can help responders understand how their nervous systems respond to stress and trauma and how to heal. By enhancing the ventral vagal state and seeking appropriate treatment when needed, responders can improve their mental health and well-being, increasing their satisfaction on the job and in life.  

Rhonda Kelly founded ResponderStrong, a collaboration between the National Mental Health Innovation Center at the University of Colorado Anschutz and emergency responders, in 2016 to build better mental health support for responders and their families. ResponderStrong’s approach is driven by emergency responders from across disciplines – including law enforcement, fire, EMS and dispatch working with their advocates including researchers, educators, clinicians and foundations. 

She started her career as an expanded-practice EMT working aboard icebreakers for the U.S. Antarctic Program. While transitioning to land-based employment, she volunteered as an EMT for a rural ambulance service. She worked fulltime for Rural Metro ambulance in Aurora, Colorado, before being hired as a Firefighter/Paramedic for Aurora Fire, where she served for 17 years. During that time, she also obtained her RN license and worked PRN as an emergency department (ED) and Psych ED nurse for Centura Health. She left Aurora Fire in March 2017 to operate ResponderStrong fulltime, growing the initiative beyond Colorado. 

In January 2020, she transitioned ResponderStrong to its new home within the All Clear Foundation and accepted the position of Director of GMR Life with Global Medical Response, where she focuses on overall wellness. FirstNet is a proud sponsor the ResponderStrong curriculum at the All Clear Foundation – which bring evidence-based tools to responders across the nation.