Cumulative exposure
Illness does not always follow a single major event. Exposure can accumulate over many incidents and years.
Initiative to establish an association
Those who help must not be left alone.
Helfern helfen advocates recognition of post-traumatic stress disorder (PTSD) among emergency personnel and other helpers as an occupational disease, assessment against transparent standards, and financial protection for those affected.
We are establishing an association and looking for people who want to help found it, contribute ideas or support the initiative.
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Why Helfern helfen?
An invisible illness with visible consequences
According to Statistics Austria’s 2025 survey, around 434,500 people volunteer in disaster relief and rescue services, contributing approximately 1.27 million hours each week.
The upper valuation scenario estimates the economic value of all voluntary work in Austria in 2021 at up to €10.1 billion. This total covers all fields of voluntary activity.
A society that relies on its helpers must also stand by them when helping makes them ill.
Sources: Statistics Austria, Voluntary Work 2025, Tables 19 and 22 (PDF, German); Non-profit Satellite Account, reference year 2021, p. 8 (PDF, German).
PTSD often goes unrecognised for a long time. Not everyone affected connects sleep problems, withdrawal, irritability or difficulties at home and at work with distressing emergency calls.
Some people try to dampen inner restlessness, memories or tension with alcohol, medication or other substances. Sometimes only the visible consequences are treated while the underlying illness remains undetected.
Early, confidential and easily accessible help can prevent symptoms from becoming entrenched and further health, family, occupational and social consequences from developing.
Many groups
Those affected may include paid staff and volunteers, civilian service participants, first aiders, dispatch staff, nurses, doctors, firefighters, police officers, military personnel and people who have already left these roles.
Gradual withdrawal
Some attend fewer incidents, move into background tasks and eventually leave the organisation altogether, without their illness being recognised as a possible consequence of their service.
Three core goals
Recognition. Standards. Protection.
PTSD as an occupational disease
Recognition is about more than compensation. It places responsibility on the relevant statutory accident insurance institutions to prevent work-related illnesses, provide appropriate treatment and support medical, vocational and social rehabilitation.
This creates a foundation for occupation-specific prevention, treatment and rehabilitation programmes.
Fair expert assessment
Austria’s Einschätzungsverordnung (disability assessment regulation) sets fixed percentages and percentage ranges for the degree of disability, including mental functional impairments. Placement within a range must be justified. For trauma-related mental conditions, there is no comparably binding, trauma-specific assessment framework for the reduction in earning capacity (MdE) under statutory accident insurance.
This gives expert reports particular weight in decisions about benefits vital to people’s livelihoods. Helfern helfen calls for understandable criteria, professional qualification standards and reviewable reasons for assessments. The degree of disability and MdE are different measures; their percentages cannot be directly transferred from one to the other.
Financial security
People who become ill through helping need more than a referral to therapy: reliable access to treatment, rehabilitation, support when returning and protection against losing their work, family stability and livelihood.
Law and reality
Two gaps in protection
1. Recognition
A single, time-limited traumatic event can be recognised as an occupational or service accident. If the same illness develops through repeated exposure over several shifts, recognition may fail because of the narrow definition of an accident. A gap remains while PTSD is not covered as an occupational disease.
2. Benefits after recognition
Even after recognition, expert opinions on causation and the assessment of MdE determine actual benefits. Without sufficiently binding standards for trauma-related mental conditions, medical distinctions and percentage ratings can decide livelihoods while remaining difficult for those affected to predict.
For the degree of disability, the Einschätzungsverordnung provides fixed percentages and ranges, including for mental functional impairments, and requires reasons for placement within a range. For trauma-related mental conditions, statutory accident insurance MdE lacks a comparably binding, trauma-specific assessment framework.
This second gap already exists for recognised occupational and service accidents. Adding PTSD to the list of occupational diseases would not automatically close it. Binding and understandable standards for assessing the reduction in earning capacity are also needed.
Independent constitutional and social-law review should examine whether the different levels of statutory detail raise questions about equal treatment, legal certainty and predictability.
OGH 10 ObS 48/21p
Exposure over several shifts
In the case of a police officer at Salzburg Central Station, Austria’s Supreme Court (OGH) denied recognition of a service accident in 2021 because PTSD developed over four shifts and no single incident clearly predominated. The case illustrates the gap between accidents and occupational diseases.
OGH 10 ObS 5/23t
Recognised, yet still without adequate protection
A tobacconist and trained paramedic provided first aid at a road traffic accident in 2020. The event was recognised as an occupational accident and as an essential contributing cause of PTSD. Nevertheless, he received no injury pension: the additional accident-related reduction in earning capacity (MdE) was assessed at five per cent and therefore did not reach the twenty per cent benefit threshold.
The proceedings also considered trauma-related mental impairments that predated this accident and were attributed to an earlier humanitarian deployment abroad. That deployment had not itself been recognised as an insured event and had resulted in no statutory accident insurance benefit. Nevertheless, the uncompensated component was treated as a pre-existing impairment when assessing the consequences of the 2020 occupational accident.
At first instance, the mental functional impairments were initially assessed together. Only after a supplementary discussion of the expert opinion on appeal were fifteen per cent classified as pre-existing and five per cent as accident-related. The OGH treated the medical coherence of this separation and the need for another expert opinion as matters of evaluation of evidence that it could not review.
The earlier component thus remained uncompensated while also limiting the assessment of the later recognised occupational accident’s effects. Recognition of the event alone does not guarantee adequate social protection.
Examine functional interaction
For trauma-related mental conditions, it is questionable whether mechanically separating pre-existing impairment from a new aggravation reflects the illness adequately. Different traumatic memories may remain distinguishable while affecting the same systems of threat processing, emotional regulation and everyday functioning. Expert reports must therefore explicitly examine and explain whether the effects can truly be separated or interact functionally.
Current scientific knowledge
Billing under ICD-10 does not mean ignoring ICD-11
Austria continues to use ICD-10 for documentation and billing. Expert opinions must nevertheless reflect current scientific knowledge, including professional consideration of developments in ICD-11.
In PTSD correctly diagnosed under ICD-11, significant impairment in important areas of life is already part of the diagnostic classification, or functioning is maintained only through significant additional effort. If the diagnosis is accepted while any significant functional impairment is denied, that apparent contradiction must be explained transparently.
This clinical finding does not automatically establish any MdE or disability percentage. It must, however, be appropriately reflected in an understandable assessment of functioning.
Sources: WHO ICD-11 CDDR (2024) · Psychotherapeutische Gutachten.
Record first aiders’ contact details
Follow-up begins at the scene
Helfern helfen calls for a statutory duty requiring police to record private first aiders and directly affected eyewitnesses at serious or potentially traumatising incidents. Ambulance and fire services must concentrate on urgent medical and technical measures. Recording people for follow-up should therefore become a clearly defined additional police responsibility.
Documentation should ensure that those affected receive information about possible trauma effects and can be contacted days or weeks later by a qualified, independent follow-up service. This requires a clear legal basis, data minimisation, defined deletion periods and protected contact details. Recording is not intended for surveillance or pathologising. Accepting support remains voluntary; people may decline further contact.
Voluntary follow-up after days and weeks can help identify symptoms early. Existing peer-support networks in many organisations are valuable, but cannot replace qualified treatment or social protection when illness persists.
Historical development
Recognition and devaluation have a long history
1889: “Traumatic neurosis” is recognised in Germany as a compensable consequence of an accident, not yet as an occupational disease in today’s sense.
Early debate and 1926: Unequal treatment of mental and physical accident consequences was criticised early on: particular susceptibility does not simply exclude entitlement for physical harm. In September 1926, a landmark decision by the Reich Insurance Office against compensation for mental accident consequences marked a legal devaluation.
1934–1939: Under National Socialism this developed into systematic deprivation of rights. On 3 July 1934, a legal mechanism was created to revoke final benefit decisions. Between 1934 and 1939, around 16,000 benefit entitlements of war-disabled people with mental illness were revoked. Those affected could be classified as hereditarily impaired, forcibly sterilised and later become victims of Nazi killings of patients.
1940: According to Stephanie Neuner’s historical account, ministerial official Kurt Günther of the Reich Labour Ministry declared that neurosis therefore no longer played any role in the Reich’s veterans’ provision system (English translation).
After 1945: This way of thinking did not disappear immediately. According to the specialist literature, the assumption of unlimited psychological capacity to compensate persisted in some assessments of Holocaust survivors until around 1991.
Today: The terminology of that era is outdated, but the central question remains: how does social law protect people who develop mental illness through their work or service?
This history calls for vigilance when trauma-related mental conditions are dismissed through alleged predisposition, the absence of an objectively visible injury or supposedly sufficient willpower. It does not equate present-day institutions with the Nazi system.
Literature: Neuner (2011), pp. 181, 184–185 and 198; Maercker (2013), p. 9.
What already works
Recognising good practice and building on it
German case law also demonstrates concrete progress: following the Federal Social Court (BSG) judgment of 22 June 2023 (B 2 U 11/20 R), the Baden-Württemberg Regional Social Court recognised a paramedic’s PTSD as a disease treated like an occupational disease (Wie-Berufskrankheit) on 14 November 2025 (L 8 U 3211/23 ZVW), retroactively from 7 April 2016. Recognition remained in place after the BSG dismissed the complaint against non-admission of an appeal on 12 June 2026 (B 2 U 7/26 B). This is recognition in an individual case under German law, not automatic recognition in Austria.
Peer support
Many Austrian organisations have established internal networks and further support services. This work deserves recognition and a reliable connection to independent treatment.
TASC, United Kingdom
The Ambulance Staff Charity provides confidential support and access to appropriate help for current and former ambulance staff and their families.
Repower: rehabilitation in Sweden
Programmes for Ukrainian paramedics and medical personnel illustrate how concentrated periods of rehabilitation with follow-up support can work. These models offer ideas, but cannot replace lasting care.
Association in formation
Turning a gap in protection into a movement
We welcome co-founders, people affected, family members, professionals and supporters who want to contribute to independent, evidence-informed and persistent advocacy.
Support the founding
Register interest in membership
Express a non-binding interest in membership once the association is established. This does not yet make you a member.
mitgliedschaft@helfernhelfen.at
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Register interest in donating
We are not currently accepting donations. Once the association is established and a transparent donation option with confirmed bank details is available, we will be happy to inform interested people.
Expression of interest: “Please inform me once the association is established and a transparent donation option is available.”
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Personal starting point
Why this initiative is being founded
The initiative was started by a trained paramedic and first-aid instructor who developed PTSD following a humanitarian deployment abroad. A later first-aid intervention at a serious road traffic accident aggravated the existing trauma-related condition. His social insurance proceedings revealed how far recognition and actual protection can diverge.
This personal story is not intended to stand alone. It is the starting point for a wider question: how do we treat the people whose willingness to help society relies on every day?
Acknowledgements
My thanks go to everyone who listened, accompanied and supported me, and did not look away, as well as those contributing their experience, time and expertise to this project. We publish names only with explicit permission.
Blog and newsletter
Latest developments
Read updates about the association and the initiative in our blog.
Blog posts also appear in the newsletter.
Go to newsletter registrationContact and press
We look forward to hearing from you.
Send a message
These contact details are also available for press enquiries, interviews and background discussions.
Possible enquiries: founding the association, support, personal experience, professional contributions or press enquiries.
Helfern helfen in the media
This section is being developed. Future coverage of Helfern helfen and the social protection of emergency personnel and first aiders with mental illness will be documented here.
For press enquiries, interviews and background discussions: kontakt@helfernhelfen.at. Sources and case references.
Important: Helfern helfen does not provide urgent medical or psychological counselling. If you need immediate support, please use the section Urgent help.
Urgent support
You do not have to face a crisis alone.
In immediate danger or a psychiatric emergency, call the ambulance service: 144. Austrian telephone counselling service: 142, available 24/7. In Upper Austria: Krisenhilfe OÖ 0732 / 2177, available 24/7.
These services are not a substitute for an emergency call. Depending on the organisation, they provide crisis support, guidance, counselling or ongoing support. Please check the target group and opening hours. Services may primarily operate in German; English-language assistance is not guaranteed.
Traumahilfe Österreich
Telephone support for acute crises and longer-lasting distress.
01 413 00 44
Mon–Fri 08:00–20:00
Weekends and public holidays 09:00–15:00
Vienna psychiatric emergency service
Immediate, accessible psychiatric assistance for people experiencing severe mental health crises in Vienna.
01 31330
Available 24/7
Second Victim Österreich
Anonymous, free and employer-independent advice for health and social care professionals following distressing or critical events.