For paramedics, critical incidents evoke intense emotions and may result in later psychological difficulties. We examined 2 ways to deal with emotions after critical incidents: (a) identifying emotions, and (b) describing and expressing emotions, and their association with recovery from acute stress and psychological symptoms. We surveyed 190 paramedics, examining how impaired capacity to identify and describe emotions (alexithymia) and voluntary expression of emotions during contacts with others in the first 24 hours after the incident were associated with recovery from acute stress and current symptoms of PTSD, depression, burnout, and somatization. Overall alexithymia was not associated with recovery, but the component of difficulty identifying feelings was associated with prolonged physical arousal (χ2 = 10.1, p = .007). Overall alexithymia and all its components were associated with virtually all current symptoms (correlation coefficients .23–.38, p < .05). Voluntary emotional expression was unrelated to current symptoms. Greater emotional expression was related to greater perceived helpfulness of contacts (χ2 = 56.8, p < .001). This suggests that identifying emotions may be important in managing occupational stress in paramedics. In contrast, voluntary emotional expression, although perceived as helpful, may not prevent symptoms. These findings may inform education for paramedics in dealing with stress.