Answering the Call and Sounding the Alarm

By Deborah C. Beidel, Ph.D., ABPP, Director, UCF RESTORES, University of Central Florida and Dustin Hawkins, Lieutenant, Indian River County Fire Rescue

Firefighters commit one-third of their lives to other people’s emergencies. Responding to a lifetime of rescues, medical calls, and fires can ignite visceral memories, behaviors, and nightmares that leave scars within the first responder’s hearts, minds, bodies, and souls. Sadly, the names on memorial walls of our fallen have continued to grow, and even the finest equipment cannot fully protect firefighters from the ruthless effects of cancer and the painful psychological impacts of this career.

Occupational hazards such as physical exhaustion, smoke, heat exposure, and sleep restriction can “prime” firefighters and make them vulnerable to the potential psychological impacts of their work.1 Exposure to these hazards produce biochemical changes within the body, creating a heightened (and chronic) state of hormonal stress. This chronic state of stress makes firefighters more vulnerable to the development of PTSD, depression, and even suicide, when acute and catastrophic traumatic events occur. Rightfully, programs have been developed to prevent physical injuries and disease. A similar effort is needed to prevent, or at least lessen, the occupational hazard of psychological stress injuries. Here we present the framework for one mitigation approach, used in the aftermath of the Champlain Towers South condominium collapse.

The condominium collapse in Surfside, Florida resulted in the third highest death toll in US history (excluding terrorist attacks). One hundred thirty-six people were in the building when it collapsed – 98 people perished and all 98 were recovered. Recovery efforts were carried out by State of Florida USAR teams, many of whom had never participated in an operation of this scope. Teams worked 12 hour shifts for several weeks, operating in extreme heat, humidity, daily thunderstorms, and physical danger. Given the enormous challenges of the rescue, the Florida Fire Marshall office’s under the leadership of Julius Halas, deployed personnel to the disaster site to provide mental wellness support to the rescue teams. The goal of the initiative, which was supported through the efforts of the Florida Firefighter Safety and Health Collaborative, was to provide active support at the site and plan for the months that followed. The first direct action provided psychological support to the USAR teams working through the debris pile. These efforts consisted of both printed and human resources. Printed literature was distributed at meeting areas and food tents, including palm cards with QR codes and links to state-wide mental health resources. Human resources included canine handlers and their dogs, chaplains, peer support personnel, and mental health professionals, available to rescuers when requested or when there was a perceived need. Dogs and handlers moved throughout the site, interacting with all rescue personnel. Peer support specialists and chaplains provided the first line of psychological support, with mental health clinicians as back- up, when a higher level of care was needed. Additionally, at the time of demobilization, teams received a psychoeducational debriefing about the potential effects of trauma, trauma symptoms that might occur, and a reminder to look out for each other.

Post-deployment, USAR team leaders were encouraged to organize a low-key social event, about two weeks following their return home, to allow team members to re-connect, destress, and socialize, if desired. Peer support was available, if team members wanted to engage. A second strategy was to provide each task force leader a list of vetted, culturally competent therapists, available to task force members who might request treatment. All clinicians on the list had completed a two day course in firefighter culture and customs, and at least 10 hours of ride-along time with a fire department. Vetting clinicians made it easier for task force members in need to quickly find appropriate care.

In the past, the fire service focused on mechanically managing a scene and letting logic dominate emotion. More recently, there has been a pivotal shift, acknowledging the skyrocketing death toll from suicide and addiction. Reaching out to partner with academia, fire service leadership created historic change and embraced strategies to protect firefighters from the long-term effects of chronic exposure to trauma. The deployment of on-site mental wellness assets exemplifies recognition of the toll that catastrophic and traumatic events may exert upon the firefighters who respond to the rescue call. However, reactions to trauma do not always occur immediately but may emerge only months later. Therefore, the final piece of the mental wellness plan was a postdeployment monthly survey conducted in collaboration with an academic institution (University of Central Florida) to assess potential emotional distress in the months following the condominium collapse, starting in September 2021. Forty-two USAR team members completed the monthly survey but after three months, the response rate dropped and the project was discontinued.2

Among those who responded, none knew anyone who lived or perished in the collapse. As a group, task force members reported low levels of anxiety, depression, PTSD, and sleep problems in the months following their deployment. However, when examined further, respondents who recovered human remains reported anxiety, depression, and PTSD symptoms that were twice as high as respondents who did not recover human remains. Furthermore, 53% of the group that recovered human remains reported symptoms so severe that their scores were the same as people diagnosed with PTSD, generalized anxiety, or depression.

These results should be a neon calling card to the first responders on the front lines. The men and women of the fire service are resilient and always respond to life’s most tragic moments. This survey provides palpable evidence of the impacts that direct contact with human remains and immersion in inexplicable loss can have on firefighters. As the fire service transitions from stifled silence to communication and science, surveys such as this one can uncover patterns of exposure to trauma that cause fractures in firefighters’ lives and offer an opportunity to find hope. The insights from this study provide clarity and detail, shining a light never before seen –providing data that move the needle away from anecdotal stories toward the path of industry-changing metrics. Finally, to the first responders peering into the academic side of this article, we hope the findings shine the light of hope that normalizes where you are in your path toward healing.

1 Walker et al. (2016). Chronic occupational exposures can influence the rate of PTSD and depressive disorders in first responders and military personnel. Extreme Physiology and Medicine, 5:8 DOI:10.1186/s13728-016-0049-x

2 Beidel, D.C., Rozek, D.C., Bowers, C.A., Newins, A.R. & Steigerwald, V.L. (2022). After the fall: Responding to the Champlain Towers building collapse. Front. Public Health 10:1104534 doi: 10.3389/fpubh.2022.1104534