First Responders Experienced Conditions Similar to a War Zone During the Pandemic –– Now they Must Heal.

By Diana Testa

New York –– The pandemic came into the world like a tornado, sweeping up all the normalcy in our lives and turning it upside down. And as a result, we are fighting another crisis alongside COVID-19 –– mental health. There’s been lots of conversation around what people can do to cope with the general stress of the pandemic, but our disaster response workers were hit on an entirely different level. Like healthcare workers, EMTs and firefighters –– many of which are volunteer workers –– were thrown to the frontlines. And though the nature of these jobs was stressful even before the spread of Covid-19, they have gotten more than they ever bargained for.

Madison Engrassia –– an EMT in East Islip –– was working in what was the epicenter of the world at one point. “We had the highest call volume in the entire world,” Engrassia says. Her hectic day began the very second she clocked in at 6 a.m. and ran way past the end of her 6 p.m. shift. “We were going from one alarm to the next and there were usually around 10 holding, so we would get back around 9 p.m.,” she says.

According to SAMHSA –– Substance Abuse and Mental Health Services Administration –– a study conducted in 2018 found that 69% of EMS professionals didn’t have nearly enough time to cope between traumatic events and as a result, suffered from depression, stress, post-traumatic stress, suicidal ideation, and a host of other functional and relational conditions.

“I remember specifically being told over the radio that I’m not getting what I need to take the patient to the hospital because there were no resources left for us.” Engrassia says. This was her last straw, and she literally sat down and cried. And she wasn't alone. "My supervisors told me that they would cry on their way to or home from work. It was a huge demand that we weren't used to at all,” she says.

EMT Madison Engrassia and her coworker Angela Halloran on duty for Exchange Ambulance, a volunteer squad based in East Islip, Long Island.

The Already-Stressful Nature of The Job

Burnout and trauma are not rarities among first responders. Mental Health America –– the nation’s leading community-based nonprofit organization dedicated to mental health advocacy and assistance –– says that healthcare workers and first responders are experiencing conditions similar to a war zone, and it is crucial to provide them with resources to cope with the trauma.

The CDC agrees, saying first responders are feeling PTSD, and that frequent exposure to physical harm to themselves, in this case via Covid-19, is exactly akin to the violence of battle.

A survey conducted by MHA from June to September 2020 reported that 93% of healthcare workers during the pandemic experienced increased stress, 87% experienced anxiety, 77% reported frustration, 75% felt overwhelmed and 76% experienced exhaustion and burnout.

Doctor Amy Nitza, the Director of the Institute for Disaster Mental Health at SUNY New Paltz and a psychologist who specializes in providing mental health training for disaster mental health and trauma recovery, says that the pandemic has elevated the baseline level of stress that is experienced on a day-to-day basis by these workers. “I think it is important to note that the pandemic is an acute sort of trauma situation for a lot of people that are still doing their day jobs, responding to all kinds of other emergencies and being exposed to these other sorts of acute trauma,” she says. “Now on top of the chronic stress they experience daily, there are these waves of acute stress from the pandemic.”

Constant Changes in a Time of Uncertainty

Emergency agencies underwent abrupt and constantly changing protocols throughout the pandemic –– adding another layer of stress to the worker’s job. They prepared for every call as a Covid-risk, and wore full-body suits, eye protection, and N-95 masks. And as the pandemic unfolded, safety protocols differed and changed between non-centralized departments in New York.

County dispatch protocols changed in mid-March for fire departments in the Hudson Valley region after an enormous uptick in people reporting respiratory problems. Josh Simmons, a volunteer firefighter at the St. Remy Fire Department in Kingston and a part of the Research Associate Department at SUNY New Paltz, says he was notified if there was exposure, a positive test, or a quarantined person at the site. But there was a major issue with this information. “That’s all self-reported, and the dispatcher can only work with what they are told,” he says.

Firefighter Joshua Simmons outside of station 2 at St. Remy’s Fire Department. Photo by Diana Testa.

By April, his department was wearing PPE for every call. Though Simmons noticed a lag in the beginning of the pandemic at the station with following social distancing protocols and wearing masks at events. “Everyone came around eventually because the nature of the job is to trust each other,” he says.

Ulster County added a section about Covid-19 in their pre-call screening in effort to mitigate first responder’s exposure––which Ephraim Minskey, an EMT at New Paltz Rescue, felt did a great job of reducing some stress. Yet the fear of the unknown still crept in. “It sounds kind of silly but there was this fear of people not telling the 100% truth in the beginning,” he says. “Like if a mother was really worried about their daughter having some sort of allergic reaction but she also had a cough, they might neglect to tell us that because they feared how it would affect our response.”

A New Paltz Rescue Ambulance outside of a Covid-19 vaccine site at the Fairgrounds in New Paltz, New York. Photo by Diana Testa.

The Need for Mental Health Support

As a group, this cohort has witnessed death, illness and tragedy –– the need for mental health support is dire. SAMHSA provides a one-hour training course by the Commission on Accreditation for Pre-hospital Continuing Education, CAPCE, created to address the mental stress first responders endure; it provides coping strategies, resources and exercises to help reduce the impact of traumatic events. The course was developed after the trauma first responders around the country experienced during the opioid crisis, and had to respond to an immense number of overdose calls.

The CAPCE also offers an online course, Service to Self, for EMS and fire personnel to address healthy coping mechanisms, techniques and how to individually and organizationally care for eachother.

Simmons says that since the trauma firefighters endured during 9/11, there has been a shift in the fire department culture surrounding mental health support. “It’s reflected in the training and attitudes but in terms of actually having services provided, they are exclusive to larger professional departments,” not smaller volunteer oganizations like his, he says.

Engrassia, on Long Island, says there were programs in place through her paid squads prior to the pandemic for traumatic events.“They'd have a team come talk to you after something completely traumatic that affected you in some type of way, such as an infant cardiac arrest, and there were resources to reach out to through the department,” she says.

Engrassia feels that there should have been additional support provided to them during the pandemic. “I really do think that there should have been something for us to cope because a lot of us just broke down eventually.”

Stigma Around Mental Health

Reaching out for help is not always easy in these fields, though. Simmons says that the stigma around mental health is a real issue among fire departments. “We have loose procedures for when we come back from a really harrowing experience, and just form a circle of support for each other to kind of agree that what we saw was messed up. It’s definitely not a group therapy thing, we don’t talk about our feelings too much,” Simmons says, explaining that it's in part out of fear that anyone will think they’re not up to the next emergency.

Joshua Simmons wearing his CSBA mask outside of the St. Remy fire station in Kingston, New York. Photo by Diana Testa.

Though there has been improvement, mental health continues to remain stigmatized. Nitza says this is not about who can handle the stress and who can’t. “The conversation has been, from a mental health training perspective, a lot easier because we're not having to convince people that this is a problem for them in a way that we have in the past,” she says. Nitza feels like people's eyes have been opened a little more to the fact that struggling with mental health has nothing to do with being weak.

“Let's face it,” Simmons says, “in this culture we don't teach young men how to discuss their feelings. We have finally gotten to a point as a society where we teach them that it’s okay to feel.”

Access to Mental Health Resources

Engrassia had access to mental health resources with her volunteer squads, but only if you sought them out. “A team would come to you if you asked, but I think I'd much rather have had a monthly or bi-weekly scheduled meeting already set in motion because sometimes it’s hard to ask for help,” she says.

Now that the intensity and initial fear of the unknown the pandemic brought on in the earlier months of its arrival has dwindled down, these disaster response workers are left to cope with the things they endured. And many departments do not have professional mental health assistance available to workers due to tight budgets.

As a volunteer firefighter, Simmons is not provided with any kind of counseling service through the St. Remy station –– with a “shoestring” budget of around $200,000 for vehicles, their maintenance and fuel, and equipment. While departments with paid first responders and firefighters are often provided with healthcare, volunteer departments don’t have leftover money to spend on mental health programs. “It’s an impracticable thing with the budget we have and it’s not like we have volunteer therapists to talk to,” Simmons says. “Which is weird now that I’m thinking about it, because I’m a volunteer to do dangerous things!”

Firefighter Joshua Simmons outside of St. Remy Fire station 2. Photo by Diana Testa.

It’s not a stretch to think we will be faced with another crisis in the future. As we move out of the pandemic, it is imperative that EMS personnel are provided with resources to cope with the trauma, increased anxiety and depression, and burnout they experienced. While professional mental health services are mostly limited to larger departments within cities, small community-run departments need access to programs as well –– or at least need to further create a culture that acknowledges the importance of asking for help.