First responders must stay calm when others panic

FINDLAY — There is no "typical day" at work for a first responder, but most days involve sudden changes in pace and activity. EMS Chief Kent Appelhans said Hanco personnel might be sitting and talking with friends, then two minutes later performing CPR on a community member. Sgt. Mark Price, enforcement supervisor assigned to communications at the Hancock County Sheriff's Office, sees the dispatchers he supervises shift instantly into gear when a call comes in — their hands moving, phones in ears, paging other agencies while talking to the caller, and knowing at the same time that, as they assist with this house fire, another call about a domestic dispute or missing child might come in at any moment. "It's amazing to watch," he said. Firefighters at Findlay Fire Department generally work 24-hour shifts, from 7 a.m. one day to 7 a.m. the next. When not responding to emergencies, Chief Josh Eberle said their work day includes maintenance of the fire trucks along with trainings and classes during the day. Firefighters can sleep in bunks at the firehouse at night — but that sleep might be disrupted at any time. It's not always a structure fire. Often, when the alarm goes off at the fire station, it turns out to be just a smoke alarm that has gone off. But firefighters always assume the situation is life-threatening "until proven otherwise," Eberle said. Even during relative downtime, they are always bracing themselves, knowing the alarm will sound at some point. "That's what I think is lost on some people … It's like a level of constant vigilance, right?" he said. "And those things pile up over time." Appelhans recalled reading that the average person sees two or three traumatic events in a lifetime, whereas the average first responder sees more than 500. "Unfortunately, it's hard to really teach or train or prepare for it, and everybody handles it differently," Appelhans said. Appelhans said that the emotion may not hit right away. Often an EMT walks away from a difficult call and initially feels fine — until they go to bed that night. Melissa Orr, a dispatcher at the Hancock County Sheriff's Office, said dispatchers need to work quickly to make sense of what is going on. Often the caller, being distressed, may be speaking quickly or not explaining the situation clearly. Orr tells them to take a deep breath and "help me help you." Sometimes she takes a deep breath herself, as that emotion can carry through the phone. She doesn't really have time to process it while she's working, though. "We have to store all the screams," she said. Price noted that sometimes a child is screaming in the background of a phone call. Other times, the caller is whispering as they ask for help, for fear someone in the next room might hear them. He is seeing more recognition today that simply hearing about a traumatic event is, in and of itself, traumatic. The job also is cognitively challenging as dispatchers must keep track of a lot of variables and respond quickly as those variables change. Orr likened it to continually playing chess. A call might require law enforcement, EMS, firefighters or some combination of all three. Orr might dispatch Hancock County sheriff's deputies or other first responders close to Findlay, or might communicate with agencies in neighboring counties, depending on the location of the call and who is available. When dispatchers hear first responders out in the field call for backup or mutual aid, they must then dispatch those personnel. They also need to keep officer safety in mind. Heather McGrain, a dispatcher for nearly five years, has taught callers over the phone how to do CPR, counting with them and pressing on her own leg at the time they do chest compressions. Price said another dispatcher helped guide a mother through childbirth over the phone. The job requires staying calm and patient, "the one in control" when others are panicking, McGrain said. The mother of a 6-year-old, she said she has learned skills as a mom that have helped her with this. A dispatcher moves from one call on to the next. Orr said there is no time to think or process, and she often doesn't receive closure. Sometimes she is able to find out the outcome from speaking to a sheriff's deputy, but sometimes she doesn't know what happened. "They don't see the end results," Price said. He said often people describe how a sheriff's deputy or a team of firefighters handled a situation, but it's easy to forget about the person who answered the phone. "It's the side of law enforcement that's not seen," he said. "It's only heard." "We're that calm voice in the dark," Orr said. Advances in technology and medical research have made it possible to do many of these life-saving jobs more effectively than in times past. Firefighters, however, face a hurdle today that they didn't decades ago. Eberle explained that in the 1940s or 1950s, most objects in a home or business were made of natural materials. Now, almost everything contains plastic — that is, petroleum. "Everything now is considered, essentially, fuel," he said. Fires today burn more quickly, giving firefighters less time, and the smoke itself contains far more toxic chemicals, Eberle said. "You have to move so fast, and you have to be so proficient at getting in there quick and trying to interrupt that fire process. … If there's somebody in there, you've got a limited amount of time," he said. "It's so much more toxic than it used to be, so much faster." The change in the chemical composition of fires has also led to an increase in the rates of certain types of cancer among firefighters, he added. Even if no one is in the house, a structure fire is emotionally traumatic to the homeowner. Once the situation is under control, Eberle said, one officer can step aside and talk to the family, advising them to call their insurance company. They also strive for a "warm handoff" to the Red Cross, which can provide shelter for displaced people and assist them with obtaining prescription medications. Eberle said these conversations, while far worse for the homeowner, take an emotional toll on firefighters as well. All firefighters are also trained as EMTs or paramedics. The fire department works alongside Hanco on medical calls. Eberle said dispatchers routinely send both agencies. Depending on location, the fire trucks may get there faster. Firefighters can then check vitals and perform CPR, and will turn the patient over to Hanco when they arrive. On bigger calls with multiple injured patients, the two agencies continue to work in tandem. In a community this size, also, it's common for EMTs to work on people they know personally. Appelhans said they're more likely to second-guess themselves after these calls. Second-guessing, in general, is fairly common, he said. While often the EMT or paramedic can provide care that leads to a good outcome, occasionally there is nothing that can be done. "In your gut you know there's nothing you can do, but yet you still try and try and try," and second-guess yourself afterward, he said. "Bigger calls will tend to stick with you," Orr said. She said she has some PTSD triggers from certain calls. She has tried counseling but found that for her, it has been more beneficial to talk to her peers. "We support each other, in and out of the office," she said. Price said he has heard a variety of approaches, with some dispatchers preferring peer support and others seeking counseling. Eberle said firefighters who are struggling with trauma may not reach out themselves, but often their coworkers encourage him to check on them. He said severe traumas, suicides and any calls involving children tend to be especially difficult. "We want them to be open to discussing it, regardless of how they're feeling," he said. "We don't want anybody to be afraid of openly discussing what they're feeling about a particular call." He said they have been working to create a culture where "people know that they're not going to be ostracized if they bring something up." After years of building that culture, he said these days he sometimes hears a firefighter talk openly about going to see a therapist in front of coworkers. After all critical incidents, Hanco starts with an informal debriefing, Appelhans said. Often it takes a few days for the emotions to really hit, so they then hold a formal debrief a few days later. Hanco can also refer personnel to its EAP. Recently, some EMTs received special training as mental health resilience officers, a type of peer support worker tasked with identifying when coworkers are struggling. Appelhans, who has been in the field more than 35 years, said in the old days everyone was expected to compartmentalize and "act tough." That has changed, however. "Nowadays it's socially acceptable in this line of work — in fact it's recommended — to open up, because it's healthier," he said. Despite the stresses, many first responders find the work rewarding, and new people are drawn to it. Olivia Hartman started working as a dispatcher a month ago and is currently being trained by Orr. She said she is good at multitasking, enjoys talking to people and wants to make a difference by being "the calming part of the worst day of their lives." McGrain, too, started in this work because she wanted to help people. And, while she hears so much that is emotionally difficult, she said people often also say "God bless you" at the end of the call. She received a written thank-you note from a mother of a sick child who she had helped over the phone. "It feels rewarding to know that I may have saved a life," Orr said. Appelhans said it can be greatly rewarding, and most patients do have a good outcome. "I think we just need to continue, in this field, to realize and recognize the mental health implications of the job itself," he said. Eberle said he has seen firefighters hone their skills through many hours of training, and has seen the satisfaction when that training pays off and they work as a team to make a difference. "I believe, at its core, there's something noble about the profession," he said.