ORLANDO, Fla. — Orlando firefighter Jimmy Reyes remembers heading to Pulse nightclub and hearing the shake in the dispatcher’s voice as gunfire echoed in the background. Upon arriving, he began categorizing the victims: Red meant “very critical.” Black meant deceased.
“It was more about, suck it up and keep going, just ball your emotions and your feelings together,” Reyes said, describing the mentality that allowed him to keep working despite the horror around him. “… But sometimes, deep down, it still hurts.”
The chaos of June 12, 2016, left lingering trauma for those who tried to save the lives of those wounded at Pulse, and led local agencies to reexamine the services and preparation available to local rescuers, with the Orlando Fire Department expanding mental health services and Orlando Regional Medical Center amplifying training protocols.
After the Pulse shooting, people began discussing trauma in ways they hadn’t before, as well as prioritizing the mental health needs of first responders after horrific incidents, said UCF Restores Executive Director Deborah C. Beidel.
UCF Restores, which provides clinical treatment to people with PTSD, responded to OFD two days after the shooting to arrange debriefing discussions, and worked with the Orlando Police Department to host trauma workshops and mental health evaluations. She said a “suck it up, buttercup” mentality exists among first responders, something she hopes to reverse.
“People get into the first responder profession because they have a love of humanity, and they want to be able to help others,” Beidel said. “If they have a hard heart and didn’t care about other people, they wouldn’t be a first responder.”
‘Stigma’ hinders healing
UCF Restores also offered its three-week intensive outpatient program, which joins exposure therapy with group treatment, to first responders who suffered from post-traumatic stress disorder following the Pulse shooting.
“To ask people to not feel a thing after this type of horrific event, it’s just something that’s not human in nature,” she said, “and that’s the stigma we have to get around.”
More than 60 people who experienced trauma related to Pulse have received support from UCF Restores services, and the organization continues to provide support for firefighters.
Reyes sought help from UCF Restores about six months after the Pulse shooting after experiencing panic attacks, anxiety and depression.
Oncediagnosed with PTSD, Reyes began attending exposure therapy sessions every day for two hours — reliving the sights, sounds and smells of the attack’s aftermath. He recalled being tapped on the shoulder by a victim with a head wound. Others had gunshots piercing their arms and torsos.
“When it comes to almost 30 or 40 people coming through with all the same injuries, it’s crazy to see,” Reyes said.
Reyes said he kept his treatment a secret from colleagues fortwo years, but felt relieved to share it with themwhen he did. He still suffers from anxiety and depression, and sees a counselor once every two weeks.
“I think it’ll be a long ways before that stigma is gone,” he said, “But I think a lot more people are reaching out.”
OFD also receives peer support from Orlando Firefighters’ Benevolent Association, a nonprofit that provides financial, physical and emotional assistance, and the Florida Firefighters Safety and Health Collaborative, a nonprofit founded to address a lack of mental health resources.
Statewide peer coordinator Jeff Orrange said the nonprofit’s 2016 founding was not just in response to the Pulse shooting but also the rising numbers of non-duty deaths among firefighters, including those resulting fromaddiction and suicide.
“The reason why we got into this profession doesn’t align with what we do on a day to day basis,” Orrange said of firefighters. “Meaning, we can’t save everybody and that is a hard, hard thing to grapple with.”
Orrange said the collaborative has helped introduce mental wellness programs within cadet school and establish a pathway to healing.
“What we realize is that very capable, strong members of our department can do the job, they just run into a very difficult patch,” Orrange said.
Training for ‘a real incident’
Months before the Pulse attack, Orlando Regional Medical Hospital had stimulated an active shooter attack in an Orange County middle school generating waves of people to the hospital, said emergency preparedness corporate director Eric Alberts. The community exercise included more than 500 volunteers and 57 agencies.
Since Pulse, Orlando Health has increased the intensity of its training drills and plans to conduct its first such training in two years on Oct. 21.
“We have to push the boundaries in training and exercise, so that when we deal with a real incident, they’re more comfortable and adept,” Alberts said.
Alberts said the exercises are now designed to be as realistic as possible, including thousands of screaming, crying volunteer victims with artificial blood, wounds and injuries. Alberts said they’ve introduced amputee volunteers and in coming years plan to include volunteers with special needs.
“It’s not a worst-case-scenario planning thing anymore,” Alberts said. “It’s really happening.”
ORMC also started a Critical Incident Response Team following Pulse, made up of mental health counselors, spiritual care professionals and licensed social workers, said Holly Stuart, a customer experience corporate director. She said the team laid the foundation for support that nurses, doctors and other staff needed throughout the COVID-19 pandemic.
“Pulse was the building block that got us to the point that we are at today,” she said.
Orlando Fire Chief Benjamin Barksdale was not present during the Pulse shooting, but served as a battalion chief during the 9/11 terrorist attack when an airline crashed into the U.S. Pentagon killing nearly 200 people. He recalled members of the National Urban Search and Rescue System telling him that he and his staff had thousand-mile stares.
“You had a fire you had to put out, you had people that you had to rescue, hazardous materials to deal with,” he said. “You didn’t worry about the terrorist aspect.”
There have been more than 250 mass shootings within the first half of 2021, and a 23% increase in deaths caused by gun violence, according to data from the Gun Violence Archive, which defines a mass shooting as four or more people wounded or killed, not counting the shooter. Barksdale said when he began his firefighting career more than 30 years ago, he did not expect to deal with an ever-rising toll of mass killings.
“You now have to have your head on a swivel, always being alert to what’s going on, just on the normal calls,” he said. “You never know what may present itself.”
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