When the COVID-19 pandemic turned life upside down last March, EMTs and firefighters—many of whom are volunteers—were among the essential workers thrown to the front lines of the response. And though the nature of these jobs was stressful even before the spread of COVID-19, they got more than they ever bargained for.
Patrick Hayes, a paramedic at the New Paltz Rescue Squad, has witnessed 9/11, SARS, the swine flu, Ebola virus, and COVID-19 during his 21 years of service in New Paltz and Brooklyn. He vividly remembers when the pandemic first hit. “Suddenly, you’re wearing a respirator mask and a Tyvek suit, and sweating like you’ve never sweat before for every call,” he says. “You’re seeing some of the sickest patients that you’ve ever seen and are living in fear.”
Dr. 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 and trauma recovery, says that the pandemic significantly elevated the baseline level of stress experienced on a day-to-day basis by emergency response workers. “I think it is important to note that the pandemic was an acute sort of trauma situation for a lot of people that were still doing their day jobs,” she says. “Now on top of the chronic stress they experience daily, there were these waves of acute stress from the pandemic.”
A survey conducted last summer by Mental Health America, a national nonprofit dedicated to mental health advocacy and assistance, found that 93 percent of healthcare workers experienced increased stress, 87 percent experienced anxiety, 77 percent reported frustration, 75 percent felt overwhelmed, and 76 percent experienced exhaustion and burnout. The report described the pandemic conditions first responders experienced as similar to a war zone—and that now it is crucial to provide them with resources to cope with the ensuing trauma.
Burnout and trauma are not rare among first responders. A study conducted in 2018 by the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that 69 percent of EMS professionals didn’t have nearly enough time to cope between traumatic events; as a result, they suffered with increased rates of depression, stress, post-traumatic stress, suicidal ideation, and a host of other functional and relational conditions.
“As a first responder, you’re just trying to be the best part of somebody else’s worst day,” Hayes says. “And you can only do it for so long before I think you get a little compassion fatigue. A lot of people pick up the bottle and whatever else to cope.”
Constant Change in a Time of Uncertainty
County dispatch protocols changed in mid-March of 2020 for fire departments throughout the Hudson Valley, after an enormous uptick in people reporting respiratory problems. Josh Simons, a volunteer firefighter at the St. Remy Fire Department in Kingston and a member of the Research Associate Department at SUNY New Paltz, says he was notified if there was an exposure, a positive test, or a quarantined person at the response site. But there was a major issue with this information: “It’s all self-reported, and the dispatcher can only work with what they are told,” he says.
Ulster County added COVID-19 protocols to its pre-call screening to mitigate first responders’ 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-percent truth in the beginning,” Minskey says. “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.”
The stress of the pandemic affected Hayes’s sleeping and eating patterns, but the worst was his insomnia. “As a paramedic, I’m trained to think about the worst-case scenarios,” he says. “If someone says they have a stomachache, I have to look at all the factors, because it could be a heart attack in hiding. So with this unknown virus, I just kept looking for research on it that didn’t exist yet.”
As a group, this cohort has witnessed death, illness, and tragedy, underscoring the need for mental health support, advocates say. SAMHSA offers a one-hour training course for first responders that includes coping strategies, resources, and exercises to help reduce the impact of traumatic events. The course was developed to provide tools for first responders around the country to deal with trauma they experienced during the opioid crisis. The Commission on Accreditation for Pre-Hospital Continuing Education—an accrediting body that reviews EMS continuing education—also offers an online course, Service to Self, to address healthy coping mechanisms, techniques, and how to individually and organizationally care for each other.
Hayes says that if it weren’t for the family atmosphere of New Paltz Rescue, he doesn’t know if he would have made it through the pandemic. “I’ve worked in other places where that wasn’t the culture and I was more of just a number,” he says. “If you have a difficult call, our chief will be calling to support you.”
Simons 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 organizations like his, he says.
Reaching out for help is not always easy in these fields, though. Simons 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,” in part out of fear that anyone will think they’re not up to the next emergency, he says. “Let’s face it, in this culture we don’t teach young men how to discuss their feelings.”
Nitza says that the continuing stigma around mental health among first responders stems from the false notion that it’s 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 first responders are now more aware that struggling with mental health has nothing to do with being weak.
Access to Mental Health Resources
Now that the intensity and initial fear the pandemic brought on has subsided, disaster response workers are left to cope with the things they endured. And due to tight budgets, many departments do not have professional mental health assistance available to workers.
In May, Ulster County Executive Pat Ryan announced the creation of the Ulster County Behavioral Task Force, which will create an action plan based on the community’s needs and invest in future mental health programs. “At a time when we’re seeing more and more of our residents struggling with mental health and addiction, we must step up our investments to meet the moment and take care of each other,” he said in a press release.
Ulster County saw a surge in the need for mental health and addiction services during the pandemic—and their mental health clinics and services were usually at full capacity before the virus even hit. In an address to the Ulster County Legislature on June 16, Ryan called for the legislature to allocate $5 million in federal relief aid to mental health and addiction services to address gaps in the county’s current mental health systems. “The reality is that we have never treated mental health with the same level of seriousness and resources as we treat our traditional healthcare systems,” Ryan said.
As a volunteer firefighter, Simons is not provided with any kind of counseling service through the St. Remy station, which has a “shoestring” budget of around $200,000 for vehicles, maintenance, fuel, and equipment. While departments with paid first responders and firefighters are often provided with health care, volunteer departments don’t have leftover money to spend on mental health programs. “It’s an impractical thing with the budget we have and it’s not like we have volunteer therapists to talk to,” Simons says.
The acute crisis of the pandemic may be subsiding, but it is likely to leave a legacy of trauma, anxiety, depression, and burnout, particularly among the frontline workers who dealt with the worst of it. “This is a moment where we must push ourselves and envision a future for our community where we don’t just return to the way things were before the pandemic, but instead seize this moment to take bold and transformative action,” Ryan said in his address. “That means not just spending the $34 million in federal relief funds we are receiving, but thoughtfully and smartly investing these funds in a way that will create lasting, generational impacts.”