The parents and two children were still alive as their car was engulfed in flames, but they were trapped. The fire left their bodies charred.
It was days before Christmas.
“This happened about 10 years ago. We immediately had to go get counseling and talk about it,” said Carlos Henriquez, tears in his eyes. The longtime firefighter for the city of Hialeah was one of the first on the scene.
“It’s a vision I can never take out of my head; I’ll never forget it. It was a horrible. You could see them screaming. We tried so hard to get them out, but there was nothing we could do.”
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Police officers, firefighters, dispatchers, ambulance personnel and other first responders can suffer Post Traumatic Stress Disorder if traumatic experiences such as this are not addressed, research shows.
From the beginning we are taught to put on this mask, this facade, that we’re tough and that we don’t let things get to us but, but truthfully it does.
Carlos Henriquez, Hialeah firefighter
PTSD is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event. It is often associated with members of the military, but is not limited to them.
Compared to non-emergency workers, first responders experience higher rates of psychiatric symptoms such as depression, alcohol abuse, sleep disturbances, anxiety disorders and suicidal thoughts, studies have found.
“The numbers are staggering,” said Daniel Fernandez, Hialeah Fire Department’s chief of training, who handles the city’s critical incident stress management program.
“From the beginning we are taught to put on this mask, this facade, that we’re tough and that we don’t let things get to us but, but truthfully it does,” Henriquez said.
In the last year, the Hialeah Fire Department has made significant moves to battle PTSD. It doesn’t just hold the standard group debriefing sessions after major incidents. Now, the department has on-call peer counselors available around the clock.
Fire Lt. Scott Disbrow is one of them.
“In the past, everyone has kept things bottled up,” Disbrow said. “The feedback we are getting is that people are open to talking; that they need someone to listen. As bottled up as we’ve kept it so long, we are turning that corner.”
The feedback we are getting is that people are open to talking; that they need someone to listen. As bottled up as we’ve kept it so long, we are turning that corner.
Scott Disbrow, firefighter and peer counselor
The sessions are confidential and can be as formal or informal as desired. One day they can take place in the office, another day at the station’s kitchen table.
“We want to make sure our members are aware that they have resources,” Fernandez said, “even if that means attaching brochures to paychecks and posting them behind toilets and urinals.”
Some symptoms of PTSD are behavioral — agitation, irritability, hostility, hypervigilance, self-destructive behavior, social isolation, emotional detachment or unwanted thoughts. Others are psychological — flashbacks, fear, severe anxiety or mistrust. Some affect a person’s mood and sleeping patterns — loss of interest or pleasure in activities, guilt, loneliness, insomnia or nightmares.
At any time, between 7 percent and 37 percent of firefighters meet the criteria for a diagnosis of PTSD, said Matthew Tull, an associate professor and director of anxiety disorders research in the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center.
“It is clear from these studies that there is a big range in PTSD rates among firefighters,” Tull said. “This is likely due to a number of reasons, including how PTSD was assessed (through a questionnaire or interview), whether other emergency responders were also surveyed along with the firefighters, whether the firefighters were volunteered or not and where the firefighters worked.”
Tull added that one of the most important protective factors is having social support available either at home or through work. Having effective coping strategies available could lessen the impact of experiencing multiple traumatic events, he said.
“This is not surprising in that, among people in general, the availability of social support and effective coping strategies have consistently been found to reduce the risk for developing PTSD following a traumatic event,” Tull said.
In recent years, the Hialeah department has lost a handful of firefighters and a firefighter’s spouse to suicide. That, mixed with heart-wrenching service calls and lack of communication, opens a door to the psychiatric disorder.
“Sometimes you walk into a call and realize that the little girl that didn’t make it had the same shoes your daughter has. Or the same dress. Or the same name,” said Fire Lt. Ruben Cantillo, who leads Hialeah Fire’s chaplaincy program, which also works to prevent PTSD.
“Chaplaincy is one of the elements and tools to help our members deal with certain tragedies or things they have on their minds that come up time to time,” Cantillo said. “These things have a way of sneaking up on you. I had guys tell me it’s a Rolodex of things in their heads that they go through before they go to sleep or when they go home to see their children.”
I don’t think [PTSD] is new, I think our consciousness of it is.
Miami Beach Police Chief Daniel Oates
PTSD isn’t new, said Miami Beach Police Chief Daniel Oates,who was chief of police for the city of Aurora, Colorado, in 2012 when there was a mass shooting at a midnight screening of a movie.
The gunman, dressed in tactical clothing, set off tear gas grenades and shot into the audience with multiple guns. Twelve people were killed and about 70 others were injured.
“[PTSD] always been an issue. I just think that as a profession, we are much more conscious of it in recent years. I don’t think it’s new, I think our consciousness of it is,” Oates said.
Two months ago the Miami Beach Police Department also rolled out a peer-support system for police officers, a strategy that has since helped spot problems that might require a higher level of professional engagement. As in Hialeah, a first responder who needs more care is referred to that city’s psychiatrist.
“It’s an additional option for an officer who is coping with the strain on the job,” Oates said. “Sometimes all an officer needs to hear is that they aren’t alone and that they should go see somebody.”
Oates added: “The theory is that cops now have someone to talk to. There have always been those options,” he said, but a cop who is wary about talking to a supervisor might open up to a peer officer who is familiar.
Pamela Kulbarsh, a psychiatric nurse for more than 25 years, has worked with law enforcement in crisis intervention for the past decade in San Diego, California, and Tucson, Arizona.
One-third of active-duty and retired officers have suffered from post-traumatic stress, but most don’t realize it, she said.
PTSD is far more rampant in law enforcement than anyone is really willing to discuss.
Pamela Kulbarsh, psychiatric nurse
“Not every call ends when the paperwork is filed,” Kulbarsh said. “PTSD is far more rampant in law enforcement than anyone is really willing to discuss. PTSD statistics for [active-duty] law enforcement officers are hard to obtain, but range from 4 to 14 percent. The discrepancy in this range may be due to under-reporting. Living through a traumatic event is hard enough for an officer. Admitting that you are having problems related to that event is even harder.”
An estimated 150,000 officers develop symptoms of PTSD, Kulbarsh said. For every police suicide, almost 1,000 officers work while suffering symptoms of the disorder.
“Law enforcement officers are also at a much higher rate of developing a cumulative form of PTSD related to their exposure to multiple traumatic events,” she said.
Roddy Monsivais, a former Homeland Security lieutenant, said although more cities in South Florida are adding programs for current law enforcement officers, they fall short for first responders who have already retired.
“Imagine seeing all you’ve seen for 30 years straight and then going home one day to nothing. I had a friend who was quick to say hello to his Glock and pulled the trigger in the parking lot right before his doctor’s appointment,” said Monsivais, who is state president of the National Latino Peace Officers Association.
He added: “The biggest issue these officers face is not having someone to talk to along the way. What are you gonna tell your family? I picked up the pieces of a dead person today? Who are you going to tell when the PTSD kicks in? How about after all those years of holding … all of that stuff in? Who do you call when you go to sleep and wake up in a cold sweat?”
It is critical that first responders understand that asking for help, when needed, is a sign of strength, not weakness.
Sharon A. Israel, Miami-Dade Fire Rescue
Sharon A. Israel, who works in the emergency medical services division for Miami-Dade Fire Rescue, said the county has been working with local municipalities for decades. Most recently, the county created a survey to help assess one’s own mental health. The interactive survey asks yes-or-no questions that when tallied, will help the employee identify symptoms of depression, addiction, PTSD or suicidal thoughts and know when to seek help.
“It is critical that first responders understand that asking for help, when needed, is a sign of strength, not weakness,” Israel said.
For now, Hialeah Fire Department’s Cantillo said the city’s goal is to have three or four peer leaders available on-call per shift. Right now there is one per shift.
“It’s very important for us to take care of each other,” Cantillo said. “Sometimes you can’t forget what you see. You try to press the reset button, put it in a little box and try to file it away. The time has come, we can’t can’t put this off to the side forever.”
Fire engineer Paul Garcia nodded as Cantillo spoke.
“A lot of people in society see that we’re the help,” Garcia said. “But they don’t think about that we need help too sometimes.”