First Responders and the Toll on Their Health
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Friday nights are usually very busy for emergency medical technician Brett Sabo. He works for VMSC Emergency Medical Services in Lansdale, Pennsylvania. It's a suburb of Philadelphia. A call comes in about a middle-aged man who says his heart is racing and he feels dizzy. It doesn't appear to be a heart attack, though. If you were having a heart attack, it would show up. You're not having a heart attack, right?

They take him to the hospital just to be totally sure he's okay.

Then, a dispatch about an older man at a nursing home who fell. Do you remember falling? Is this normal for him? I know you said it's kind of not, but he's not really verbally responding, not really answering questions he normally would. Brett and his partner transport him to the hospital, and then there is a bit of a lull, so they decide to get dinner. Ready, roger, dodger. They run into some colleagues and chat over slices of pizza. I was watching the movie.

As far as an ambulance shift goes, this is pretty quiet for Brett. And the nature of the calls is not as horrible as some of the others they get. At any moment, they could be responding to car accidents, violence, children getting hurt, people suffering or dying. And that's the really dark side of the job. It's a lot to carry.

Brett says for a long time, people in this industry would bottle up their emotions. Nobody wanted to see you cry. Nobody wanted to hear you talk about it. Nobody wanted to admit that this does affect you. You know, everybody has to keep that stoic sort of helper mindset. And I think a lot of times we think that showing emotion is going to be perceived as weakness. I think a lot of us, myself included, know better now.

The job can take a very serious toll on people's mental health. Brad has lost colleagues to suicide, including his former ambulance partner. The last time I talked to my full-time partner that I lost to suicide, he was happy. He had a big smile on his face. He told me to let him know how paramedic school was going. He said he was okay. He said, I'm good, I'm good, I'm good.

And Brad has felt the emotional burden of the job himself lots of times. I'll be the first to admit I had a horrific call about two weeks ago. At the beginning of the call, this gentleman was short of breath, but he was awake and talking to us. And by the end of the call, he had passed away. They declared him dead at the emergency department. It shook me really hard that I was having a conversation with someone one minute, and then the very next minute they're gone from this earth. I broke down. I was in a lot of pain.

I truly did. I stood in the ambulance bay and had myself a mini panic attack, but I was surrounded by the people that understand what was going on. We turn to first responders for help during emergencies. We expect them to stay calm and cool, to know exactly what to do. In scary, dangerous or life-threatening situations, they are the ones tasked with saving us. But who's looking out for them?

On today's episode, first responders, the toll the job takes, and what helps them cope. The emergency medical service Brad Sabo works for is trying to offer support and mental health services for their employees.

Neil Brady is the chief strategy and experience officer for VMSC, and he spent more than a decade in the field as a paramedic himself. COVID really pushed the envelope for providers, and you saw providers leaving their careers. We're recognizing that this talk about mental health affecting providers is

is a real thing and look what's happening. We're not having those folks come back. They've gone somewhere else. And for those who have stayed, we really need to support them and understand how to support them better.

VMSC has started a wellness program that includes a chaplain who also serves as a counselor. She not only provides counseling, but she actively rides as an observer with the crews. So she's understanding what they're experiencing as providers. And I'm finding that our staff seek her out for counseling and to share their emotions with

But a lot of EMTs around the country don't have this kind of support, or really any mental health support. And they pay the price. Liz Tong met one man who's been battling a lot of demons from his time as a firefighter paramedic, and he's trying to chart a path forward.

John Keller started seeing a therapist five years ago. And in one of their early sessions, the therapist asked him to draw a picture of the ambulance John spent a decade riding in as a paramedic. And at that point, I didn't feel like I could draw it, but I felt that I could write about it. So he did. The result was a poem called Drawing the Box, which is what paramedics call the ambulance. Here we go.

How you gonna draw this, then color it? The inside or outside of the box? It's too long to read out the whole thing. But there were certain lines that stood out. The worn-out tools he used to try and save lives. It's a green airway bag in an orange drug box in a blue trauma bag. The smell and colors of sickness. Sick is gray or ashen or blue or yellow or red.

and the ways, even now, these experiences still haunt him. I can hear a siren from so far away, usually before anyone near me does these days, and it takes some effort for me not to find myself behind that windshield again in an instant. Six years after John quit working as a paramedic, a part of him still lives there, inside the box.

John applied to become a firefighter paramedic at his local fire station in Corpus Christi, Texas in 2007. In part, he was attracted to the work schedule. You worked 24 hours and you were off for 48. That meant you worked about 9 or 10 days a month. That sounded pretty good to me. He also liked the shared mission and tight-knit teams. But there was another, more important reason he felt drawn to the work.

A couple years earlier, John's mom was assaulted outside her apartment complex in Dallas. The Dallas Fire Department, their paramedics saved my mom's life. And so I felt a sense of obligation to look into that. I needed to give that sort of effort back is what I felt.

After a year of training, three months on firefighting, and nine on emergency medical services, he was out on the street. It was a trial by fire, literally. I fought house fires. I stopped gunshot wounds. I responded to stabbing. I've, you know, car wrecks, diabetic emergencies, heart attacks, strokes, difficulty breathing, emphysema, sexual assault, broken bones. You know, like, I've seen all kinds of s***.

John spent those first few months feeling constantly overwhelmed and stressed out. It was a lot to absorb, so much suffering and fear and pain, not to mention the pressure of holding people's lives in his hands. But also felt good. You know, like I was very proud of what I was doing at that point in time. I held my head high. But those 24-hour shifts...

It turned out they were a lot harder than John had expected. His unit was one of the busiest in the city, in the country even. And a lot of times they were just racing from one call to the next with no time to catch their breath.

It was exhausting. I know early on, I remember being at one call one time and I was speaking with a patient or their family and I know that I was just talking gibberish. Over time, his body adjusted to the new schedule. But one thing he couldn't get used to were some of the horrific, shocking things he saw as a paramedic. Images that, years later, remain burned into his brain. It's like I've got this Rolodex of experiences.

and some of the pictures have like a sticky note on them that make them stick up. I guess one of them that very early on in my career was, it was a suicide, and it was in my own neighborhood. John wasn't ready for what he would find, the body of a 15-year-old kid. And I just remember walking into his bedroom. Parents were screaming and freaking out.

And like, his music was still playing. There was nothing for John to do. No vitals to take. No medications to give. There was nothing I could do. And that's part of it, you know? Like, as a paramedic, you're not going to save everyone. And that was when nothing could be done. Calls like this were hard to take and to shake.

But it wasn't really something they talked about, at least not directly. Don and his co-workers relied on something else, dark humor. And you would joke about s*** like that, like the few days later, you would look at the old bits in the paper and you'd joke around with the guys at the table and say, who'd you kill? Looking for the patients, the people that you encountered.

It was all part of the culture there, and in a lot of paramedic units. Dark jokes, ironic, not ironic catchphrases like "living the dream" that they said back and forth to each other all shift long.

These jokes were about as close as John and his co-workers would get to acknowledging the horrible, traumatizing things they were seeing every day. It was the kind of place where you didn't show weakness, where you laughed off the things that would make most other people cry. This is a pretty toxic culture. About five years into the job is when John started to struggle.

There was the stress of work and then trouble in his personal life. John had broken up with his girlfriend of 12 years and found himself suddenly alone, grappling with a lot of hard feelings. Around the same time, he responded to a couple of especially horrific calls, including one with a child and another suicide that happened right in front of him.

The images of those calls haunted him and robbed him of sleep. Those two things kind of rocked me. Those are two calls that the images, the images are always going to be sharp and clear. John was starting to show signs of post-traumatic stress disorder, though he didn't know it at the time. He just knew that he was struggling.

For support, John did have his dogs, who he says saved his life, and friends he could talk to after a particularly rough day. But in the end, dogs can't talk and friends go home to their families. So for the most part, John just kept his feelings about what he'd seen to himself. In the meantime, the traumas kept piling up.

Eventually, John requested a transfer to a slower station, Station 15, which was known back then as the Florida of Corpus Christi Medics, the place where older guys at the ends of their careers went to relax before retiring. John got the transfer, but it was not relaxing. In fact, it almost had the opposite effect.

He went from being constantly busy on calls to suddenly having a lot of time to sit around and think and to notice his anxiety. I found myself, I would pace. I would pace around the station. I would pace around the ambulance, waiting for a call to drop because I didn't know how else to be. I didn't have time. When I was at a busy station, I didn't have time to pay attention to myself. There was no such thing as self-care anymore.

Self-care was getting a surf if you could or just, you know, going home and starting to drink. Eventually, the anxiety got so bad that John started having trouble getting himself to work. He knew he needed help. So he requested a meeting with his battalion chief, the guy in charge of his section of the city. This guy came out and I told the chief, I said, man, I'm having a hard time coming to work.

I'm experiencing these symptoms. I'm nauseous whenever I come in. I don't know what to do. I'm having a real hard time being here. So John requested that he be allowed to just be a firefighter, to drop the paramedic part of his job. It's something that some firefighters are allowed to do after being on the job a few years. But the chief immediately shut that idea down. They were short-staffed, he said. They needed him as a paramedic.

And then he said something else to John. Basically, he told me, he's like, Keller, you're already at the slowest station in the city. I can't do anything more for you. This is the best that it's going to be for you. And if I didn't like it, that Home Depot was hiring. John still remembers that moment as vividly as any of his calls. How the two of them were leaning over the hood of his ambulance, still warm from his last run.

the "What Would Jesus Do?" bracelet the chief wore on his wrist. I was basically telling this guy that I was hurting and I needed help and I didn't know where else to turn. And I remember, like, at that moment, I was like, "I am going to leave this job as soon as I can." John decided to stay three more years to make it to 10 total so he could get his pension.

And after that, he finally quit. Soon after, John got married, moved across the country, and started a new life. It was a relief to no longer be working such a demanding job. And yet, John still felt haunted. I was still walking around town like I was still a firefighter and a paramedic.

That's when I started realizing that I was spending a lot of time dissociating. This is when I started noticing that I was being triggered by certain things. John was reluctant to see a therapist. He says he was still caught up in the suck it up, stiff upper lip mindset. But finally, his wife convinced him. That was when the puzzle pieces finally came together.

All the weird things his brain was doing, the dissociation, the hypervigilance, they were echoes of his trauma. They were symptoms of PTSD. It's been six years now since he quit, five years that he's been in therapy. And John's made progress. But a lot of that trauma still lives in his body. It didn't go away immediately. It's still not gone. I still haven't slept a full night. I'm getting better. But...

I still, on most nights, automatically wake up sometime between 2.30 and 3.30 in the morning because that's what my body's conditioned to do. I'm conditioned to be awake and respond to someone's emergency at that time of night. Even now, anything can put him back in the ambulance, back in the box.

Hearing sirens, seeing a drunk guy on the street who's clearly in crisis. A scrap of paper that's the same color as the boxes of atropine they kept in the ambulance. It's like he's always holding his breath. A lot of times I'm waiting for something bad to happen. I still feel like I'm going to see people dying on me. I carry a first aid kit with me wherever I go. I carry stuff that I can stop massive bleeding in my backpack.

I've got a tourniquet and trauma dressings. I feel like I am incomplete if I go anywhere and I don't have those things. And that's still to this day. I asked John if there's anything he wishes would have been done differently to support him when he needed it the most.

And it's a tough question, because while not everyone will get PTSD, most of them will be exposed to horrible things. It is unavoidable. When you sign up for that job, that's part of it. I guess I just wish that I had had more access to knowledge about what some of these things are. Like, how is PTSD going to manifest? If someone had told me when I was a rookie what dissociation was...

You know, maybe I could have started recognizing these things. I don't know what could be done really at this point in time, but I know something does need to be done. That story was reported by Liz Tong. We're talking about first responders and what kind of support they need to do this difficult work. Some agencies are trying to do better by their employees and allow them time and resources to process everything they witness.

Patrick Fitzgibbon says it's crucial for first responders and their employers to think about mental health. He's a retired police officer and an Army veteran who long tried to live by the whole just suck it up mantra. The big thing for first responders and myself is we're very proud. We don't want to admit that we're suffering, a lot of us. And the hardest thing I had to do was pick up the phone and say, I need help.

When you were a police officer and you had a bad day, you saw something terrible, you were in a really difficult situation, how did you handle that? How did you think about it? Well, you know, when I was young in my career, they do the best they can to prep you to say, look, you're going to see things. But as time went on, I became more withdrawn. You know, I became disconnected.

into my family, to my kids, to my wife. I was married twice. And it was a gradual kind of thing. But by the end of my career, I was just burned out. I was tired. I was frustrated. I was

depressed. I would still do my job, and I was a good police officer, but it's putting on that mask like, hey, I'm a tough guy. You know, I don't need any help. That tough guy act didn't hold up, though, after Patrick retired in 2019. He went through a string of really painful events. His dad died, his son attempted suicide, and then his wife filed for divorce. All those events...

kind of triggered me. And I was drinking heavily at the time to ease my pain. And there came a point where I wanted to take my life. And then that was the point where I knew I needed help.

Patrick enrolled in an inpatient program in Deerfield Beach, Florida. It's called Shatterproof at FHE Health. It's just for first responders to help them navigate mental health issues like PTSD and substance use disorders. They do yoga, breathwork, acupuncture, neurostimulation, talk therapy, and group therapy.

Is there any episode that sticks out in your mind from your own recovery where you could tell, like, wow, I'm becoming a different person? Or I was just able to relate to this other person in a way that I wasn't able to do before? Yeah, it was recounting a traumatic incident. You know, it always stuck in my mind. And that was the death of a toddler that I was the first one on scene. And I remember

You get dispatched is one thing, but when I got on scene, it was something else. And that happens sometimes. But I remember sitting in, I was in a group, and I remembered hearing a young female first responder that was right next to me recount her story and some of the trauma she had been through. And she had mentioned something similar to what I just mentioned, and I started crying. And that was kind of like an aha moment. I'm not alone.

There's other people that are suffering with some of the same stuff I am. And then after that, I started opening up more. Patrick ended up spending 35 days in the inpatient program. And then, eventually, he got a job there. He's now the program lead for Shatterproof. So it's kind of...

Weird how life turns out, but I love it. I'm very passionate about it. When you were working as a police officer, did you think about trauma? Did you think about, oh, this was a really terrible event and I might be scarred from this on some level? Or did you not even think in that way? No, it's just the way I was raised. It was just, you know, being in the military, I was in a tough unit. You know, I was jumping out of planes in the Army.

It was bred into me like, you know, it's a sign of weakness. You can't admit that you're struggling. But I equate it to a cup of water. There's only so much water you can put in the cup before it starts overflowing. And that's what happened to me. Then that trauma and PTSD starts manifesting. It starts manifesting in drinking. It starts manifesting in isolation. It starts manifesting in mood swings and depression and anxiety to the point where you're only comfortable when you're at work.

For me, it was like an addiction. You know, you're addicted to the chaos and the hypervigilancy, you know, where you're hypervigilant all the time. Talk a little bit more about hypervigilance, where you are always on high alert, whether you are in a restaurant or the movie theater or the mall. How did that affect you? Well, I think there's good and bad to it. You know, there's good that you're being aware.

You know, every day you walk around and people got their head buried in their phones and they're not paying attention to the world around them. But yes, you know, you're always watching or at least I was always watching, you know, exits and doors, a way out if something went haywire, hands, you know, are a big thing. Because that's just, that's officer safety. That's officer survival. That's things that are taught into you.

They're always on edge. They're always hypervigilant. The problem is, for me, is turning it off. You know, okay, so I'm at home, you know, and there's no threat.

And so, okay, my mind is racing. I'm wondering if it's almost like your mind is used to being so busy, you know, because you're always scanning, scanning, looking, looking. What is this person doing? What is that person doing? And then if you're at home, your brain is kind of like, what do you want me to do now? Yeah, exactly. You know, a lot of police officers, right?

or a good chunk of them, when they retire, a lot of them have health problems. Some of them unfortunately die because their body is now decompressing. They're so used to operating at that hypervigilance that now they're starting to relax a little bit and the body's not used to it.

Now, after 9-11, there was a big movement to do more debriefing, to give first responders a place and a space to talk about all the things they had encountered. Did that filter into your workplace at all? Yeah, of course. I mean, you know, every agency out there, at least the agencies I'm familiar with, anytime there's a critical incident, critical meaning a serious, like a shooting or a stabbing or something critical,

There's a debriefing. A debriefing consists of, you know, going over the call, you know, what we did good, what we need to improve on. A debrief is a time also where the command staff or leadership within the agency are talking to members, you know, of the agency and saying, hey, if people need help, we can make that happen for you if you need to talk to somebody. But debriefings are necessary. See, when I was a young cop, we didn't do this stuff enough.

And a lot has changed in law enforcement over the years, especially after 9-11, like you mentioned.

The issue is some agencies are good with it, some agencies are bad with it. Patrick says first responders can run into something called agency betrayal when somebody asks for help but is ignored. Like John in the story we heard earlier. He was told to get a job at Home Depot if he didn't like being a paramedic. I see this sometimes in my current work where

That's part of the reason that they're in treatment is because they feel betrayed. You know, they've given all this time and they've sacrificed, you know, given 110 percent and the agency is kind of turning their back on them. And that circling back around is like I said before, there are really good agencies out there who take care of their people. And unfortunately, there are agencies that are not. You know, they talk to talk, but they don't walk the walk.

And are people also afraid how their colleagues might look at them? You know, if you admit I had a real problem with this, then maybe your colleagues are like, ooh, that's because you're weak and you shouldn't be out there in the first place. Absolutely. That is probably the biggest barrier with first responders and police officers getting help is their peers. I'm not going to work with Patrick.

because he's struggling. And we are having a very important job. It's a critical job. We have weapons. We make life and death decisions. And if he's not 100% with his clarity and his cognitive ability, I don't trust that guy. And it makes sense. But again, it comes back to a culture of an organization. If you have

senior leadership in an organization that, you know, filter that down the chain of command and say, hey, it's okay to come forward. We know this is a tough job. You still got to do your job, but we understand you're going to suffer. You know, it's okay to come forward. And it's changing, you know, for the better. We still have a long way to go.

But it's good to see the change. In departments that do this well, what are some of the elements to create a place for people to talk but to not make it feel like, you know, you get all the eye rolls from everybody because they're like, here we go with the debriefing again. So you kind of have to set the right tone so it doesn't feel like a chore, if that makes sense.

Well, I think, you know, every department should have a wellness team or an EAP team, which is an employee assistance program. Some people don't like EAP teams. I do. But you need to have the right people in the right roles. That's one of the key elements. You want to have people that are empathetic, you know, are good listeners, that have some background, you know. Maybe they're psychologists. Maybe they're counselors. But that's a critical component.

of an organization. You know, some organizations have a big advocate for chaplains. The good thing about a chaplain is everything an officer says to a chaplain is private. You know, it's that private conversation, kind of like an attorney-client privilege. The same with a chaplain. The chaplain's bound. He or she's not going to divulge

private conversations that this officer is struggling with that is divulged to them. So I think organizations, you know, the key component to make this a success or have a better chance of success is have the right people in those roles and then create an atmosphere where, you know, officers, men and women feel comfortable coming forward. It doesn't have to be in front of everybody, but, you know, seeking those key players out where they can go and they can talk.

Patrick Fitzgibbons is a retired police commander, and he leads a first responder program called Shatterproof at FHE Health in Deerfield Beach, Florida. He's also the host of the Criminal Justice Evolution podcast. We'll put a link to that on our website. ♪

Coming up, firefighters risk their lives by running into burning buildings or putting out forest fires. But there is another, less obvious risk that comes with their work. I just started feeling like dizzy. I just kept going to different doctors because I'm like, something's wrong. That's next on The Pulse. ♪

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Firefighters have always risked their lives by running into burning buildings or putting out wildfires. But there's growing awareness of a more insidious risk they face, cancer. Sophia Schmidt has more.

Linda Long spent about two decades working as an EMT and paramedic. Then, in her late 30s, she decided to go after her dream, become a firefighter for the city of Philadelphia. This was in the early 2000s, and there weren't many women on the job at the time. I got along with the guys pretty well. You know, like the first time I'd see them or we'd go to a fire or something, they'd be like, oh, okay, you're going to do it. I was like, yes.

It turned out she really liked fighting fires, everything about it. Fun, hot, messy. You know, I need to work hard.

You're using your body and you wake up and you're like, oh, that felt good. You know what I mean? She worked her way up the ranks of the fire department. Firefighter, captain, chief. The first female battalion chief in Philadelphia. Linda says she responded to hundreds of fires over her career. About half were in homes, but there were other kinds. There's trash fires. There's garage fires.

One fire stands out in her memory. In June of 2019, an ominous call came over the radio early in the morning. A fire had broken out in a massive oil refinery complex in South Philadelphia. Picture a jungle of buildings, pipes, and tanks, some filled with flammable fuels and toxic chemicals. Linda's battalion was one of the first called to the scene.

Battalion 11. And as we got dispatched, I was like, oh, this is going to be really bad. Soon, there was a series of explosions. We were there when stuff blew up. One explosion sent part of a tank the size of a bus flying through the air. Battalion 6 reports we just had an explosion with heavy fire. He's requesting a third alarm for this location. We were at the front step. And then the, you know, the chemical that came out.

So I got exposed to that. A lot of firefighters did. The fire burned for hours. Hundreds of tons of hydrocarbons were released, as well as more than 3,000 pounds of dangerous hydrogen fluoride, which can damage lung tissue when it's inhaled. Afterwards, Linda says she didn't feel well. I had trouble breathing for like a year maybe.

Because my throat got tight. My lungs got tight. Then Linda started having other symptoms that were totally different. I just started feeling, like, dizzy. And I would go, I went to, like, treatment for the dizziness. I went to different doctors.

because I'm like, something's wrong. Finally, she went to see an ear, nose, and throat doctor. She told him her dizziness would come and go, and nobody seemed to be able to find a cause. He just looked at me and he was like, you know what, let's just check your brain. And they took me in for like an MRI, and boom. Linda was diagnosed with glioblastoma, a brain cancer, in 2021.

Two years later, she had to retire from the job she loved. Linda doesn't think any one incident, like the refinery fire, caused her cancer. But she does blame her decades of exposure to hazardous materials and fumes that came with working as a paramedic and a firefighter. Lots of factors contribute to people's risk for developing cancer: genes, lifestyle, or the environment they live in. But scientists are learning more about specific risks for firefighters.

A decade ago, a major federal study found U.S. firefighters going back to the 50s were diagnosed with cancer and died from it more often than the general population.

Then, in 2023, an international cancer research agency within the World Health Organization made a striking determination. We found sufficient evidence from all the firefighters around the world to reclassify the act of firefighting as a group one carcinogen. And it's specifically for mesothelioma and bladder cancer. Alberto Caban-Martinez is one of the researchers who worked on the project.

He's a professor of public health sciences at the University of Miami and says he and the other researchers combed through dozens of scientific studies to make their determination. In addition to mesothelioma, the cancer caused by asbestos, and bladder cancer, they found emerging evidence that firefighting is associated with other types of cancer too, like colon, prostate, skin melanoma, and non-Hodgkin lymphoma.

For cancers that aren't on that list, like Linda's brain cancer, Alberto says scientists have not ruled out a connection with firefighting. Brain cancer is rare, and that makes it harder to study. So that's not to say that there's not an association. There just hasn't been a sufficient number of cases to be able to see whether or not that relationship holds true when compared to the general population. ♪

But scientists know firefighters face a lot of hazards on the job. First, burning materials can unleash a soup of toxic chemicals and heavy metals. Collapsed buildings can release dangerous materials like asbestos. Firefighters often end up inhaling these contaminants. And even after the fire's out, soot, chemicals, toxic stuff can cling to their jackets and helmets. And there are more risks. Some of the foams firefighters use to put out fires contain PFAS Forever chemicals.

And the trucks they ride in spew diesel exhaust, which is known to cause cancer. There's a couple of different ways that these different environmental pollutants can enter the firefighter body. So some are germally absorbed, right? So if you have any of that dirt or smut on your skin, it's going to go right inside. The other place is through inhalation. Brian McQueen used to think dirt and grime were just part of the job when you're fighting fires, evidence that you were doing hard work. I'm

I mean, we were all that type of firefighter that, you know, the dirt on our faces was great. You know, the dirty gear, you know, the dirty hoods and stuff like that. Because for us, that was a badge of courage. Brian has been a volunteer with the Whitesboro Fire Department in a small town in central New York for four decades. He now serves as the department's safety officer.

His wake-up call came 10 years ago when he was diagnosed with a type of non-Hodgkin lymphoma. It was a total shock to my wife and I and to my family that I had cancer.

His doctors told him his illness was likely related to his work as a firefighter. After his treatment, Brian attended a conference with other firefighters where he heard researchers and advocates talk about the health risks of soot and other exposures. We looked at each other and said, what in the world did we do to ourselves? And how can we mitigate that so that the future of our fire service is not going to have to go through those battles that

Now, Brian helps lead a health, safety, and training committee with the National Volunteer Fire Council and helps write a best practices guide for firefighters. The guide recommends they wear their protective gear and breathing apparatus the entire time they're at a fire scene, even after the fire's been extinguished. Also, shower within the hour and wash contaminants off their clothes and dirty gear.

It also recommends fire departments control diesel exhaust in the fire station and provide annual physicals to catch any cancer early. We needed to change the culture in the fire service to reduce cancer risk. And you know, sometimes that's the hardest thing in the world to do when you try to change culture.

Before Linda Long retired from firefighting, she says she tried to push co-workers to take safety precautions, like cleaning and replacing dirty gear. She says sometimes this was an uphill battle. Yeah, and so many of us have cancer now.

Back when Linda was diagnosed in 2021, her doctors gave her just six months to live. But she's far outlived that dire prognosis. She's had two surgeries, chemotherapy and radiation to keep the cancer at bay. She wears a special device on her head that sends electric fields into her brain to try and stop tumor growth. It's powered by a big battery she totes around in a backpack. I need a new battery.

Can you get me one over there? Yeah, totally. The things that are charging. Yeah. Despite her serious health challenges, Linda has been able to do a lot over the past few years. She's organized friends to participate in 5K walks to raise money for brain cancer research. And she's traveled. I've been to Iceland now three times because I just love Iceland. But a few months ago, before she was set to leave for another trip, she went to her doctor. And I went for my...

And my doctor was like, Linda, there's something wrong. So I had to cancel that trip. The cancer was back. Linda started chemo again. Now she has a hard time getting around. By the end of our conversation, she was worn out. I think I'm getting tired already. But she's hoping next year she feels well enough to walk in the 5K to raise money for research and to keep raising awareness. So hopefully next year I can go again.

For The Pulse, I'm Sophia Schmidt. You're listening to The Pulse. I'm Maiken Scott. You can find us wherever you get your podcasts.

Coming up... Good morning, 988, how may I help you? Answering calls from people who are in the middle of a mental health crisis takes just the right approach. You throw out ideas, they may say, well, I've tried that, I've tried that, and then you find yourself in a circle giving a suggestion and then rejecting it. That's next on The Pulse. This is The Pulse. I'm Maiken Scott. We're talking about first responders and the challenges tied to their work.

So far, we've heard about people who physically rush to the scene of an accident or fire. But many first responders are remote, answering calls from people in need. More than two years ago, the U.S. launched a federal suicide crisis prevention number, 988, that connects people in crisis with counselors when they need help.

Millions of people have since called or texted using 988. Answering these calls is hard, and it can take a toll on the counsellors themselves. Alan Yu has more. Sean Kinney has worked in call centres for most of his adult life.

He answered calls at Ticketmaster, concerts, sporting events, Broadway shows Sean had you covered. But more than a year ago, he started answering calls of a very different nature. He got a job at a suicide and crisis hotline in West Virginia.

Sean went into this new line of work thinking he would help people solve their problems. That's not the case. We're not here to try to fix their problems. When someone calls you and they're having thoughts of suicide, your first instinct is to say, hey, man, there's so much to live for. What about your family or

Sean says crisis counsellors have to fight that instinct to jump in and try to fix people's problems.

Instead, their role is to help people cope with their feelings so they do not get to the point of hurting themselves. He says counsellors have to walk a fine line. They want to lead people to help, but not offer solutions because people may have tried those already. Like if you tell somebody who is homeless to find a shelter. And a lot of times people don't want to hear what they should do. You throw out ideas, you

They may say, well, I've tried that. I've tried that. And then you find yourself in a circle giving a suggestion and them rejecting it. They may have tried everything that you're offering. And that can be frustrating because now you're trying to fix it and you can't when all they need somebody to do is kind of validate how they're feeling and maybe help them cope with that feeling. Counselors at their center call this sitting in the suck.

About two years ago, Sean took a call from a man with a gun in his hand. Sean listened. He learned more about the man's circumstances. For example, that he was using a wheelchair.

He says usually counselors avoid talking about themselves. But Sean also uses a wheelchair, so he decided to bring that up. By doing that, it kind of opened him up to listening more and giving me more. And by the end of the conversation, he says, hey man, you saved my life.

That moment there is what I think is the most rewarding for us when we're taking these calls. The work can be rewarding, but also very taxing. When Sean first started the job, he had to learn how to leave things at the office, not take things home with him. Some of the chats and calls I would take when I leave work,

But Sean almost never finds out, and it's hard for him to not know the end of the story. Sean says he and his colleagues have a debriefing session after each shift to cope with the emotional burden of their work.

They all sit together, talk about how they are feeling and what they are doing after work, like going out to eat, going to the gym, or to a park. Lata Menon is the CEO of First Choice Services, the non-profit where Sean works. They run several helplines in West Virginia.

Lata says the group debriefing is a common practice now among crisis call centers. And that's really helpful because we know that we're catching up with everyone who works every day before they leave, putting eyes on them, listening to some stories about how their calls went that day, how their interactions went, and providing support through that manner. They have clinical support staff that can support workers who need help.

and amenities like quiet rooms with massage chairs, cots to lie down on, and VR goggles so they can relax on a virtual beach for a few minutes. Lata says First Choice Services is fortunate because the West Virginia Bureau of Behavioral Health funds the call center adequately.

But not all call centers are that fortunate. You're talking about a network of centers that aren't funded in a uniform way. So you have states...

that have taken a lot of care to try and fund their call centers in a robust fashion. You have set states that have not done so, and you've got call centers that are relying on a largely volunteer workforce. Not having enough funding and staff can create a tough situation. Of course, the goal for crisis centers is to answer calls as quickly as possible and avoid putting people on hold.

but how quickly councillors can get to calls varies from state to state, or if they answer them in time at all. Some states are answering more than 90% of calls, whereas others are answering only around 70%. Emily Bloom is the CEO of Foundation 2 Crisis Services, an agency that runs a crisis line in Iowa.

She says she does not have as many people as she would like to handle incoming calls and texts. We would consider ourselves to be almost fully staffed based on the contract that we have, but not fully staffed to meet the demand of the volume that continues to increase. High volumes of calls can lead to burnout. Emily estimates the staff turnover is at 50%.

And most of that happens in the first few months of someone starting the job. Employees may figure out that this isn't a job for them. They may realize that their mental health can't tolerate supporting others. They might be activated by past experiences. It's stressful work. It's stressful work and it's also not particularly well paid.

Emily has increased pay and benefits to try and attract more people. If we're looking at lessening burnout, giving staff the opportunity to do the things that they need to do between calls, we definitely need more crisis counselors to adequately staff the lines. To some extent, crisis call centers around the country have similar problems with staff leaving.

Tia Do is the Chief 988 Officer at Vibrant Emotional Health, which oversees the Federal Crisis Response Programme.

She says the attrition is difficult to address because they need to find a particular type of person who is suited for the job. Someone who is calm, someone who doesn't get easily activated. And this is going to be a big one for burnout is someone who is able to leave work at work and be like, I did my best in that moment. And I've given that person tools to help themselves and to be able to like really leave it at work.

Vibrant Emotional Health is working with researchers at the Mayo Clinic, a large non-profit health organization, to study burnout among call center staff. The idea is to learn which specific issues lead to burnout and come up with effective ways to address them. That story was reported by Alan Yu. Special thanks to Ryan Levy and the team at the podcast Tradeoffs for their help with this story.

That's our show for this week. The Pulse is a production of WHYY in Philadelphia, made possible with support from our founding sponsor, the Sutherland family, and the Commonwealth Fund. You can follow us wherever you get your podcasts. Our health and science reporters are Alan Yu and Liz Tong. Charlie Kyer is our engineer. Our producers are Nicole Curry and Lindsay Lazarski. I'm Maiken Scott. Thank you for listening. ♪

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