By Kellie O’Dare
On June 24, 2021, at approximately 1:30 a.m., the Chaplain Towers South condominium in the Miami Beach town of Surfside, Florida, suffered a catastrophic collapse. Local area first responders, including fire rescue, tactical response teams, and law enforcement, were on scene immediately and rescued approximately 30 survivors from the collapse scene. The “pancake” building collapse was the most devastating of its kind since nearly 20 years prior on 9/11. In a matter of seconds, the collapse shattered lives, created tens of millions of pounds of wreckage, and left upward of 140 people unaccounted for.
Florida Urban Search and Rescue (USAR) teams, comprised of highly trained first responders specializing in urban search and rescue, disaster recovery, and emergency triage and medicine from around the state, began mobilizing and deploying to the collapse site to assist with the massive response effort. USAR teams are typically comprised of firefighters/first responders, engineers, persons trained in emergency medicine, and several other specialty professions. However, USAR teams have not historically incorporated a comprehensive mental wellness plan for first responders deployed to disaster scenes.
Evidence indicates USAR deployments require a high level of mental and physical effort. The physical, social, and psychological demands of disaster response work can become overwhelming and, without mitigation, contribute to longer-term behavioral health and substance use issues. Immediately in the aftermath of the collapse, state and national experts working in first responder mental wellness began working together to develop and implement a comprehensive mental wellness plan including immediate-, short-, and longer-term strategies to ensure and protect the mental health of the first responders on scene. These experts included the Florida Firefighters Safety and Health Collaborative, the State of Florida Fire Marshal’s Office, the 2nd Alarm Project, University of Central Florida RESTORES, the International Association of Fire Fighters, and Miami Dade (FL) Fire Rescue. The plan focused on 24/7 provision of trained peers as well as the availability of on-site first responder proficient clinicians. Team members worked to provide immediate services as well as participated in longer-term planning to ensure that USAR members have access to evidence-based resources after demobilization from the deployment.
While the Surfside responder mental health initiative was complex and multifaceted in scope and relied heavily on partnerships, collaborations, and expertise across multiple organizations, the purpose of this article is to share one novel approach to addressing the mental health needs of USAR team members.
Although USAR teams often include members of specialty professions (physicians, engineers, etc.), historically teams have not included embedded mental health resources, such as trained clinicians and peer support team members tasked with overseeing the mental wellness of first responders at the site. Working in partnership with the 2nd Alarm Project, Florida USAR Task Force 7 had the opportunity to pilot an innovative approach to embed mental health resources along with their first responders deployed to Surfside, Florida. The primary purpose of the embedded resources was to engage in supportive/active listening; risk screen for longer-term adverse reactions; and ensure referral to appropriate medical, psychological, or tangible services if needed. The embedded resources relied on evidence-informed approaches for acute mental health interventions, including psychological first aid and peer support strategies for disaster response.
Based on initial feedback from task force members, their family members, and leadership, having these mental health resources embedded on this deployment was tremendously beneficial to our first responders. The success of this pilot relied heavily on several conditions:
1. Fire department leadership, command staff, and USAR team leadership strongly supported the embedded mental health initiative. Leadership is creating a culture where mental wellness is considered as primary as physical health. Mental health during day-to-day operations among first responders is of utmost concern, and this is amplified during special operation deployments, as those events are likely to be large-scale and traumatic, subjecting responders to massive amounts of human suffering and large-scale property damage.
2. Peer support is a force multiplier. The work the Tallahassee Fire Department Peer Support Team has done to lay the groundwork for mental wellness initiatives was invaluable for members on this deployment. Trained peers who are embedded, known members of the organization are often more valuable than professional mental health services.
Peer support is the heart of any resilient responder organization, and the brotherhood of the fire service is a tremendous strength and asset. Focusing on connectedness, belonging, and shared experiences among peers decreases the long-term negative consequences of disaster. Peer support members who were also K9 handlers were incredibly effective in mitigating acute stress on the scene at this event, and we highly recommend peer support teams incorporate K9 components as they are able.
3. Embedded mental health resources focused on strengths-based, resiliency approaches and used only evidence-based methods.
4. Embedded mental health resources were previously and personally known to the USAR team members. 2nd Alarm Project has done extensive work on behavioral health, including mental health awareness education and peer support capacity building with the Tallahassee Fire Department. We have worked hard to establish trust and rapport with this community of first responders. Authentic relationships increased the acceptability of mental health resources among task force members.
5. USAR team members had a preexisting, standardized level of mental health awareness training provided by their department through 2nd Alarm Project.
Having a preexisting level of mental health literacy increased members’ self-awareness during this deployment and improved the acceptability of mental health resources. Members are skilled in looking for signs and symptoms of distress both in themselves and others. This event highlighted the importance of establishing resources well in advance of potentially traumatic events.
6. We included the families. Developing a way to attend to the mental wellness needs of family members back at home was imperative to the success of this initiative. We created a peer group for family members to connect while their loved ones were deployed. This provided a sense of connectedness, belonging, reduced anxiety, and increased peace of mind for both the family members and the first responders.
7. We acknowledged the efforts of the responders back at home. Many members of the department back at home were working double and triple time to cover the shifts of those deployed. These responders back at home continued to put the needs of their communities and department above their own during this stressful and trying deployment.
8. Recognizing that potential psychological effects may not manifest for weeks, months, or years after the event, immediately upon deployment, we began working with our partners including the TFD Peer Support team and state and national experts to plan for longer-term supports and resources.
I believe our approach was effective because of its simplicity. We did not provide “counseling.” We relied heavily on the concepts of “tending and befriending,” being present, instilling hope, and a willingness to support the needs of these men and women by meeting them where they were. We spent a lot of time listening, talking, and normalizing the stress response in a very chaotic and abnormal environment. We provided support and comfort. If responders wanted a certain type of soft drink that wasn’t on site, we made it happen. We attended to simple things like making sure they had moleskin for their feet and ibuprofen–a lot of ibuprofen.
Being embedded with the team allowed us access to parts of the collapse site the general public and media were not. We watched our responders work for hours in the south Florida summer heat and sometimes in torrential rain, all this while wearing oppressive layers of protective clothing and gear and handling heavy equipment, adverse terrain, and other dangerous and tragic elements.
These responders were exposed to frequent, recurrent, and traumatic scenes including sights, sounds, and smells that no human wishes to experience over a lifetime. While they are incredibly well trained, proficient in their work, and highly resilient, they are still human beings and need time and resources to process things the human brain was not intended to experience.
We spent quite a bit of time in the “rehab” area, the respite area adjacent to “the pile” where responders took intermittent breaks while working. In the rehab area, we provided candy and light conversation. Often the candy was more welcome than the conversation. Responders worked in areas of the pile for hours on end, sometimes with larger tools, sometimes with hand tools, and often with just their hands, appearing to be almost surgical in certain areas when needed. They worked tirelessly toward the shared mission of bringing these loved ones back to their family members amidst the gravest of circumstances. We made a point to remind them of their efficacy and a difficult job well done.
Task Force 7 was demobilized and returned home on July 5, 2021, to a hero’s welcome. While the deployment has concluded and their mission is complete, the 2nd Alarm Project continues to remain steadfast in our resolve to evidence-based approaches to support the mental wellness needs of these first responders and their families, and our hearts remain with all of those impacted by the tragic collapse of the Champlain Towers.
Personally, I have never been prouder to be a part of something. It has been my honor and privilege to serve these responders, their families, and this important mission in a small way.
Dr. Kellie O’Dare is the founder and director of the 2nd Alarm Project, Inc., a Florida-based 501(c)(3) not-for-profit corporation serving the mental wellness needs of first responders, primarily fire/EMS, in the Florida Panhandle.