Aside from responding to a call involving your own family, can you imagine a worse scenario than what firefighters and EMTs are dealing with in Connecticut? A school full of children, a madman with a gun and you to pick up the pieces.
The situation is bad enough when the victims are strangers. But these children and adults will be friends, neighbors and acquaintances of responding firefighters and medics.
By all accounts the firefighters and medics from Newtown, Easton and Monroe volunteer EMS companies as well as the five volunteer fire companies of Newtown: Botsford, Dodgingtown, Hawleyville, Newtown Hook and Ladder and Sandy Hook responded as firefighters most often do, with competence and professionalism.
Mental health professionals have and will continue to go to Newtown to assist the children, teachers and relatives of the victims. They are going to need all the help they can get.
But what happens to the firefighters and medics when the scene is cleared and the rigs returned to service? Will there be anyone there to help the firefighters and medics cope with what they've experienced?
I posed this and several other mental-health related questions to Jeff Dill. Dill is the founder of Firefighter Behavior Health Alliance, a licensed therapist, and a 23-year veteran who serves as assistant fire chief in Palatine, Ill. He's also leading an effort to quantify firefighter suicides with the aim of preventing them.
"This is difficult for the loss to the families, but when you look at the first responders, this could be a very critical time for them," Dill said. "Not only do you have to look at grief, but rage, and how does that effect them going on calls in the future."
Something Dill is concerned about is a rash of responders, especially the volunteers, resigning after this event. In addition to the individuals still wrestling with the problems, the fire departments will find themselves short staffed.
One of the barriers will be getting the responders to simply acknowledged that they need help. We are, Dill said, a group that typically internalizes the stress of dealing with the loss of life.
"There are no heroes anymore, we need to talk this out," he said. "This is something we can't bury."
The key, he said, will be to get them in a room and make them understand that they are not first responders but human beings. And it has to start with the chief and officers and has to include everyone. It has to be mandatory and ongoing.
One problem of course is making sure the help offered is professional. Help that is unprofessional can leave people with a bad experience and make them avoid seeking help in the future.
The big picture
Dill is pushing for the formation of a national response team that can be deployed to areas like Newtown with mental health professionals who understand firefighters and medics.
"We send councilors out to help the people who lost their homes (like in Joplin, Mo.)," he said. "Why aren't we sending councilors to talk to the first responders? In this case here, you've got first responders going from room to hallway to room seeing the children and adults laying there."
The risks to those who go untreated can range from difficulties at home or work to addictions to suicide. Dill said that some firefighters who responded to the Oklahoma City bombing took their own lives, as did the firefighter who rescued Jessica from the well.
"Where does this leave us and who is the potential risk in this scenario?" Dill asked. It is important that there are no future victims from this tragedy, he said.
There are warning signs these responders can watch for in their colleagues. Chief among those are sleep deprivation and anger. Also look for longer-term grief.
"We need to make sure that our people are taken care of, otherwise there will be additional victims. It might not be suicidal; it might be depression, but they become victims over the long term."
This tragedy cannot be undone. The only thing to do now is ensure that it does not continue to ruin the lives of those who responded.