ATLANTIC CITY, N.J. -- Crash scenes, fires, shootings, freak accidents. First responders depend on their training and adrenaline to help when they arrive at a scene.
Often, there is a good outcome. Other times, those tasked with saving lives are faced with death.
"When they don't save a life, they look at it as a failure," said Tom Eppler, a former emergency medical technician who works as a peer counselor for first responders.
For thousands of South Jersey emergency responders, saving lives is a vocation that drives them. But after the urgency of a trauma scene gives way to the thoughts of what more could have been done, the responders are sometimes left with no outlet to handle what they've seen and done.
"That's when we have to talk them through it," Eppler said. "The death part doesn't make it too easy, especially when you roll up on a scene and there's an accident victim you can't do anything for."
The rain was pouring down when Atlantic City's Rescue One arrived at the Revel site Sept. 15, where a construction worker had been struck by lightning. The lightning hit a basket used to mix cement, knocking worker Bryan Bradley unconscious and injuring Joe Forcinito.
Workers led the Rescue One responders up several floors of the casino project by elevator and then two more levels by ladder until they reached the roof deck, where Bradley was lying on the ground.
Quickly, Firefighters Vernon Cruz, Fred Granese and Greg Desantis began cardiopulmonary resuscitation.
"As they're doing that, I'm assessing the situation," Fire Capt. Duane Brock recalled. "Making sure there's no one else down, making sure we have a means to get him down, relaying information to our battalion chief, telling him what I need while he's on the ground trying to get all the stuff squared away."
The struck basket was replaced with a basket to take Bradley down to awaiting ambulance workers.
"We're trying to stabilize this patient so he can get to the next level of emergency service," Brock said.
But the work couldn't save Bradley, who was pronounced dead at the hospital.
"Once we get back to the station, we can kind of evaluate what just happened and how we felt," Brock said. "We always try to do everything we can. But you always kind of sit back and say, 'I wish I could have done more.'"
Sometimes, those who respond first to a scene need a little extra help getting past that. There are groups such as the New Jersey State Police Office of Employee and Organization Development, which includes counseling for first responders.
"We call it vicarious trauma," said Jim Nestor, the office's director. "You're not involved in the trauma, but vicariously you are because you're in the midst of it."
Responding to the parkway crash
"Chief, this ain't what you think it is," the officer said, his voice cracking. "This is bad."
Leonard Tilley -- chief of the Farmington Volunteer Fire Co. in Egg Harbor Township -- already had an idea of what to expect when he got to the Garden State Parkway crash site Aug. 20. He has family members who work as dispatchers in the township, and they told him there were kids involved.
There were eight teenagers from Mainland Regional High School's football team in the car. As Tilley approached, at least two were being worked on by emergency medical technicians: one died at the scene; the other at the hospital.
As he surveyed the crash's aftermath, there wasn't time to think about how young the victims were. Emotions need to come later.
"You learn to focus on the care that's needed by the patient at the time," said Aileen Holmes, senior vice president of Clinical Affairs at New Jersey Hospital Association Inc. "You really need to put aside your personal feelings. (First responders) focus on what they have to do to try to save the individual."
Holmes knows that well. She was a Vietnam War nurse for four years.
"You have to teach yourself how to separate your emotional feelings," she said. "You have to have the personality and psyche where you learn to distance yourself a little bit emotionally."
Sometimes that's harder than others. Tilley said a few of his younger firefighters knew the Mainland players. At least one grew up with them.
Tilley told them they didn't have to stay. None left.
"They did what they had to do," he said. "And they did it with dignity."
Farmington Firefighter Jim Garth Sr. -- a past fire chief -- was in the same spot once.
On Sept. 25, 1975, Garth responded to a crash that killed four Absegami High School football players -- three of them brothers. He had coached the boys in baseball.
"It's just devastating to see this happen to young kids," Garth said.
When a news station aired a story on that crash after the Mainland accident, it was difficult for many of them, Garth said. He was taken back to 1975; some of the younger firefighters who had just worked the parkway scene had their own flashbacks.
"Your mind starts to think about these kids and their families," Garth said.
"You're looking at these kids," Tilley said, "they've got their whole lives ahead of them, and it's gone."
A volunteer company such as Farmington especially worries about the stress after something like this.
"We just got these guys, we don't want to lose them," Tilley said. "Some of the young guys were in disbelief. They were seeing the worst of it. It's new and it's hard."
The firefighters were invited to a memorial service for the teens the day after the crash, but they couldn't make it. Instead, they were gathered at the firehouse, getting peer counseling from Eppler and others, and just talking it out among themselves.
"You have to spend time taking care of yourself," Holmes said. "I give myself permission to grieve or cry at home that night. I would also seek out people -- either good friends or family -- to listen."
Tilley turns to his wife.
"I come home and I sit at the table and talk through everything," he said.
The point of all of it is "getting them ready for the next call," Eppler said.
Tragedy follows tragedy
On Aug. 20, it didn't take long for some to go to that next call. Seven people died in three incidents that day. Some emergency workers responded to more than one of those fatal scenes.
Tilley watched as a female worker gave everything she could to the Mainland teen who died at the hospital.
"She worked on him the whole way to the hospital," the chief said.
Then, a few hours later, a call came again. She went. This time it was the Black Horse Pike near the Egg Harbor Township-Atlantic City border. Another crash. Another car with eight people. Two children died at the scene; a third at the hospital.
"Just because somebody dies, you've got to keep doing your job," Eppler said. "That's the rule of (emergency medical service). That's the work of first responders. Just because you had a traumatic call, you can't say, 'I'm not going to go out on the next one.'"
They have to focus on the positive cases, Tilley said. For the younger ones, he stressed to them that they've seen the worst. But there are those times when, weeks after a rescue, you see the person, all healed.
"That's what we do it for," he said.
"You hate to see anyone lose their life for any reason," Atlantic City's Brock said. "We try to make sure this person makes it home to their family."