Hurricane Helene has taken its toll on everyone. And now we must ask, “How do we recover from this event?” On the first-responder side, I cannot imagine the level of rehabilitation we need, and how many staff will we lose to suicide or abusive behaviors. The simple fact is that even on a good day, we still don’t have a consistent mental health program for people in public safety, specifically EMS.
I have seen the post-hurricane mental strain in my coworkers and myself. I have never been so irritable and restless. The exhaustion, fatigue, and lack of focus has been ongoing. After the first 48 hours, I came home with a heightened sense of awareness. The intensity reached the point that my wife recognized early signs of mental struggle: the irritation and fight-or-flight sensation.
I had to have a purpose. I was hyper focused and generally unpleasant. I identified this behavior and had to work to stop it. When I returned to work, the fatigue and frustration were very present.
The Hurricane Helene Experience
The Federal Emergency Management Agency (FEMA) EMS units came in on day three and were added to our system. The lack of consistent communication about the roles of each team added to the stress of the event. We went from being run over in challenging scenarios to now being among three crews, answering a total of only 10 calls in four days. We had to ignore requests for wellness checks, or a FEMA unit would take those calls. It was not clear to us that the role of the FEMA units was to offset our workload and give our department a break.
People were elated and excited to learn this. They could work without having to deal with the consequences of all the 911 calls during a natural disaster. The other extreme reactions were visible anger and sadness, so much so that they could do nothing. When speaking to these coworkers, they told me they felt a sense of uselessness and despair. They wanted to go home because of the immense stress. The guilt of not being able to do anything was exacerbated by increased radio traffic or a bad call playing out on the radio. Additionally, watching any social media also added to their internal rage and frustration. The amount of misinformation increased the stress response to the event itself as well.
Battling Survivor’s Guilt
Survivor’s guilt is an area of concern, especially since so many people have lost everything and must continue to function with other first responders. Other locations still have all their possessions. Having lost a minimal amount, their responders get to leave the event when they’re done with their tours of duty. I can identify with this because I was able to evacuate to a safe area of the state, outside of the line of destruction.
At the end of my shift, I could leave the stimuli of the event behind me. I have spoken with coworkers who face challenges at home and getting to work can be frustrating. This adds to mental stress even before they get to work. One interesting point about adding FEMA units to our system is that we have a blended system. We now have staff that are not used to our area. And they have minimal navigational help, as most of the technology has been shut down due to a lack of cell phone service.
Adapting to the Situation
The variety of calls during this time was challenging. Many of the temporary providers came from different systems of operation, having shorter treatment times and different patient populations where they were not as comfortable with treating for longer timeframes. Many were not used to the hospital-to-hospital transfers with very sick or injured patients, and the use of a helicopter was a new tool that they had to become accustomed to very quickly.
The constant exposure to new situations significantly increased the stress load. It also began to encourage the mentality of “work until you drop.” Working when you’re fatigued is the same as working drunk. Your brain has no concept of this level of distress. I asked the crews how they functioned, and one crew member said, “until I drop.” We wanted to ensure that all crew members from FEMA were showered, and had access to food, enough sleep and good work cycles. The tragic reality about this arrangement was that their leadership—and ours—were only partially informed.
Again, looking at the mental well-being and now physical well-being of the provider became a “between the crews” approach instead of a top-down strategy. The sheer number of stimuli for the FEMA crews cannot go unnoticed. Since Hurricane Helene has now become such a large-scale event, my concern will always be for the personnel when they return home, and how they will deal with all their experiences and process them going forward.
The one question I always make sure to ask is, “How are you doing today?” It is used as a self-evaluation tool. If the word “fine” is in that answer, we must ask what is wrong in this situation. If we proceed with the day, that individual needs to be carefully monitored or given a step-down assignment as a way of protecting them. We must give them time to open up in a safe secure environment that will foster a good outcome. This will allow them to grow and heal from their trauma.
How We Heal
The next few weeks, months and years will be challenging for our profession due to Helene. The number of public safety personnel that will need to be debriefed and helped through this crisis is unimaginable. The public outcry will be much louder than our small group of professionals. I also think about the new linemen who are experiencing this type of event for the first time and the separation and growing challenge of being away from home. They’re learning a new trade and this isn’t what they signed up for. Dealing with this is not easy.
I end with a call for constant vigilance for our profession and the other public safety teams as we process this event and the fallout on a personal and professional level. Being willing to help or get help is vital. Seeing coworkers and friends and family in distress and being able to get help for themselves is critical for healing.
A Path of Uncertainty: The Days and Weeks Following
In the days after, the mountains of North Carolina were filled with a lot of uncertainty and questions. I was fortunate to be able to evacuate to Hickory, North Carolina, to a haven from the active zone on my days off. The flood of emotions was surreal, and at times, overwhelming.
My return to work proved challenging. Prior to my shift, I would go in the night before and check on my house and my subdivision, then bring food or other supplies into the neighborhood. Since we now had extra resources, for a few days the FEMA assigned EMS units primarily operated to give our staff a chance to recharge and assess our community needs. We also had to deal with our own staff members who had lost homes and all their belongings. And at the same time, we continued attending to family, friends and community needs.
A Sense of Community
We saw the community come together, and welcomed the flood of supplies and support from all over the country arriving to help rebuild and restructure our world. This is where the depth of disaster struck everyone. I related to both sides of the situation.
I saw the clear line of damage as I came to work. I spoke to people who had no clue about the mass and breadth of the storm. Sadly, many people chose to make the hurricane response a matter of politics and spread opinions, not facts. This only increased anxiety and stress among those affected. It made their depression and sadness worse.
As we proceeded through the week, I was assigned to a local fire department, and my focus was on community. I had to assist with helping chronically ill patients with getting prescriptions filled or diverted to other pharmacies. Temporary pharmacies were getting set up, but they were still not in place yet. This presented a challenge for the health of the older generation in Mitchell County, especially those with comorbidities. I can only imagine the fear and concern they had, rationing the life-maintaining medications that were once readily available.
Diabetics were our biggest concern, along with hypertension and anxiety patients. During the day it was busy, with rescues and recoveries being performed. As people ventured out, injuries became a challenge. The remote location meant the injured had no opportunity to call 911. And rescues were now becoming a challenge with the already ongoing recovery and restoration of the county.
Facing New Concerns
We received assistance from large groups of helpers in our community. They stayed for several days and helped clear storm debris. As much help as they brought to our community, they also brought concerns. Many of the helpers had great skills, both manual and medical training. However, they were not prepared to work and hydrate.
Vetting helpers was also an issue. A great example of this is when a seizure patient, who is normally very functional at home in normal circumstances, wanted to help. Being away from their routine and medications for their conditions, they could have become confused or at risk of having seizures. And then if the worst happened, it would tie up an EMS unit and stop the mission.
These types of scenarios also presented issues like medical legal risks and concerns for other ongoing issues. Not to mention we have many underprotected helpers who are now dehydrated and tired and need to call 911 because of exhaustion. Lastly, and arguably most impactful, is falling limbs and other debris now striking helpers and people trying to clean up their yard. The secondary injuries were profound and impactful on the mission.
We had a young nurse who was struck as she exited a vehicle, causing significant injury to herself along with injury to the crews trying to help her. The crews also disregarded their own safety and the safety of the responders who brought aid and transportation out of the affected areas.
This was a war zone, and the rules of medical aid in a war zone applied here. Anything less was a safety concern and a distraction, and we were one hour from the closest trauma center. Many of the routes to the trauma center were challenging to navigate due to ongoing restoration, and at times poor communication regarding accessibility.
Making Our Way Back to Normalcy
With more resources coming back online, the need for FEMA EMS units decreased. We began running at full capacity, with the addition of extra staff, to ensure we had safe operational periods. The hospital was back up and running. We also had a mobile hospital to aid in overflow and other details like pharmacy services and taking care of minor treatment patients.
This greatly reduced stress at the hospital and assisted with good turnaround times. As we move forward, the stress and anxiety associated with the complexity of the event, as well as the personal effect it has had on our crews, will continue to be a challenge. We must find ways to cope with the depression and sadness of what we as a community have seen.
The Eye of the Storm: Community Resilience
I have reached out to the regions east of our department and spoken to peer support leaders in preparation for the need for assistance. They have also expressed their concern and offered help. Many of their staff assisted with the initial days after the natural disaster and have been through debriefings to begin the process of healing. For many of my colleagues, this decompression is going to be key for their healing process and for their families.
As Hurricane Milton made landfall in Florida, some of our resources were reassigned. The consecutive storms left us very open and exposed to stress. We had many more busy days of injury, illness and challenges after these historic storms.
I am amazed at the community resilience of the people of the mountains. It is truly amazing to see how people from all over, and even next-door neighbors, helped each other out. Maybe we can take a page from this event and apply it to everyday life to build a better world. For now, we must focus on putting the southeast back together.
Please don’t forget the communities in North Carolina, South Carolina, Tennessee, Virginia and Florida as we heal from the 2024 hurricane season. We will still need help for the weeks and months ahead.
