June 23, 2023

Today marks the two-year commemoration of the Champlain Towers South building collapse in Surfside, FL. In June 2021, as first responders from across the state convened on the site to navigate the mountain of rubble, retrieve survivors and recover victims, UCF RESTORES’ Critical Incident Response Team was deployed to provide psychological first aid to the attending first responders. In the following months, Dr. Beidel and UCF RESTORES faculty led the development of a study assessing the psychological symptoms that emerged in these first responders – and the published results of that study are the focus of today’s Director’s Cut.

Click here to access the full study and read on for the highlights through the lens of Dr. Beidel’s first-hand experiences. To catch up on past Director’s Cut features, click here.

In June 2021, the Champlain Towers condominium in Sunrise, FL, collapsed. A few days later, you led the UCF RESTORES Critical Incident Response Team as it deployed to the site to support first responders on the scene. Can you recall what it was like to first arrive on the scene? What did you see? How was everyone responding?

“This was not the time for formal therapy. We were there to provide psychological first aid.”

We arrived on the scene about three days after the collapse, as part of the State Fire Marshall’s Office State Emergency Response Plan (SERP). This was the first time that mental wellness teams had been deployed to participate during the actual rescue and recovery effort. When we first got there, we met with Chief Chris Bator (Coral Springs Fire Department) and LT. Jeff Orrange (Orlando Fire Department) who were running this part of the deployment. When we arrived, there was a large area cordoned off and there were emergency vehicles everywhere … I remember thinking how extensive the operation was.

The first responders were very professional and focused, going about their assigned tasks. Soon after we arrived, a member of the peer support team led us to the site of the collapse, much closer than other civilians were allowed to go. She knew that we needed to understand the scope of the disaster if we were going to effectively help coordinate its response. I was also allowed to take as many pictures of the rubble as needed, as there was an understanding that we would need the images later to create the virtual reality scenarios that would be used in treatment of first responders who attended this disaster.

The Urban Search and Rescue Task Forces were dedicated to finding everyone who might have survived or who had perished in the rubble. This was not the time for formal therapy. We were there to provide psychological first aid. We did not have an office – we borrowed some space at times but, most often, we did our work in the food tents, joining people at tables to check on them and see if they wanted to talk.

Psychological First Aid (PFA): An initial disaster response intervention delivered by mental health professionals to promote safety, stabilize survivors or responders of disasters, and connect individuals to help and resources. The purpose of PFA is to assess the immediate concerns and needs of an individual in the aftermath of a disaster – not to provide onsite therapy.

Recently, you led the development of a study assessing the psychological symptoms that emerged in first responders attending to the Surfside tragedy. What led to the launch of this study and how did your team go about conducting it?

“The Champlain Towers collapse resulted in the third highest death count in US history, excluding terrorist attacks.”

There were seven Urban Search and Rescue (USAR) Teams throughout the state of Florida who participated in the recovery effort. There was concern on the part of state officials and firefighter professional organizations about the mental health effects of this deployment on the rescue personnel. The Champlain Towers collapse resulted in the third highest death count in US history, excluding terrorist attacks. The recovery effort took weeks and occurred in extreme heat and humidity, daily thunderstorms, the threat of a hurricane, and the continued threat that the rest of the building was unsafe and might collapse. The recovery effort was stressful both physically and mentally.

Part of our efforts as the Critical Incident Response Team was to consider and plan for the potential need for long-term intervention. We decided to survey mental health symptoms on a monthly basis, as we know that not everyone will experience symptoms immediately after an event. (It may take several months for distress to occur and/or be recognized.) So, in collaboration with the Florida Firefighters Safety & Health Collaborative, we launched a survey that was distributed to all the members of the seven participating USAR teams. We asked people to complete the survey monthly, and our plan was to conduct it over the course of a year.

Could you please walk us through the findings?

I think the first thing to note is that the response was not as robust as we had hoped, but it was consistent with the response rate that groups receive from this type of survey. (Typically, about 10% of people who are asked to complete a survey actually do so). So, we had about 45 participants sign up for the survey, and most of those continued on for the first three months. After that, the response dropped off – I think people got tired of filling it out every month, and I can’t say that I blame them! (In the future, we would likely consider incorporating fewer questions.)

What we found, overall, was that symptoms of anxiety, depression, posttraumatic stress disorder (PTSD), sleep disturbance, and suicidal thoughts were very low in this population throughout the three months of the successfully conducted survey. I was intrigued, however, because it appeared that half of the respondents had participated in the recovery of human remains – either adults or children – and half had not. So, we took the opportunity to split the sample into rescuers who discovered human remains and those who did not, and we found some important differences.

The rescuers who discovered human remains had significantly more symptoms of depression, anxiety, and PTSD than those who did not recover human remains. Most importantly, 52.6% of the individuals who recovered human remains had anxious, depressive, and/or PTSD symptoms that were sufficiently severe and impairing to benefit from mental health treatment. 37% had probable depression, 26% had probable generalized anxiety disorder, and 16% had probable PTSD.

Did any of these findings surprise you, personally?

“This is the first time that [first responder mental health response to body recovery] has been documented with data.”

I don’t know if it surprised me personally, but I think that many people would be surprised to find that the most common emotional reaction of the USAR teams who responded to this traumatic event was depression, followed closely by generalized anxiety – with PTSD in a distant third place. I think this illustrates once again that we have to understand the multidimensional nature of trauma and the multifaceted reactions that may follow such an event.

Trauma can elicit many different types of responses or even no response at all. We saw that in this sample – some first responders who “worked the pile” endorsed few symptoms of depression, anxiety, or PTSD, whereas others were more affected. In this case, the individuals who discovered human remains were most affected. Although that might seem like an obvious finding, this is the first time that this has been documented with data. The study suggests that it is not simply being exposed to a trauma that results in emotional distress – it might be your proximity to the center of the event or your specific role or function that might be important.

But it is also important to remember – among the first responders who shared the same task of recovering remains, half suffered emotional distress and half did not. There is so much more to learn about how to predict response to traumatic events.

How do we move forward with the results of this study? What steps should be taken to allow for improved psychological support of first responders attending to critical incidents?

There are several steps that we can take with respect to mitigating the psychological impact of these critical incidents:

  1. First, we need to recognize that at different points in the cycle of an event, different actions will be needed. During active operations, responders are in “work mode” – short conversations can occur at meals or when their shift is over, but it is not the time for long conversations. Psychoeducation and psychological first aid are the preferred actions.
  2. Second, there should not be any assumption that everyone is negatively impacted.
    It’s OK to be OK, and it’s OK to not be OK.
  3. Afterwards, follow-up resources need to be in place – this means ongoing peer support, chaplain availability, and access to culturally competent mental health clinicians who (a) can provide an appointment within a short period of time and (b) provide treatments that are evidence-based.

Florida is leading the nation in addressing the mental wellness of first responders and we at UCF RESTORES are proud to be part of this endeavor.

Beidel, D.C., Rozek, D.C., Bowers, C.A., Newins, A.R. & Steigerwald, V.L. (2022). After the fall: Responding to the Champlain Towers building collapse. Front. Public Health 10:1104534 doi: 10.3389/fpubh.2022.1104534