(siren blaring) - First responders have an incredible amount of stress.
If you think about what they're doing, but also what they're exposed to.
- As a first responder, you see so much that the general public maybe doesn't see on a very regular basis.
There's definitely a stigma that you have to just be this unbreakable person.
- First responders will show up and will complete a rescue no matter what level of depletion they're at.
But we have lost first responders in our community to suicide.
- In our own case with law enforcement officers, they're not as likely to ask for help.
They're not as likely to seek help.
- First responders are scared to be deemed sick, unwell, unfit for duty.
- We're able to take on a lot.
We can handle a lot of stress, we can handle a lot of really difficult situations, but it takes a toll.
- Some people might think, well, you'd get hardened to seeing things, but it can change people's lives, and it's not for the positive typically.
- And the stigma that goes with that creates a rigidity that we're strong, strong, strong, until we break.
- The culture has changed significantly.
It's no longer the go home and drink whiskey by yourself to numb out what you are experiencing.
- So the hope is that we can build a resilient community of people who can continue to do this work.
- The mental health challenge though is that it is impacting first responders at a much higher rate, and unless we do something significant, that could have lasting generational effects.
(dramatic music) - [Announcer] Funding for this program is provided by the Hughes Charitable Foundation, energized by love and faith, and inspired by the vibrant community around us.
Hughes Charitable Foundation supports organizations that are directly helping those across the state of Wyoming who need it most.
A private donation from Jack and Carole Nunn.
The John P Ellbogen Foundation, empowering the people of Wyoming to lead healthy lives in thriving communities.
Blue Cross Blue Shield of Wyoming, a proud partner with Wyoming PBS and other community organizations to provide funding for education to raise awareness of the mental health crisis in Wyoming, reduce stigma around mental health and connect people to available care that promotes positive mental health, and hopefully saves lives.
(birds chirping) (gentle music) - My name's Drew Kneeland.
I'm the ski patrol director here at Jackson Hole Mountain Resort.
Jackson is by far the largest ski resort in the area.
We have a staff of 87 on in the wintertime and about a dozen working in the summer.
In the summertime, we respond to incidents that happen on the mountain with the bike park and with hikers and so forth.
And in the winter we do avalanche mitigation work, and we also respond to injured skiers and riders.
Ski patrollers, a lot of them gravitate towards the mountains for the skiing, but then they realize what a service they're providing and they get some real joy from helping people who are in trouble in the mountains.
I like the variety.
Every day you come to work is a little different.
An average day in September is, it's kind of getting ready for winter.
Myself, I'm working on hiring and planning our training.
We are doing a job that we really enjoy in an environment we really enjoy, but it can be dangerous and you don't necessarily think of that even though you're surrounded by it every day, because there are a lot of different ways for people to get severely injured or be killed.
- Hello, valley dispatch.
Yeah, I'm on scene with a 33 year old male requesting a wheeled litter and suck bag.
- Okay.
One possible injury.
Is he conscious?
He's okay?
He's in a lot of pain?
Okay, let me call patrol for you.
- We live in a very rural area that it can be over an hour to care.
And even that care is still at a rural level.
These are the people that are plucking us off the mountain when things go wrong.
The first responder community, we take them for granted.
- Hello.
- Hi there, I'm Jack.
I'm gonna help you out, buddy.
- Since the pandemic started, we've seen a huge uptick in people that are recreating, especially in these extreme environments.
We have more people that have decided that they want start mountain biking and wanna start doing more extreme sports.
- The Ski Resort, National Park Climbing Rangers and Search and Rescue are all providing different levels of care, including air rescue with a helicopter, land, technical rescue.
And most accidents are very complex.
So that already is creating a load.
The number of calls is increasing exponentially.
The amount of users in the backcountry as well as the amount of inexperienced users in the backcountry I think is creating a unsustainable problem.
- Okay, here we go.
- I've been a volunteer with Teton County Search and Rescue in Jackson, Wyoming.
I've been a volunteer on the team since 2015.
The demands on the volunteers are incredibly high.
We just hit a record all time of having 110 rescues and it's only September.
I believe last year we had 105 total for the year.
As a volunteer, you're on call 24/7.
I'm one of 42 people who respond to backcountry emergencies under the direction of the sheriff's department.
We are working in extreme weather situations in extreme cliff out areas, avalanche areas, those sorts of things.
Responding to people who are in crisis or a trauma with one of their climbing partners or a skiing partner in the back country.
It takes a toll and a demand on the individual rescuers that were not always trained and prepared to deal with.
(gentle music) - I remember, it was a Friday the 13th in March of 2009 and a couple of ski patrollers were gonna go out the boundary and look at some terrain.
It's pretty steep terrain.
Not too long after they departed, a call came over the radio from the other patroller on scene.
Katherine, she was one of our patrollers and had taken a fall.
- Hello mountain patrol Drew.
- Katherine, when she landed, she crashed.
Sustained a very significant head injury.
We got her loaded.
We knew that it was a significant injury.
She was semi-conscious when we got there, and then she became unconscious.
Didn't have any brain activity essentially.
She was a real amazing person and a good friend and coworker, and that was a really tough time for our whole crew to process that, the loss of Katherine.
We didn't have a lot of tools to deal with those kinds of incidents.
We've had four patrollers killed here on the job over the years.
Wally was one and Katherine, those were in my time and that's had a huge impact on this group of patrollers that I work with.
The trauma that's created is pretty deep seated.
- We're told that if you're a first responder, that's what you sign up to do and you need to be prepared for that.
There is that idea that you have to be really tough and you can't show your emotions, but you don't necessarily see the accumulation over time and how that affects people.
- Virtually every law enforcement agency in North America is struggling with the downsides of the profession.
The average citizen of the United States in their entire lifetime is gonna have just a handful of critical incidents that occur in their life.
Those things that just rock them to their very core.
But it's estimated that a law enforcement officer will have eight or 900 of those same critical experiences, and we expect them to not carry any of that with them.
- Being around traumatic emergency situations where there's possibly danger to yourself or to other people.
Eventually it is going to start chipping away at your mental health.
- Just a few months ago, one of our most beloved employees began to suffer.
He had been involved in several critical incidents.
In a private meeting, he assured me everything was fine.
I was completely unaware that that would be the last time that I would see him.
And he tragically took his own life just a few days later.
- The risk of suicide, suicidal ideation with first responders is significant, off the charts compared to the general population.
(tense music) (tense music continues) - There's been a little bit of a paradigm shift in the first responder world in how we respond to these incidents.
There are stress injuries that happen the same as a physical injury to your body.
If you have a knee injury and you get injured while you're out rescuing somebody, we're gonna address that, and why aren't we doing that for these stress injuries that happen in terms of mental health?
- First responder work is a recipe for stress injuries, if unmitigated, if not treated well.
- There are things that really strain our first responders and I consider nurses to be in that first line as well.
It weighs you down when day after day you're faced with really horrifying things.
I teach for the undergraduate and graduate programs in the School of Nursing.
The way I explain it to my students is that when you have a pattern in your nervous system of dealing with trauma or difficulty in your life, it's like you've worn a path in your neural circuitry.
And what you have to do is get yourself out of that path and build a new path.
And it's really easy to slip back into that old path because it's physical neural connections that are happening.
- There are really two different things that happen with volunteers to lead to burnout.
The first is just the accumulation of exposure to stress injuries, repeated calls to very traumatic scenes, and very traumatic accidents.
And then there's also the one critical incident that can push people over the edge.
- A critical incident might raise their awareness, but the reason why that blip hit is because they've got so much going on.
The life stressors, that accumulative load of partner not fully understanding me when I come home tired all season, financial stress.
- Wyoming is in a mental health crisis along with the rest of the country.
But the interesting thing is a lot of people across the state sort of judge us as this is a beautiful place.
People come from all over the world.
So I think there's this judgment of like, this is a paradise.
How can you possibly have mental health issues?
But the reality is the cost of living in Teton County has always been high.
- Jackson, Wyoming is a hard place to live in terms of it's expensive to live here, it's hard to get daycare for your kids.
It's hard to get a job that has upward mobility and increase in income.
The pressures of either their daily life or the rescue work can build up to lead to consequences they weren't expecting.
- We have made huge steps in search and rescue in the first responder community, addressing mental health concerns.
That alone has opened the doors for many programs to start to evolve.
Opportunities to seek help have become available because we've started this conversation.
- Teton County Search and Rescue Foundation is a nonprofit in Jackson, Wyoming that supports Teton County Search and Rescue volunteers.
And then the big piece on mental health is we personally support the volunteers as much as we can.
And so we offer things like the TIPS program, the Teton Interagency Peer Support Program.
- It is a group of first responders dedicated volunteers from various agencies around our area.
So we have people from Jackson Hole Fire EMS, the Sheriff's Department, Jackson Hole Police, we have National Park employees.
So we want to support each other and help people connect to mental health services and supports that help them get through some of these really tough times.
We also do have therapists that are connected to TIPS as well.
All the agencies that participate in TIPS help with the funding source, and that covers the cost of therapy sessions.
- Whatever we can do to limit those barriers.
Whatever's most comfortable.
I was just even talking to a first responder today to say "hey, remember, I can meet you here.
You don't have to drive all the way into town.
Even if I can catch you on a quick break."
I've got the easy job.
I'm just creating space for their body, their system, their spirit to recover, to heal and to be their whole self again.
- Sometimes in the short term you really have to just buckle down and get back to work because the snow's still falling, the avalanches are still happening, the job is still there and you have to go back out, and you have to get back out there and do it.
And that independence is a valuable thing in a lot of ways.
But our job is to try to get people to accept that they may need help and to be vulnerable.
And that's a hard thing for people to do.
- There is a longstanding stigma that somebody might say you're not ready, you're not prepared to go on this mission, you're not on your A game.
- Law enforcement, military, those type of areas are all still concerns where we need to do more education.
It's a fear of being discriminated against.
People won't respect them or that something bad will happen to them or they'll lose something because they said "okay, no I'm not well, I need help".
- There has been a belief that if you seek any type of support, whether it's peer support or counseling, that it'll somehow reflect back that you are not fit for duty.
- To be on a helicopter, to have a firearm, there is a a certain protocol for fitness for duty, and if I'm a first responder that is dealing with some stress injuries, that is going to be on my record somewhere, which is why TIPS was started in the first place.
The TIPS program, we have no documentation, no paperwork.
Our role for mental health is to say "we're not trying to catch you.
We just want you to be at your best and we recognize the impact you're dealing with daily".
- All right, moving.
- It's always been kind of the ski patrol way to suck it up and get back out there and do your job and kind of repress those things.
But that is, it's a shift that's slowly taking place.
- Peer support, it's literally just reaching out to your teammates and your friends, and being able to have that relationship that you can openly communicate about what you're experiencing because you are impacted by a difficult call that you are on.
- There is a level of understanding that you don't have to explain all the things.
You're not talking to just anybody, you're talking to somebody who can relate to you in that way because you can't necessarily talk to your family and your kids and your wife or your husband about that stuff.
And so that makes it hard for people I think to have to try to hold that in - Try it from there.
Got it, back on that.
Is that enough for you?
- Yep.
Ready to lower.
- I remember one call out, it was mostly peer support that I sought to help me kind of process.
Last year the team was paged out for a group of snowmobilers who were involved in an avalanche involving multiple burials with one fatality.
It was very close to sunset.
We only had about 30 minutes to complete the mission and our flight time was at least 10 minutes just to get on scene.
And so we did a helicopter response, but it was very close to dark.
On a short haul mission, you get flown into the side of a mountain.
From there you detach from the rope, collect the patient or patients, secure them, and you're able to fly out.
We were able to recover the body and get the body out of the back country that evening.
And what really hit me was we didn't have a lot of time to spend with the people who survived the incident, and they had been doing CPR on their loved one for hours before we were able to get there.
- One of our duties is to, if we're called out on a rescue for someone who has had a terrible accident, it is Search and Rescue's kind of duty to go and try to number one, save that person's life, and if saving their life is not possible, then we try our hardest to bring that body back.
That could be really hard to leave family behind and just kind of do the mission that could have some real mental anguish for those involved, including the first responders.
- Sometimes those things, they can definitely weigh on you.
We weren't able to essentially comfort them and give them some peace of what they did was the best they could do.
Didn't feel human.
In the several days following that incident, I was definitely down.
When I realized that it was kind of sitting with me for a couple days, which is not the norm for me usually.
Like yeah, I think about it when I get home, my adrenaline's up, I'm kind of excited.
Myself and the other rescuer talked repeatedly about what had happened and how we could have done things differently.
It weighed on both of us enough that we actually reached out to the son of the individual who passed away in the avalanche and talked to him.
And in a lot of ways, that gave us closure and that's been really helpful.
(gentle music) - Search and Rescue team here in Jackson, we train twice a month.
Tuesday night's meeting is really kind of a time for us to all come together.
We have dinner together and then one of the things we do there is an anonymous check-in on where our mental status is.
So we utilize a stress continuum to identify where we are in that spectrum of stress responses.
This was something that is adapted from the military, and we have these colored slips of paper.
It's green, yellow, orange, and red.
And anonymously, you select the color that you're at and drop it in a cup and we display all of those once a month, just kind of taking a straw poll of where everybody on the team is at.
And green means you are good, you have tons of capacity in your life, feeling great, you have high energy.
Yellow is like hey, I've got some background noise, but all's good.
Orange is when you start seeing people being impacted.
Maybe they might not be as communicative as they used to be.
You'll see behavior changes.
Certainly in the red, that means somebody is critically injured, they might have suicidal ideation, they might have really decompensating coping mechanisms where they are drinking or utilizing drugs to an excess that is incredibly harmful, and they've probably withdrawn from family and friends and certainly their organization.
- So it's one thing to have an individual snapshot of people, but you also wanna have the overall health of the team.
And if the team is looking like they're pretty stressed, we as a team might wanna do things to kind of counteract that.
- It's more to build self-awareness than anything else.
Nobody knows who the red person is, but it's really just about self-assessment.
Maybe at one point when you are on that deeper color in the spectrum, you'll realize that it's okay to reach out for help so you're not always in the orange or the red.
- The right answer is not green.
We want to help you stay in green or trend towards green.
The right answer is just accurately knowing where you're at in that moment.
That self-awareness is key to being able to stay resilient.
When the threat's over, it's okay to say, "I'm not taking that shift this weekend.
I'm not gonna do the next rescue that night".
It's saying "whoo, that one hit different.
I'm gonna go talk to a buddy.
I'm gonna go talk to a chaplain, a therapist".
- You can't make someone get help.
But if everyone's aware that this is something that we deal with on a regular basis and that we have tools to manage it, it creates a community that supports that mental health of those individuals.
That's the goal.
- I think sometimes people think they get tired of talking about it, like "oh, are we still talking about mental health?
Haven't we talked about mental health?"
And I'm like "well, it's sort of like you go for your annual checkup each year, you're hopefully not forgetting about your physical health".
So the mental health piece should just go right along with that.
I think there's still some age old issues on funding for mental health is a huge deal throughout the state and the country.
But I'm optimistic that there does seem to be this kind of ground swelling of people that really truly do believe that taking care of yourself mentally and physically is equally important.
- [Drew] And so I think that's the real strength is that we're all looking out for each other, and that's the part that gives you a lot of hope.
- When people are learning from each other and teaching each other, together with not feeling alone, that helps with the stigma.
- The fact that we're having these conversations across agencies and we're all speaking the same language of stress injury, it's huge.
- We're called to go places and do things that are outside the ordinary scope of someone's experience.
And when those things happen and you're the one who's called, it's good to know that you have resources behind you and you have the rest of your crew is there to help get you through those things.
When we find something that works and find a way to manage those difficult times, we need to shout it from the rooftops a little bit and let people know that it's working.
- And the good news is if you might be in the orange or red, there's a continuum back to green.
We can do something about it.
It's not just this helpless trend.
- All the ski patrollers, they're my friends.
I want to create an environment where people can have a career like ski patrolling.
It's a great job.
The camaraderie is amazing.
I want to be able to allow people to continue to have that kind of experience that I got to have.
- First responders anywhere, they all feel a bit of machismo and, you know, we're invincible.
But I think part of that invincibility is the fact that we can address what is actually happening.
Because that's what makes you invincible.
It's about being fit for the next call out.
It's not saying that you're not fit for duty, it's how do you be ready for the next call out.
It's about moving forward and staying fit for duty.
(upbeat music) (upbeat music continues) (upbeat music continues) (upbeat music continues)