First responders talk about the often-hidden pain and trauma of working in a pandemic

For Neda LaFuente, everyday moments with her family are not only precious, but they also play a vital role in her job.

“They say, as paramedics, your most important time is your downtime … because that keeps us healthy,” she told “Nightline.” “If we have a healthy life outside of work then we can maintain a healthy life at work.”

The 42-year-old has been working as an EMT for almost 20 years. She’s a field commander in the Austin-Travis County Emergency Medical Services Unit and her team is on the front lines of the COVID-19 crisis in their corner of Texas.

When she’s not responding to calls, LaFuente volunteers as a team leader in the department’s peer support group. For medics like her, the group is a critical way to process the traumatic situations they often encounter on the job. The group’s goal is to destigmatize the mental health crises they often face, and not just in the field.

“As a leader, my job is to serve not only the patients but [also] to serve my paramedics and my medics, so I just focus on one task at a time,” LaFuente said.

In the early mornings, as she says goodbye to her husband and her nearly 2-year-old son, she says she thinks “about making sure that my day is as safe as possible so that I can come back.”

Her fears are more than valid. In Austin, over 50,000 COVID-19 cases have been reported since December. And last month in March, Governor Greg. Abbot lifted the mask order.

The policies around COVID-19 directly impact the lives of medics like LaFuente. Their work is twofold: caring for others while also making sure they care for themselves.

“It's hard as a medic to look at yourself and say, ‘Hey, I need help,’” she said. “We go to the extreme and then we realize that our limb is broken and we need to get help, too.”

Daniel Owens, a field medic who is also with Austin-Travis County Emergency Services, says it’s “one of the most fulfilling jobs that you can absolutely do.” But he admitted, “in full transparency, it's a profession that really does kind of tear at you.”

Owen said he often thinks about the people he was able to help on the job and its this sentiment that makes the job meaningful.

“You run certain 911 calls where you know that you absolutely made a difference, and you realize that, at that point in time, you were able to perform an intervention that may have saved someone's life,” he said.

Owens and his partner, Andre Thompson, have been working in emergency services since before the pandemic began, and their experience shows.

“You get up and you come to work and anything can happen. A workday could turn out in a million different ways,” Thompson, a field paramedic at the department for over 11 years, told “Nightline.”

In March 2020, Owens made the difficult decision to move away from his wife Jessica and their two boys, ages 6 and 4, in order to keep them safe from the risk of contracting COVID-19, which his patients might expose him to at any time.

“When Jessica and the kids left, we decided we'd just ride out -- two or three weeks until things kinda got under control. Things never got under control,” he said.

Returning home to his boys made his hard days at work more bearable, Owens said.

“If you want to feel like a million bucks after you have just a horrible, cruddy shift, come home to two boys who think that you're just the man who hung the moon,” he said. “[They] just think that you're an absolute hero… They are just happy that you're home.”

During the hard times, Owens said he leaned on counsel from his father, who was a firefighter for more than 30 years.

“He's the reason I am in this occupation. I just kind of followed in his footsteps,” Owens said. “So, dad understands my stories when I talk to him about work because he lived it, too, and he carries a lot of burdens from … years of being a first responder as well.”

Owens said the overwhelming changes to his job and personal life over the last year came as an onslaught.

“Everything about our profession, and how we responded to very basic 911 calls, changed,” he said. “We're dealing with picking up extra shifts because we're now short-staffed with multiple coworkers ... experiencing COVID-19 of their own, and we are now experiencing life with daily COVID-positive patients,” he said.

While many of their calls are for suspected COVID-19 cases, they must be cautious to treat seemingly unrelated cases as possible COVID-19 exposures, too.

“You can run a stabbing victim -- boom, they have COVID,” Thompson said. “So, even people who have other kinds of complaints may still have COVID and be contagious. So our safety is a bigger concern.”

Owens said they were just beginning to grasp their new responsibilities during the pandemic when the country was rocked by a reckoning on racial inequality.

“Not only were we dealing with this pandemic that was going on, but now we also had political unrest,” Owens said. “Every single 911 call you do, someone is judging your performance, whether it's the public, it's your bosses, it's your coworkers.”

He says that having Thompson by his side has helped him navigate a world he couldn’t understand.

“It is very rare to have a Black paramedic,” Owens said. “Only 3% of our paramedic workforce is Black, and so, for Andre and I to go into calls, especially into Black homes, you see a difference.”

“It makes a huge difference in the quality of health care, I wish people could understand how important that is and why representation is so needed in a critical way,” Owens added.

Thompson said working with Owens has been a “mind-expanding experience.”

“He's a white guy from rural Texas and then I am me,” Thompson said. “So the conversations we've had, some of the perspectives that he has are things that I would never have considered.”

Both of the first responders agreed that these conversations are just the beginning for truly understanding the long-held pain and trauma in this country.

“We are pretty open with what we talk about and nobody gets hurt feelings. Yeah, we both say what we need to say,” Thompson said.

And with a job that is physically and mentally exhausting, there is also a pain from their work that’s rarely discussed.

“We can't call 911 because we are 911. There's no backup,” Owens said. “We have created this false machismo. If you start having cumulative stress, it's because you are weak. For most medics in the profession, it's going to come at a great cost.”

In 2015, two Austin medics died by suicide. In response, the department launched the peer support program, one of several initiatives focusing on mental health and wellness.

Tania Glenn, Psy.D., specializes in treating severe stress and trauma. She’s worked with first responders in the aftermath of the Oklahoma City Bombing, the Sept. 11 attacks and Hurricane Katrina. “When you take a human being, and you put them in the worst days of people's lives, and they see the worst things happening to innocent people, and they see awful things and tragedy and accidents and death and destruction, it does take a toll,” she said.

Glenn launched the paramedic peer support program in Austin and several other cities across the country.

“First responders will not go to therapy if there's a paper trail, if there's a diagnosis attached to their name,” Glenn said. “I proposed this program to put my practice on a separate contract with the specialty of dealing with first responder issues, and that I would submit an invoice once a month with no names on the invoice.”

She said her number one focus is “mitigating those traumas so that it doesn't become post-traumatic stress disorder,” and then helping the medics cope with the burnout while trying to keep it all in perspective.

Owens explained that many of his colleagues want to stay anonymous because “there is that fear that somebody is going to hold your struggles against you in a professional setting.”

“A peer support team creates this bubble of trust. Because it's someone who works in the same profession as you,” Owens said. “It's someone who is not going to go on an administrative tear and try to take away your job.”

“Post-traumatic stress disorder is when an individual is exposed to a stress trauma [that’s] so extreme it's beyond their human coping capacity,” Glenn explained.

Glenn said that while the country has made some progress in the way mental health is discussed and understood, it still has a long way to go.

“I think that the more we do education and awareness and normalizing mental health issues, the better we all get at understanding what that is,” she said.

LaFuente said that at one point in her career, she experienced symptoms of PTSD. She says she was able to better cope with the stress and trauma that had compounded after talking to Glenn.

“When my son was born, something turned on inside of me where I was constantly anxious and looking for things that may happen,” she said. “I've been on lots of calls where the baby died because the parent slept while they were holding their baby, and then whoever wanted to hold my baby, I would watch them. I couldn't get my eyes off them because I was afraid they'll fall asleep even though it was broad daylight.”

LaFuente said the anxiety caused her to begin asking her family and friends if it was normal since she was a first-time mom.

“They had to bring it to my attention. They said, ‘Out of the thousand times that somebody does something, you see that one time where it went wrong,’” LaFuente said.

LaFuente also has an additional layer of stress: She’s one of the very few women leading a team in a field traditionally dominated by men.

“Statistically, being a woman and being a woman of color, I'm outnumbered,” LaFuente said. “As a woman, your voice has to be a little stronger and you have to have a little bit more of a presence to get that attention. And it's not just from our department; it's society in general.”

For LaFuente and her fellow front-line heroes, success isn’t just measured in how many lives they save, but how they maintain their own.

Owens has been working toward building that balance for other first responders. Over the past three years, he said he’s volunteered his time as the executive director of the Association of Texas EMS Professionals, lobbying to ensure EMS professionals are “recognized and represented at all levels.”