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How to Build a Transport Service from the Ground Up · The JEMS Report

• speaker-0: Good afternoon, everyone. Welcome to episode 34 of the Not AFib Podcast, powered by the Journal of Emergency Medical Services. My name is Mark Flauter. Riding on horseback through brush and over numerous dead turkeys, Margot Mellon spent Tuesday scanning the flood ravaged ground of Texas' hill country for dead bodies. As she and her rescue mates trudge through the muddy terrain, state officials announced more than two than 160 people are still believed to be missing. With countless miles swamped by the floods, nobody knows when the searches will end. The triumphs of finding people alive ended days ago, while the mission of recovering bodies that might include even more children is far from over. The grim undertaking has prompted questions about how first responders and rescue teams are able to mentally reckon with the work ahead. Mellon, a 24-year-old volunteer with search and rescu search and recovery organization Texas Equisearch. That is a working that is working with local fire departments, said for now she feels emotionally detached as she focuses on the task, but she knows the experience will be difficult to process once she returns home to Corpus Christi. I'll try not to think about it too much, she said. I'll just think about the fact that at least the families have closure. The flash floods deluged homes, campgrounds, and an all girls summer camp over the fourth of July weekend. More than one hundred people have been killed, including thirty children. We process it the best we can, Lieutenant Colonel Ben Baker of the Texas Game Wardens said Tuesday at a news conference after taking a deep breath. We're making sure they have the support, Baker said of the search teams, adding that to see a child in that loss of life is extremely tragic. The discussion about first responders' mental health likely wouldn't have occurred a generation ago, experts say, and while first responders have higher rates of post-traumatic stress disorder and other psychological health conditions. Most are able to process the heavy realities of the job. Nick Collada, who was a paramedic in New Orleans during Hurricane Katrina in tw 2005, said people in a profession are able to compartmentalize and work on autopilot. Despite the challenges of recovering bodies, he said the work is crucial. It's definitely not the goal you were hoping for, he said, but just being able to give someone closure that their loved one was found can give us a sense of accomplishment. There are still people unaccounted for from Katrina. Mental health challenges may follow, he said, which is why learning how to rest and get support is important. People will still continue to call for police, people will still get sick, things will still catch fire, he said. What's really important is understanding your limitations and having resources available to use, whether it be an anonymous helpline or a sit down with a mental health counselor. The stresses of the job affect everyone differently, said Robin Jakobitz Jakovowitz. Interim director at the Institute for Disaster Medical Health at SUNY New Polts. A lot of it depends on what the first responder experienced previously, both on the job and off, she said. For those responders who are working in Texas, it's probably not their first It's probably not their first incident, she said. So what they're dealing with now is probably layered on top of what they have dealt with in the past, and those things add up. Stress from the job can show up through sleeplessness, flashbacks, or introversion, Jacobowitz said, as well as feelings of could I have done more? Did I do enough? Most will lean on friends and family as well as clergy or spiritual advisors, but because many don't want to burden them with what they've seen. They also lean on each other and mental health professionals. One of the biggest predictors of recovering from a traumatic event is the degree of social support a person has. Not every traumatic incident turns into full bone PTSD, Jacobowitz said. You may struggle with PTSD like symptoms and then be able to work through them. There's been a marked shift towards acknowledging the mental health challenges of the job, said Ian Stanley, a University of Colorado emergency medicine professor. Much of the change has occurred in the last decade, pushed along by the growing focus on PTSD among veterans, coupled with the stresses of the COVID-19 pandemic on first responders, Stanley said. But there's still a long way to go because the issue hasn't been talked about for so long, he said. Challenges include serving first responders who work for volunteer organizations or in rural areas where there are fewer mental health resources. The issue also hasn't been studied as extensively as it has among veterans and service members. Stanley stressed that most first responders are resilient to these challenges and live happy, healthy, productive, resilient lives. But he noted that many of those recovering flood victims in Texas are in small communities. They might be recovering bodies of people they know or their neighbors, he said, and that's really challenging. And that's an article from PBS dated July 9th, 2025, entitled Focus on First Responders Mental Health Grows as Death Toll Passes 100 in Flood Ravaged Texas. Joining me today is Chief Brandon Hill. Chief Hill is a fourth generation public servant who began his involvement with emergency services in 1994 with Apollo Hose Company number two as a volunteer firefighter. He worked for Schertz EMS from twenty eleven to twenty twenty five as an EMT, advanced EMT, paramedic, field training officer, and served as the assistant chief of operations. He is currently the EMS chief for Hayes County Emergency Services District 9 in Kyle, Texas. He obtained his paramedic certification in 2011 and went on to continue his education at the University of Texas Health and Science Center in San Antonio, where he obtained his bachelor's degree in emergency health science. He continued to pursue his master's degree at the American Military University with an emphasis on emergency management, graduating in December of 2020. He is currently pursuing his PhD in health science. Brandon led the peer support program in the city of Shurts for three years before co-chairing a regional peer support program with the Southwest Texas Regional Advisory Council and is currently serving on the Regional Peer Support Committee with the Capital Area of Texas Regional Advisory Council. He was part of the first ever state-approved peer support deployment with the Kerrville flooding incident on July 4th. He served as the team lead for multiple crews in Kerrville. Providing mental health resources to field crews deployed to Kerrville. Brandon is an avid cyclist and volunteers countless hours at different cycling events across the country. He has two children, Marissa and Preston. Chief Hill, Brandon, thank you for joining us today. So let's start off with what got you into EMS. So what did what detracted you to the field and to becoming a volunteer firefighter? speaker-1: Absolutely. Happy to be here. ⁓ man, we're gonna go back a lot of years now, aren't we? so I am fifth generation as as you had mentioned, and you know, I grew up around public safety. ⁓ you know, my dad, my grandfathers, ⁓ great grandfather, uncles, ⁓ you know, we weren't hanging out at the fire station, we were sleeping or in school. So, you know, we were just we were there and I I you know, it's just it it was the environment I grew up in. ⁓ You know, the guys at the the station were, you know, they were second family to us. So ⁓ we couldn't have a family get together or a picnic over the summer without having a a fire engine pull in the parking area, you know, the driveway and and come join us because I mean we were just very close knit. So, you know, when I got to be old enough that I could get involved with the fire service, I said, Man, this is this is kind of what I wanna do. ⁓ so I got in the volunteer service and Surprisingly enough, I am the first one in my family that actually made a career out of it. ⁓ everybody else did the volunteer thing and they always had something else going on. But ⁓ you know, I I enjoyed the medicine. you know, I made a transition from the fire service ⁓ into medicine and and you know, just kinda kinda went with it, man. And, you know, it's it's been it's been great. ⁓ it's been a great career. And, you know, I still love what I do. So come to work every day with a smile on my face. speaker-0: Outstanding. Outstanding. Talk to us a little bit about the agency where you work, Hayes County Emergency Service District Nine. talk to us how big your is your agency, how many folks do you have working with you? ⁓ areas that you cover. speaker-1: Yeah, so a little bit of a unique situation I'm in right now. So ⁓ I spent fifteen years with the city of Shirts and and as you mentioned, I worked my way up through the ranks and and I was the assistant chief over operations ⁓ when I left there. ⁓ I I left Shirts in October of twenty-five. there was an opportunity here in Hayes County. They the the emergency service district that I work I currently work for, ⁓ contracted private EMS service to to run EMS in their their district. And the opportunity was that they wanted to bring EMS in-house rather than than contract it out. So ⁓ they opened up a position and and I threw my name in the hat. And part of me was like, you know, I'm I'm kinda happy where I'm at and I'm kinda stable and secure. I didn't kind of don't want to go anywhere. And the other part of me was, man, this would be some this would be really cool to go and build something new and and build something from scratch. So ⁓ I was offered the position and ⁓ I came up here and Had no idea what I was getting into. And you know, when I got here, it's like, all right, so where do we start? And my boss, our district administrator, ⁓ he said, Well, we have ambulances ordered. I said, Okay, what else? He's like, We have ambulances ordered. I said, Okay. So we had to, you know, go through the the state licensing process and and we had to do some graphic design and design patches and badges and graphics for the units. And start figuring out how we were gonna hire people and and what our timeline was and and just everything. So ⁓ from October to February, ⁓ it was it was getting a lot of the logistics and the background of the agency kind of built and the foundation. And then ⁓ in March we hired our first field staff and we got our officers on board. And since March it's been ⁓ it's been full throttle, man. We've ⁓ we've stood one truck up every month for the last five months and We're fully implemented and you know we got 45 people that that work for us now. as many of you, you know, we're we're kind of finishing up our budget season and and getting into the new budget years. So I've got some ⁓ new positions approved to be able to bring them on after October one. we service about 187 square miles ⁓ and it's it's a very geographically challenged area. ⁓ so we have a city right in the middle. ⁓ of our service area but we don't cover the city. We cover everything around it. So if you look at a map, our service area almost looks like the letter C. ⁓ Ninety percent of our calls are on the north end of that C, and about 10% of our calls are on the south end. ⁓ The city that we surround is San Marcus. ⁓ it's about halfway between San Antonio and Austin. ⁓ And our primary response area is just north of San Marcus in in the city of Kyle. So ⁓ Texas State University is in San Marcus, so we're ⁓ you know, we kinda get ⁓ a little bit of residual college atmosphere, you know, in in our service area. But man, it's it's been fun. ⁓ it's been a great experience to come in here and and do the things that we've been doing, but it's challenging. It's it's a new challenge. I love it. speaker-0: What's what's the call volume like ⁓ since you stood up the ⁓ the units? Is it what you expected? Have you found it to be more? Is it consistent? How does the call volume shake out for you guys? speaker-1: Yeah, the volume isn't bad. ⁓ our crews run about five calls per ambulance per twenty four hour period. ⁓ so twenty five to thirty calls a day ⁓ across our system. ⁓ we are growing. ⁓ this this area of Texas is is definitely becoming more populated and and just a little saturated along the I thirty five corridors. So ⁓ we don't anticipate that number to drop at all. So we're ⁓ you know, that comes out to about seventy five hundred calls a year and We're at about a sixty percent transport rate. So ⁓ it's it's kinda what we anticipated based on the numbers that we got off of our contract providers. So we're we're kind of on on track with that. ⁓ I will tell you the acuity of the patients surprised me. ⁓ I did not think that we were gonna have the the high acuity patients that we had or that that we deal with every day. ⁓ our crews love it, you know, because they can they can practice medicine and and they can do the paramedic stuff. So ⁓ The the the number of calls that we get wasn't surprising, but the acuity of the calls that we get is definitely surprising. speaker-0: How many units are you running, Brandon? speaker-1: We have five full time right now and then a battalion chief that oversees the the shift every day. So ⁓ speaker-0: Okay. Outstanding. What are some of the other challenges that you faced starting up the ⁓ the the program? You you talked about the hiring, you talked about how all you had was ambulances. What are some other challenges? State licensure ⁓ being excluded as well. Yeah. speaker-1: I mean a lot of it was just ⁓ it was the red tape stuff that we just kinda had to get through, you know, DEA licensing and and state licensing and things like that. ⁓ you know, I came from a very established organization where a lot of this was already in place. So you don't realize the order in which things need to be done. Right. I couldn't apply for a DEA license until I got my state license, but I couldn't get my state license without having some kind of narcotic tracking and DEA permission. Right. So there were some things that we just kinda had to juggle and and kinda work around. ⁓ you know, and just figure out what those processes look like. I think our biggest challenge was was standing up that number of units and hiring on that many people at once and maintaining a standard and and maintaining a quality of paramedic that we wanted to bring into this area. ⁓ You know, it's it's easy to get applications. And you know, ⁓ at the beginning there was there was a little bit of hesitancy from applicants that you could tell ⁓ they didn't know where this was going, right? They didn't know if we were gonna be successful, they didn't know if we were gonna fail. ⁓ it was the same reservations I had when I came over, right? I mean, I had been in an organization for quite a long time and it's like, man, I'm I'm kinda putting all my eggs in one basket here. I mean, failure's not an option, right? But ⁓ You know, getting those applicants in wasn't the issue after a month or so. The issue was what kind of quality are we gonna bring in? you know, we were we're we have some pretty progressive protocols ⁓ and our clinical department does a fantastic job of of keeping up with the research and the medicine. ⁓ but to bring somebody in with very little or no experience and expect them to do some of the progressive stuff that we're trying to do, that can be challenging. Right. So we gotta determine what those training plans look like and and get these guys kinda up to speed with the medicine that we're practicing. ⁓ you know, we're carrying vents and pumps and all the other stuff on on every truck. ⁓ you know, we're we we have whole blood in this region, so ⁓ just somebody coming fresh out of school, ⁓ with no experience. I mean, some of that's difficult, you know. I mean, you want them to get a good foundation of just being a paramedic and and you know, transporting these patients to the hospital and then we add all this other critical care stuff on top of it. ⁓ that that was probably the biggest challenge. speaker-0: Obviously you've been in peer support for a while, ⁓ that's as we discussed in in your bio. What ⁓ what piqued your interest or what prompted you to get into the peer support realm of ⁓ service? speaker-1: Yeah, this is ⁓ if you would have asked me ten years ago what I thought about peer support, I probably would have told you what a bunch of folks our age are saying, right? Suck it up and move on. It's part of the job. And if you can't do it, too bad, right? ⁓ it was ⁓ during COVID. ⁓ you know, I was I was in the assistant chief role for about a year and I was finishing up my graduate degree and I had to write a thesis paper and you know, I I started looking at different topics that I could write this on. And we were six months into COVID at that point. And I started seeing a lot of a lot of the effects of COVID on the staff and things we had to adjust within our organization to to kind of accommodate these ⁓ these changes, you know, between our staff members. So what dawned on me was we do a very good job here in Texas of preparing our staff to deploy for a hurricane deployment or You know, some kind of swift water or something like that. And and they deploy for seven days or 14 days and they're excited. And then they come back and they take a couple of days off and then they're ready to go back to work, right? ⁓ and everybody loves the deployment money. So that was always a benefit for them, right? What I noticed about COVID was that declaration or internal deployment never really ended, right? I mean, it it it it was that declaration or emergency declaration was put in place. And it just kept going and it kept going and kept going. And it was affecting everybody. So our guys weren't going away for a week and coming back and you know patting their bank account. No, they were being affected by this at home. And they come to work and and it was the unknown. It was, you know, we're gloving and gowning and masking and all the stuff. And you know, it was difficult for them. ⁓ so I decided with my research that I wanted to kind of look into what effects does that extended emergency declaration have one folks. ⁓ you know, it in comparison to those short deployments and and short emergency declarations. And what we found was the burnout was real, right? I mean, the the guys were, you know, they were taking a mental toll on, you know, just the happenings in the world. And we had to do something about it. And that's when work-life balance really slapped me in the face. And was like, hey, you need to give these folks some time off. You need to let them decompress. You need to let them recover. And then we need to do some things internally to be able to support that. So once I finished that project, you know, I started talking to my boss and you know, it was, hey, what what can we do? What can we do so this doesn't happen again? And and we can kind of get ahead of the A-ball and and mitigate some of the problems that we were having. And You know, we came, you know, peer support was starting to kinda rear its head and and it's like, hey, ⁓ we're here, let's let's do something kind of thing. And it's like, man, what if we put together a peer support program? And it was not an easy task, let me tell you. ⁓ with ⁓ in the city and and city government, like we had to get HR involved and and HR had to approve it. I didn't want to just do it for EMS either. ⁓ I wanted to make sure that we built this program and it was covering all public safety eight entities. So we ⁓ I needed to get buy-in from our fire department, needed to get buy-in from our police chief, ⁓ needed to get buy-in from our communications and and telecommunicators. so I put a work group together and and had representation from each one of those ⁓ disciplines. And we sat around the table and it's like, man, what do you guys need? You know, what what can we do to take care of each other? ⁓ And and it it took a while, ⁓ I'll be honest. the initial meetings, you know, as as many things go, the initial meetings you have a lot of participation. And as things go and you know, you you try to get ⁓ try to get some of that traction, you know, your your help kind of dies off or or people get preoccupied or other things come up, right? ⁓ so there were, you know, a few of us that did a lot of the work ⁓ and we and we put this program together and we pitched it. And you know, the initial couple of times that we pitch pitched it, ⁓ it was a no-go. There was something in there that somebody didn't like or one of the chiefs couldn't agree on, or HR is like, no, we can't do this. And ⁓ there was a lot of questions about confidentiality and and anonymity and things like that. And it's like, you know, HR wanted to be in the know, and it's like, no, like we're not gonna tell you when we're doing peer support. Like that, that defeats the purpose, right? So we had to kind of navigate some of that red tape and and figure out. How can we effectively do this and maintain the trust of our employees? ⁓ and we finally got a a draft together that everybody could kind of kind of agree on. You know, we all had to sacrifice some things, but there was some things that were not negotiable. And that was the confidentiality and anonymity of the program. so it it took about a year and a half. ⁓ I mean it was a it was a long uphill battle ⁓ before we finally got everybody to sign off on it. And ⁓ we were able to implement that. I'm gonna say it was April of twenty four. So ⁓ it was about two years ago that we got that implemented at Shirts. ⁓ and then it was a year later that we had the flooding incident up in Kerry. speaker-0: When you bring in the different ⁓ services, you talked about bringing in police, bringing in fire, was their reception were they open to it or was it one of these they went in kind of because they had to and weren't really liking what you were pitching? speaker-1: No, I think ⁓ I I think everybody was open to it, but everybody had their own idea of what it would look like. and the the issue with our our police department was the the brass, the administration was all for it. ⁓ but it was the the application of the model that we were trying to trying to implement, right? So when you talk to the guys, the the street guys and the and the officers are like, Yeah, I don't I don't want to come in and talk about this. You know, that they just had that mindset, right? It was that stigma of I'm just gonna, you know, compartmentalize and I'm gonna move on. And and I really don't want to talk to anybody about this. So the police chief that was there, he wanted to mandate some debriefing stuff ⁓ after some critical calls, which there's you know, there's some research that goes both ways, ⁓ depending on how you want to look at it. And you know, him and I kind of got into some pretty good conversation about You know, do you mandate this or not? He said, Well, in my experience, I feel like if we mandate it, they get into the room and then they'll open up eventually. I'm like, but if they're not ready to open up, they're not ready to open up, right? So that was probably the biggest challenge. like I said, everybody was on board. We just had different ideas of what that looked like. we all wanted to take care of each other, you know, and and it it almost it exposed some some issues that we had in the past, right? So we weren't really doing a good job of checking in on each other after bad calls. Like yeah, I asked I would ask the EMS guys, I say, Hey, do you guys ever go over to the police department and just talk to the guys after a call? Like, no, but we go talk to the fire guys. Like, well, you know the police guys were on scene too, right? You know, it was kind of the the relationships that they had and the rapport that they had. And then ⁓ you know, you start you start talking to them about, you know, we should probably check in on them too. ⁓ and what about your dispatchers? Like, did you ever go over and you know just let the dispatcher know what the outcome of that call was? I was like, well, no. I'm like, well, you know their call stops when your starts, right? I mean, they hang up the phone when we get on scene and they're like, man, I didn't even think about that. Right. So we, you know, once once we started to kind of communicate what the program actually was and what we wanted to accomplish with it, you know, we definitely got a lot more buy-in. ⁓ but there was really no pushback from any of the departments. It was just the approach in which we were taking. speaker-0: What was your experience after you you mentioned April of 2024 is when and when you guys had the program between then and July of twenty twenty five? What was your experiences? Did you have ⁓ people that were actively using the program? Did you have success? Talk to us a little bit about the the initial stages of the program. speaker-1: Man, this is ⁓ this is a little bit sensitive, but I'm gonna talk about it because I I think it's I think it's important. so we had pretty good participation. ⁓ you know, we had and our participation came more in the regard of references than you know, you calling and saying, Hey, I I need to talk to somebody, right? It would be ⁓ more like me calling in and saying, Hey, ⁓ you know, my partner, he's having a hard time with his call. Can you guys reach out to Mark? Right. So we were keeping track of the numbers of people that we were talking to, not necessarily who, but we did want to keep track of how many people we were seeing, how much time we were spending with them, ⁓ what discipline they were coming out of, right? And it was pretty even across the board as far as, you know, how many people we were seeing out of each one of the disciplines. and in any of the major incidents that we had, you know, obviously all of our disciplines were involved with that. And and we would set up some debriefings, we would set up some individual and group counseling and things like that. So ⁓ we also had licensed therapists that we were, you know, we had agreements with that would come in and and help us kind of get through some of those times. the one of the things that we had a challenge with was We opened it up to some of our outside fire departments as well. ⁓ you know, we figured we have we have a program, you know, if you guys want to use it or you guys need something, give us a call, we can come help you kind of thing. ⁓ they had their own as well. ⁓ but it wasn't it was more of an informal kind of in internal program. so when we opened it up to them to get them to buy into you know a a regional or a group ⁓ program. ⁓ the the buy-in wasn't necessarily there, right? I think some some of the mindset was we were trying to take it over and it's like, no, no, no, we're just trying to supplement what you have, right? Because if you have an incident within your organization, you guys probably aren't gonna be able to handle this yourself. So we just want you to know that we're here, we can kind of help you out. ⁓ it was about six months after and and we passed out flyers and and all kinds of marketing stuff to let them know it's like, here you go, you know, we're here if you need us, kind of thing. ⁓ It was about six months after we implemented ⁓ one of our fire departments had a a suicide within their department. And you know, we reached out and and we were there the night of and you know they told us, they said, Hey, I think I think we got this. And I was like, Well, listen, you know, you're you're probably not the right people, you're too close to this. ⁓ what we didn't realize at the same time was we were too close to it, right? And because we worked with this fire department. So But we had the resources to be able to bring some outside folks in and get them in there. but you know, it grew. we we definitely got some buy-in after something hap, you know, obviously something happens and and you have proof of concept and you show that hey this this stuff works and we have the right people to come in and do the stuff, ⁓ you get a lot more buy in after that. But ⁓ you know, we we we had participation after that incident. And it it was unfortunate that that incident had to occur to get a lot of our surrounding departments to buy into it. But, you know, that's you have to look at the silver lining at that point. ⁓ somebody asked me at one point, how do you measure the success of the program? And I said, well, if you don't have anybody commit suicide, you know, and then it was six months after, you know, we implemented we had we had that suicide. And it was like, so I had to do a lot of self-reflection. And it was, you know, did this program fail? You know, or what we were trying to do and trying to implement, did this just fail? And what I realized was it it didn't fail. We just didn't do a good job of communicating the ability and the capability of of the program, right? And you know, I had to come to the realization that you can put all kinds of opportunity and all kinds of options in front of somebody. And if they don't want to take advantage of it, they're not going to. But I'm going to do everything that we can to try to mitigate that. Right. So and that's the whole point of the pure peer support. ⁓ is to really get get an individual the help that they need. ⁓ we're not gonna solve the problems of spear support, right? But I can be a conduit to get you to that like therapist or that counselor or whoever, right? ⁓ let me get you to that help. But there wasn't a good understanding of what that program did at that time. So I don't even know if this individual knew what we you know, what we had to offer. So but Yeah. Yeah. I mean it was it was tough. It was a tough couple of months. speaker-0: Yeah, I imagine so. It's and it's unfortunate that that that had to happen. ⁓ when you moved from Shirts to Hayes County, did you did they have something in place with peer support? Did you bring your ideas to them? how how have you continued the peer support role there at Hayes County? speaker-1: Yeah, so w ⁓ being a brand new department, ⁓ they had nothing, right? I mean we had nothing. So the county had ⁓ they do have something ⁓ like a regional kind of program, but I think it's more law enforcement based, ⁓ which isn't a bad thing. ⁓ because I think we can absolutely jump on a you know, jump jump on a bandwagon with them and and hey, let's make this better and and let's, you know, go across all disciplines kind of thing. ⁓ We have been, I've got a lot of guys that we brought on that are very passionate about peer support as well. ⁓ but our priorities have been, hey, we got to get our trucks up and we gotta start serving the community and things like that, right? So I don't want to say that peer support's been a back burner project by all means, ⁓ but it has not been the forefront priority ⁓ as we're starting this service. but ⁓ in the last couple of weeks, we've I had a work group meeting for peer support work group. I had a bunch of people come in. ⁓ we have signed an agreement with a local ⁓ therapist and we're putting a program together. And that program, we are extending that out to all the other county EMS systems, and we're all working together to build a countywide or region wide ⁓ peer support program. So they all kind of have something, right? They're all a little siloed, ⁓ but everybody has something in place. So I know And I'm confident that if we had something happen within our organization tomorrow, ⁓ you know, I have plenty of contacts that I can call ⁓ to get to get some assistance in here. ⁓ but we would definitely want to be there to to help them as well. So we are in the process of building our our team now. ⁓ the state of Texas is ⁓ also implemented Texas Department of Emergency Management or T Dem ⁓ has started a statewide peer support program as well. ⁓ and they're getting ready to push out an app with ⁓ a statewide phone number and things like that ⁓ to be able to ⁓ to support anybody, right? So if I don't want to talk to anybody in my county, I can get on the app and I can request somebody and and it can be some stranger from the East, you know, from East Texas that I don't know, right? Or or anybody else knows, right? So if I'm worried about confidentiality and anonymity, here we are. You know, I'm talking to somebody that's has a background in the field, but we don't know each other. So that that makes some people more comfortable. But we are definitely growing locally, ⁓ internally and then you know, we're gonna be involved with not only our county and our region, but we're gonna be involved with the the T Dem program as well. So speaker-0: Outstanding. Outstanding. Let's move to last July. just for reference, how close is Hayes County to Kerr County where the majority of the flooding occurred? ⁓ speaker-1: That's probably 70 miles ⁓ from where I'm at the Kerrville. so about an hour and fifteen minutes is is what it took us to get up there. the river that flooded the Guadalupe River that flooded up in Kerrville, actually comes down just south of Hayes County. ⁓ so I'm I'm probably fifteen minutes from the river. ⁓ but fortunately for us on this end, ⁓ there is a there is a lake and a dam that ⁓ stops and and catches a lot of that water that that came down last year. But ⁓ yeah, it's about an hour and fifteen minutes away. speaker-0: How did you first hear about what was happening ⁓ in Kerrville? speaker-1: ⁓ yeah, I mean it was fourth of July, so I was at home in bed, ⁓ when ⁓ phones started ringing about four thirty. I got a couple of notifications that, you know, there was some significant flooding that was happening in the hill country. at the city of Shirts we had one of the state's ⁓ mass casualty ambuses. ⁓ so they were actually calling to, you know, activate our bus and and get our bus up to Kerrville to help with some of the evacuation or treatments. And ⁓ So was about 4 30 or 5 o'clock that morning. ⁓ phones started ringing and it was like, hey, can you get the bus up to Kerrville? This is what we got going on. ⁓ the the water's still rising. I think at that time it was twenty five or thirty feet and it that we were still anticipating it to go up higher. ⁓ they at that point we did know that there were some campgrounds that were affected and there were some some people trapped. They were basically on islands ⁓ you know, around where the river was coming down. So I d we didn't really know the extent of the damage at that point. We just knew that it wasn't good, right? We didn't know how many people were gonna be affected. We didn't know when the the river was gonna crest. ⁓ you know, I obviously I I follow a lot of different weather apps and and water apps on my phone. So I started looking at, hey, what what's the CFS and and how fast is the river going? And one of the big warning signs for me was when some of the monitors up up river ⁓ They were not reading, right? And it was like, ⁓ the it damaged. Like, I mean the water was running fast enough that it it took these monitors out, right? ⁓ but you see the last readings on it, and it's like the water went from twenty five or thirty CFS up to you know, eighty or ninety thousand. And it's like, ⁓ yeah, this the water's moving for sure. ⁓ you just didn't realize how high it was at that point, right? So it was difficult to wrap your head around everything. You know, it's like the water's 35 feet deep and running at 105 CFS, 105,000 CFS, right? So ⁓ to the extent, Mark, that when when we were driving up there, Interstate 10 crosses over the Guadalupe River ⁓ just before you get out ⁓ into the the main part of Kerrville and and the hill country. And when we crossed over the river, I looked out the window and I looked down and I'm like, I don't know what the big deal is. There's no water down here. Like the water just hadn't got to that point yet. Right. I mean, it was still coming downstream. So when we got into Kerrville and ⁓ we crossed over one of the main bridges in in downtown Kerrville and the water was pretty much slapping the side of the bridge, it was like, Yeah, this isn't good. I mean that's that's a forty foot drop down to the the park underneath, right? So ⁓ it it was pretty amazing ⁓ to see the power ⁓ that the water had ⁓ and it was pretty mind boggling to just not realize, you know, it's like the all this destruction, all this water is is still moving downstream and this isn't gonna end for a few days. speaker-0: So your initial response then was to bring the the mass ⁓ casualty vehicle down for response for flooding victims, is that correct? speaker-1: That's correct. Yeah, we were part of the initial ⁓ the initial response, initial deform. speaker-0: At what point in the incident, and I imagine it probably wasn't until ⁓ at least a couple of days later, did it switch to the peer support role ⁓ that you described when you were ⁓ presenting at Pinnacle a couple months ago. Yeah, it was speaker-1: ⁓ about five days. ⁓ so July 9th is when we had our first pure support teams that went up to Kerrville. So ⁓ and that was a blessing in disguise, right? So you know I I don't know how many of your listeners are were a pinnacle that to hear this, right? But it was ⁓ you were flying the plane as you were building it kind of thing. Like peer support, I mean we knew it we we knew it was needed. We just didn't know how we were gonna integrate this with with the event and you know how what that looked like. So it was very much a broken model ⁓ when we first went up. ⁓ T Dem had a or I'm sorry, TEAKS or Texas ⁓ AM extension service they had a team out there ⁓ T Dem had a team out there ⁓ there were some local ⁓ folks that were out there trying to do some peer support ⁓ there were some mental health folks that were out there for the community ⁓ I mean it was just kind of everybody was kind of doing their own thing. ⁓ everybody was all over the place. And and we really had to sit down and and come together and try to figure out how are we going to make this work so it's more efficient. But July 9th is when the first teams got up there and and it was very broken. ⁓ peer support was not on the ground, it wasn't boots on the ground kind of thing. there was a static location that folks could come in and and talk to somebody if they wanted to. ⁓ but the problem with the first few days, and I've said this before, right, is everybody's in such an operative mode, right? You're still trying to do recovery. I mean, you're still trying to do rescue, really. I mean, ⁓ we hadn't even switched over to recovery yet, right? ⁓ you know, they're they're digging through this debris and and they're cutting through all these wood piles and and unburying structures and just all the stuff, right? ⁓ and people couldn't break away or they didn't want to break away. ⁓ to go talk to anybody, right? I mean, they were still very much in that operations mindset. So after ⁓ after a few days, and that that's what I mean by the blessing in disguise, right? Because peer support wasn't going to do anything the first few days anyway. I mean, because everybody was so focused on the task at hand. ⁓ but after a few days and you know the the mission kind of transitioned from that rescue to that recovery, ⁓ and then we had peer support up there and we kind of started figuring out, hey, this is gonna be the best approach for our peer support teams. it was definitely better received, ⁓ in my opinion. I I think the guys would would see that, you know, we're we're coming out, we're just checking in on them. You know, we we care about what's happening. ⁓ we know it's been a long week for everybody, right? I mean it's we're all kind of up there. So but we we ran into some challenges, you know ⁓ It's, you know, initially when peer support would would start going out and seeing some of the guys, because we had a very, you know, initially it was it was a static location and we transitioned to, hey, let's go out and see the folks boots on the ground and and out where they're at, right? Because we knew they couldn't break away and that they couldn't separate from their teams. ⁓ when we would first start going out and seeing teams and seeing the guys on the ground, we were ⁓ Our initial mindset was, hey, we need to be identifiable so they know that we're coming. And then that was kind of a slap in the face because we realized that we probably shouldn't be identifiable because people don't want to come talk to us if we're identifiable. They want to stay confidential. They want to, you know, they want to stay anonymous. So, ⁓ you know, one of the the the plan that we thought was such a great idea is like it backfired. And it's like, no, we can't do that. but one of the other advantages we had was we had ⁓ mental health canines ⁓ in the San Antonio area that we had up there as well. And that was a great icebreaker for a lot of folks. So we'd take the dog out and people would come over and just start petting the dog. And it's like, man, that's exactly when you just you know you just start chatting, right? I mean we we didn't have a script that we were going off of. We weren't asking mental health questions. We were just talking to ⁓ right? And it's hey, you know, how how you doing? How long you been here? Did you come up on the fourth? It's like, you know, have you have you talked to your wife? ⁓ you know, how how are the kids? You know, how old are they? You know, you just start having that conversation. And you know, initially you might get some hesitation. ⁓ and and you gotta break down some of those barriers and then you show up the next day. And then you you show up after lunch, and then you show up the next day, you know, and you just keep, you know, kind of revisiting some of those conversations. ⁓ we found that if we have a task that we can combine with going out and seeing the folks, ⁓ we're we're even more well received, right? So we started we started delivering lunches to the guys that were in the field. It's like now we weren't just the pure support guys. We were the guys bringing you food, right? Or we were the guys that brought you a case of Celsius or something of the sort, right? I mean we're we're finding the heart, you know? It's like, ⁓ so, you know, we would go out and and that was just another icebreaker, you know? And ⁓ but yeah, I mean it's you know we we tried to find ways to just connect with the guys on the ground. speaker-0: Yeah. speaker-1: And you we were all in this together. And I I think it helped that some of us were in a different capacity at the beginning of the event, you know. So I went up on our mass casualty bus and then I was a a strike team leader for a few days. And then I finally transitioned over to peer support. So when the guys started talking about this, and it's like, yeah, man, I was I was right down there with you. Like I I I haven't just been doing this mental health thing for the last three weeks. Like, nope. I was I was down in the down in the trenches right there beside you, man. So I saw what you saw, I I smell what you smell, I see what you see, right? It's and you just connect with them a little bit better that speaker-0: One of the unique aspects of of your response that you presented that really piqued my interest and is the reason that we're talking today is the peer support lounge that you had set up there. And I when you described it, I was like, this is fantastic. I have never heard anything like this. And talk to us about what prompted the peer support lounge. and and how it ran and how it was received by the ⁓ by the responders. speaker-1: Man, I wish I knew where this was birthed, but I think it came out of T Dem, ⁓ working with with some of the TX guys. so this lounge, it was a it was a western shelter is what it ended up being. ⁓ but you know, we had AC and we had a closed area and it was private and but we had a bunch of nonsense inside this lounge. I mean, we had, you know, tables set up, it was coloring books and crayons and markers and we had rocks with paint that guys could come in and paint rocks, right? And ⁓ we had TVs in there, we had video games, we had the big connect four, you know, game that you could play in the middle of the room. We had slushy machines. We had snacks and sodas and waters and it whatever you wanted, right? ⁓ part of it was to attract the guys to come in. ⁓ Part of it was to give them a place to decompress. But they're not gonna come in and decompress unless you get them in the door. So what better way to get them in the door than food and drink? ⁓ you know, but what a lot of the strike team leaders started doing was they were using this ⁓ peer support lounge as kind of our briefing area in the morning before they would go out into the field and then a deep debriefing at the end of the day. So it kind of forced the guys in there. But man, they would come in and I I'll tell you, Mark, never in my wildest dreams. And in the 30s some years that I've been in public safety, I have never seen a big old Texas DPS guy sitting on, you know, sitting at a table with a a small paintbrush painting a rock or or you know with a crayon coloring and a coloring book without kids there. You know? I mean, he's just doing it. And and why? Because it's mindless. Like you can get your you can get your mind off of everything that's happening in the field. Just come in there and just hang out, right? ⁓ it was so well received. ⁓ some of our responders, ⁓ DPS specifically, you know, they were kind of they were locked into their locations out in the field. a perfect example was Camp Mystic. ⁓ it was thirty minutes from where our peer support lounge was, ⁓ and that officer would report straight to Camp Mystic in the morning, he would provide security there for twelve hours, and then he would go home at the end of the day, right? He never really came to the lounge or did anything. But every day when we were going out and and we would see these guys and we would, you know, try to break down those barriers and just have those conversations. You know, we would drive out to Camp Mystic and we would we would see the officer. And it's like, hey man, what do you need? He's No, man, I'm good. And it's like, Hey, we got Celsius. You want some Celsius? He's like, ⁓ man, you got a Celsius? you know, because he's been living on water and and, you know, cheese crackers for a week, right? So ⁓ you know, that that kind of broke down that barrier with him and and just opened that door. So Next day we would go out and it's like, hey man, we some snacks. You want some snacks? I got chips for you. I got you know, here, man, we brought you a slushie, you know, just this stupid stuff, right? ⁓ and eventually we took him a coloring book and and a box of crayons. And we're like, man, we know you you got a lot of windshield time just sitting here doing nothing, man. But here, if if you wanna if you just wanna color and and do something, get your mind off things. And we went back out that same afternoon and it's like, Hey man, how you doing? It's like you coloring? And he holds up the coloring book and he's got two pictures colored. It's like, yeah, man, this is this is awesome to kill some time, you know. ⁓ it was the next day that that we went out and you know, he was on the phone with somebody when we pulled up. So we let him have his conversation and and he hung up and he's like, Hey man, you guys have any more of those coloring books? I was like, Yeah. He's like, I was just talking to my buddy down the road. He wants something to do. Can you take him a coloring book too? You know. So, you know, they started talking to each other, but it it was just that mindless thing. But you know, we We wanted to encourage the guys to come into that lounge and you know, have a snack, have a drink, and and just decompress, get your mind off of everything that just happened over the course of the day. Come in there and just have a little bit of fun and and just try to relax, right? I mean, th it was a stressful time for so many people. And you know, the the the least we could do is give them an escape, give them an outlet to to do something else. So ⁓ speaker-0: Slushing machines were a huge hit. ⁓ I was at the National Information Officers Association conference ⁓ last month where ⁓ a couple, one from Kerr County Sheriff and one from Kerrville Police, they did a presentation on the communications. and I had a chance to speak to ⁓ the representative from Kirk County Sheriff afterwards, and he specifically mentioned the slushing machines because I talked to him, mentioned that we were gonna be having a conversation. And talk to him about the lounge and he specifically pointed out the slushy machines. So ⁓ you guys ⁓ guys were doing some good work. speaker-1: be clear, it was non-alcoholic. Okay. I mean it was non-alcoholic at the beginning and the end of the day. ⁓ but you know, in the morning we would we would do like coffee flavored slushies and send the guys out, you know, with their frozen coffees. And then at the end of the day we'd have we'd just pick some flavors, man. We'd we'd have cotton candy in there one day, we'd have mango in there another it just didn't matter. Like we mixed it up. But no, it was ⁓ it was it was awesome to see the guys come in and they were what flavor do you got today? You know and It's ⁓ they were so excited about coming over and seeing what kind of slushies we had. speaker-0: That's outstanding. That's outstanding. So how long did you have ⁓ the the lounge set up before you decided or the decision was made that it was no longer needed, that the number of responders was being reduced that were were working the incident to the point where that was no longer needed? speaker-1: Yeah, so I don't know I can't quote when how long the lounge itself was set up, but I can tell you that, you know, July ninth is when we ⁓ you know had formal peer support on the ground in Kerr County. ⁓ January sixteenth is when they demobilized the last peer support members. So ⁓ it was a good, you know, what is that, six months? six months and and some change. ⁓ Over the course of that six months, we had ⁓ thirty-one total peer support members deployed. ⁓ now some of those deployed multiple times. I know myself, I went up three different times. ⁓ but ⁓ I I don't know when the lounge was broke down, but we definitely had mental health resources up there for everybody and for the responders ⁓ for the entire six months. So ⁓ it ended up being just over almost 21,000 people they came in contact with. Right. And that was between the EOC, ⁓ between the responders, between local fire departments. ⁓ you know, it was and some of those, I mean, ⁓ some of those were duplicate, right? I mean, it's like you might see the same guy four days in a row. ⁓ you know, we were counting that as a contact, you know, because I mean we saw ⁓ right? And and what you might feel today might not be the same you feel tomorrow. So ⁓ you know, we were we were counting them as well. But ⁓ over the course of the from September to January or whenever the the The lounge was demobilized. ⁓ there were over fifty five hundred people that came into the lounge at some point. And, you know, it's we probably served five thousand slushies. So I mean it was definitely a hit, but ⁓ you know, a lot of people that that we were able to hopefully make an impression, make an impression. speaker-0: Like I said, you made an impression on at least one individual. So you talked earlier about you guys were or ⁓ the peer support, mental health, everyone they were out in the field going to ⁓ engaging with the responders. Did you have situations where you would kind of focus on some of the responders, some of the people that were in some of the more high pressure areas? Obviously, you mentioned Camp Mystic a few moments ago. Were were those were the mental health folks, were they concentrating and keeping eyes on people and trying to recognize signs of cracking, crisis, what have you? We w speaker-1: Yeah, and you know, those heavily ⁓ affected areas. obviously with the initial days of the response and and initial days the peer support was there, that was where the focus was, right? Because that's where the impact was the heaviest. ⁓ but you know, we would we would rotate our teams in and out. ⁓ the advantage of having the dogs up here is they're they're actually trained for that as well, right? I mean, they'll they'll you know, sense that stress and and they'll kinda go over and they'll they'll target some individuals. So we're we know at that point it's like, hey, this this person's the one that we we kinda need to talk to. ⁓ one of the things that we were trying to emphasize when we would go out and having that casual conversation, it's like, hey man, if if you need to talk to somebody, like we've got we've got somewhere that we can go talk and we have some private areas that that we can go sit down or we have some other contacts, you know, if you want to talk to somebody else. So ⁓ we were definitely trying to kind of keep our our eyes peeled for those individuals that that may benefit from additional help. ⁓ we would offer some ⁓ some additional resources to those individuals. but yeah, to your point, I mean we were definitely we had a heavy presence or at least we tried to maintain a heavy presence in those higher affected areas ⁓ and until things started to kind of slow down a little bit, right? And then we would still make our make our rounds and make our appearance, but it wasn't as ⁓ It wasn't as heavy as, you know, initially when when there was a lot of people. speaker-0: So now that this ⁓ you mentioned ⁓ January was the last I guess demobilization of the mental health. What's the next step for the peer support program? Since you've had what you would consider success with this response, what is what's the next steps for your for your program? ⁓ you talked about the T Dem with this with the statewide program. What are the next steps now that you've shown that we have that this is effective and it's successful and it's well received? speaker-1: Yeah, I mean, I you know, I think this was proof of concept in a lot of ways. we learned so many lessons ⁓ by by deploying this. ⁓ peer support is now ⁓ an additional element for the emergency medical task force response, so EMTF in in Texas. it and and the great thing about this, Mark, is it's scalable, right? I mean, we don't have to send as many resources as we sent to Kerrville. Like, you know, if we just need a team of three or four guys to go to an incident, we can we can send a team of three or four guys. If we need to go all out and we need to sp you know, send thirty people with a peer support lounge, we know how to do that now and we know where those resources are, right? ⁓ so it's really what is the incident? What are we you know, what are we anticipating that the time frame of that incident's gonna be? How many responders are gonna be there? You know, and and we can kind of scale what that peer support response looks like. ⁓ A as far as the the T Dem aspect with the statewide response, ⁓ you know, I don't wanna speak for ⁓ for for Kelly or or the chief that's kinda over that. ⁓ but you know, she's looking at growing that to a point where we have kind of regional teams across the state. So if if we have some kind of a regional ⁓ deployment or or regional response that we need to ⁓ stand up, you know, there's there's local people. ⁓ you know, if If all of your listeners are not use or not familiar with the state of Texas, like I can't call the guys in El Paso and ask them to be in Houston in an hour because of an incident, right? I mean it's right. Yeah. We have to you gotta give me a day. You know, exactly if we have these regional teams across the state and we have an incident that happens, it's like, man, we can pick up the phone call and we know within three or four hours we can probably have some have some peer support boots on the ground. But you know, I I think ten years ago, if you would have went on to Google ⁓ or or any of your search engines and you would have typed in, you know, first responder peer support, you probably wouldn't have got a whole lot of results. And if you do the same thing today, I mean, it is page after page after page of of resources that are out there. So, you know, two things that that has kind of changed drastically over the the past ten years is the stigma's not quite as bad as it used to be. Right. Right. I mean, people are more willing to to come forward ⁓ when they need. And the other thing is the generations, right? And I hate to say that because I'm I'm not dogging an older generation or a younger generation. But I will tell you that the younger generations now, they are more more willing to have these conversations than what some of us ⁓ some of us old farts are, right? I mean we're still we still have a little bit of that mindset to c compartmentalize and just push it down and and I think a lot of our fault is we are looking To take care of others, right? Well and so we're we're looking to make sure that our partners are taken care of or our co-workers are taken care of, and we don't look at ourselves. ⁓ so that that's the couple things that I I think has changed a lot. ⁓ it it's peer support and mental health and just in in whole is definitely much better received ⁓ than it used to be. ⁓ people are more willing to talk about the issues that they're having. ⁓ going to see a therapist is not like taboo anymore, right? I mean it's I mean, people go and and they actually talk to pe you know therapists to build a rapport in case something does happen. It's like now I have a contact, right? So they're they're mitigating their own issues, which is fantastic. Right. I mean, and you know, as I mentioned earlier, it's like how how do you measure success in a program? It's like, well if you don't have a suicide, it's pretty successful. But you know the suicides are going to come. You know we're gonna have these unfortunate events, but what are we doing to mitigate it? And and you know, or how many people are actually coming through our program. I'm actually working on my dissertation right now and my research is what is the effect of a peer support program? What influence does a peer support program have on a responder to seek professional mental health care? Right. So we've had a lot of research that's out there that's it'll talk to you about, you know, it is Does do agencies have peer support programs? And is mental health is it on people's awareness and and and you know in their ⁓ in their systems and organizations? And that's great. I mean, quantitatively, it's like you can probably ask a hundred different agencies if they have some kind of mental health or peer support program, and 95 of them are probably gonna say yes. ⁓ but how effective are they? And that's that's what my goal is with this research is we're all doing it. But is it is it making a difference? Right. And and you know, if you go and you t you, you know, seek out peer support help, you know, do you feel safe enough and are you influenced enough to now go get professional help? ⁓ which is the whole point of the peer support program is is to serve as that conduit. So I'm I'm interested to see what ⁓ what comes out of this research. I hope that, you know, it it's positive and and I hope the results that we get is showing that peer support programs are working. ⁓ Because that's the whole goal, right? It's it's let's let's take care of each other and let's take care of our people. speaker-0: have said it better myself, Brandon. And I want to take time to to thank you again for ⁓ for joining us is as we get ready to wrap up. ⁓ anything that you want to leave with us, any final thoughts ⁓ to leave with us before we ⁓ sign off for the day. speaker-1: I I think I just said it the best I can, right? It's like let's start take care of each other, take care of yourselves and and look out for our people because you know, at the end of the day our our people are our biggest asset. So let's ⁓ let's do what we gotta do to take care of them. speaker-0: One final question before I let you go, and it's not related to peer support or flooding or anything. What ⁓ what's the last book that you read? speaker-1: ⁓ extreme ownership. Actually I I read it for the second time about five months ago. As we were standing up our operation, we gave a copy to all of our officers in our organization and I said, You know what? I'm gonna read this again because I'm not gonna ask them to do something that I'm not gonna do myself. So I read it a second time. So speaker-0: Outstanding. for you. and have you read any of the follow-ups, the dichotomy or need to lead? speaker-1: I have not yet, but I have purchased the ⁓ dichotomy and it's sitting on my ⁓ bookshelf at home. I just have not read it. speaker-0: Outstanding. Outstanding. Well, good. Good. ⁓ any ⁓ social media you want to leave with us anyway? ⁓ obviously you ⁓ Hayes County ⁓ emergency ⁓ services district nine is where you're working. Any other social media or anything you want to leave for connection speaker-1: I would absolutely check out the Texas Department of Emergency Management and then they will be posting some stuff as far as their pre peer support program. And as they get that app and ⁓ the phone number and everything ⁓ officially 100% underway, they're gonna be posting and and getting some stuff on there. But check out our Facebook. ⁓ we will absolutely be sharing a lot of their information when it comes to mental health and peer support as well. It's it's Hayes County ESD9EMS ⁓ on Facebook and then As I mentioned, Texas Department of Emergency Management Facebook page. So speaker-0: Outstanding, outstanding. Well, ⁓ Brandon, thank you again for joining us. ⁓ as far as the podcast, we are on Instagram. Our handle is at not underscore a underscore fib underscore podcast. want to take time to thank Brandon once more for joining us. Thank you all for joining us and listening, and we will talk again next month.