Lt. Rob Ramirez, a firefighter with the city of Margate, Fla., was dispatched to the casualty collection point during the Parkland shooting.
There, people who were injured inside Marjory Stoneman Douglas High School were brought out to be assessed and treated before going to the hospital.
I know I'm not the same person I was the morning I went to work as who I am today, two weeks after the call. This changes you as a person.
Ramirez says first responders were overwhelmed with victims who had what he called "battlefield" injuries.
"All of them with major traumatic injuries," he said. "As you can imagine, these small-frame, small-bodied, high school children taking these large caliber weapons — multiple rounds, to the torso, legs, arms, extremity."
They transported 14 people to the hospital. Two victims died at the triage scene.
Ramirez says that while he's "doing well" since the shooting, he thinks about it often and he worries about post-traumatic stress disorder developing in the Parkland first responders.
"The men and women that responded to that call are not the same men and women that walked away from it," Ramirez said. "I know I'm not the same person I was the morning I went to work as who I am today, two weeks after the call. This changes you as a person."
PTSD is characterized by reliving an event through flashbacks and nightmares. It often isn't diagnosed immediately after a tragedy.
Being hyper vigilant and startling easily are normal reactions to experiencing or witnessing trauma like the Parkland scene. It becomes a disorder if the symptoms don't subside in a month or two, or start causing trouble at home or at work.
Right now, Florida law allows first responders to get medical coverage under workers' compensation if they get PTSD on the job. But if they need time off for treatment, or if the PTSD becomes disabling, they must also have a physical injury to have their salaries covered.
A bill to address that failed last year, and was on an uncertain path before Parkland.
Carlos Guillermo Smith, who represents Orlando in Florida's state legislature, supports it.
"Many of the first responders from the mass shooting in Parkland are going to need this bill," he said during a recent committee debate. "Some of them probably don't even know it yet."
Until now, the bill's main sticking point had been financial. The Florida League of Cities estimated it would cost between $15 million and $95 million to include PTSD as a qualifying condition for workers' comp, assuming first responders take between six months and a year off to recover. The organization cited the price tag as it lobbied against the bill.
That drew an angry rebuke from Jimmy Patronis, Florida's chief financial officer who is also the state's fire marshal. In a statement, Patronis called the League's opposition to the bill "disgraceful" and called its report "wrought with flawed and erroneous data, to support why they don't care about the first responders who make up the communities they represent."
Afterwards, David Cruz, a lobbyist with the Florida League of Cities, backed off. His organization now supports the bill.
One of the most outspoken advocates for change has been Jessica Realin. Her husband Gerry Realin was diagnosed with PTSD after spending at least four hours inside Pulse nightclub, preparing and transporting the 49 dead.
He was in the heat of summer, wearing a hazmat suit with no helmet, and his boots turned yellow, then red, from the blood and gore.
When Jessica Realin heard there were still bodies inside the school the day after the Parkland shooting, she cried. "It reminded me of my husband, and just him reiterating how they needed to get them out," she said.
About a year passed before Gerry Realin was granted a disability pension from the Orlando Police Department, outside the Florida workers' compensation system. He sued the department within the state's workers' comp system for about $26,000.
Judge of Compensation Claims Neal Pitts ruled against Realin in January.
"If he had sustained even a minor accompanying physical injury, he would be entitled to both medical and indemnity benefits," Pitts wrote. "To change this outcome would require action by the Legislature, should they deem it necessary."
Final votes on that action are set for Monday.
Rep. Matt Willhite, one of the legislation's sponsors, is encouraging his fellow lawmakers to pass it so that the death toll attributable to the Parkland attack won't grow to include "first responders who take their life because of this."
WMFE and ProPublica are investigating PTSD and suicides in first responders as part of the ProPublica Local Reporting Network. If you are a first responder with PTSD, or if you've lost a first responder to suicide, visit ProPublica.
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