Abe Aboraya

PTSD

‘Update on Active Shooter?’ How Orlando Authorities Failed to Prepare for a Mass Shooting like Pulse

The Orlando Fire Department had been working on a plan to respond to a mass shooting. It had even purchased vests filled with tourniquets and special needles to relieve bleeding in chest. But at the time of the Pulse nightclub shooting, the plan had already sputtered and the vests sat untouched.

This article was produced in partnership with ProPublica as a member of the Local Reporting Network.

“I need the hospital! Please, why does someone not want to help?”

The man’s screams inside the Pulse nightclub pierced the chaos in the minutes after the shooting stopped on June 12, 2016. With the shooter barricaded in a bathroom and victims piled on top of one another, Orlando police commanders began asking the Fire Department for help getting dozens of shooting victims out of the club and to the hospital.

“We need to get these people out,” a command officer said over the police radio.

“We gotta get ‘em out,” another officer responded. “We got him [the shooter] contained in the bathroom. We have several long guns on the bathroom right now.”

A few minutes later, the Orlando Police Department’s dispatch log shows the police formally requested the Fire Department to come into the club. “We’re pulling victims out the front. Have FD come up and help us out with that,” one officer said.

The Orlando Fire Department had been working on a plan for just such a situation for three years. Like many fire departments at the time, Orlando had long relied on a traditional protocol for mass shootings, in which paramedics stayed at a distance until an all-clear was given. The department had tasked Anibal Saez Jr., an assistant chief, with developing a new approach being adopted across the country: Specialized teams of medics, guarded by police officers and wearing specially designed bulletproof vests, would pull out victims before a shooter is caught or killed.

The Orange County Fire Rescue Department began training firefighters to enter dangerous situations in 2013. The county brought bulletproof vests to Pulse nightclub, but on-scene commanders from the Orlando Fire Department declined to use them. (Cassi Alexandra for ProPublica)

After a recommendation from Saez in 2015, the department bought about 20 of the bulletproof vests and helmets. The vests had pouches filled with tourniquets, special needles to relieve bleeding in the chest, and quick-clotting trauma bandages.

None of that equipment was used at Pulse. Emergency medical professionals stayed across the street from the club. And the bulletproof vests filled with life-saving equipment sat at headquarters.

In the three and a half years before the shooting, bureaucratic inertia had taken hold. Emails obtained by WMFE and ProPublica lay out a record of opportunities missed. It’s not clear whether paramedics could have entered and saved lives. But what is clear is Saez’s plan to prepare for such a scenario sat unused, like the vests.

His effort had sputtered and was ultimately abandoned after a new fire chief, Roderick Williams, took over the department in April 2015. Williams named another administrator to finalize and implement the new policy. That administrator declined multiple requests to comment for this story. Saez said he offered to help but never heard back.

“There was a committee that was responsible for the [policy], however, I am not sure whether one was created and approved,” one fire official emailed another on March 30, 2016.

In April 2016, two months before Pulse, Williams emailed his deputy chiefs asking for a progress report: “Update on Active Shooter?”

The only response was an email asking if anyone had responded. No one did.

Ultimately 49 people died during the Pulse attack, one of the worst mass shootings in modern history.

Saez, a 30-year veteran of the Orlando Fire Department, a paramedic and a member of the bomb squad, has been haunted by the possibility that things didn’t have to turn out the way they did. “I wonder sometimes if I should’ve done something else,” he said in an interview.

“In my mind I’m thinking, ‘Man, if I would have had that policy, if I could have got it done, if I could have pushed it, maybe it wouldn’t be 49 dead. … Maybe it would be 40. Maybe it would be 48. Anything but the end result here,’” he said.

A study published this year in the journal Prehospital Emergency Care concluded that 16 of the victims might have lived if they had gotten basic EMS care within 10 minutes and made it to a trauma hospital within an hour, the national standard. That’s nearly one third of victims that died that night.

“Those 16, they had injuries that were, potentially were survivable,” said Dr. Edward Reed Smith, the operational medical director for the Arlington County, Virginia, Fire Department, who reviewed autopsies of those who died with two colleagues. Smith, whose department was one of the first in the country to allow paramedics into violent scenes with a police escort, has reviewed more than a dozen civilian mass shootings using the same criteria. “How would they be survivable? With rapid intervention and treatment of their injuries.”

A separate Justice Department review last year concluded “it would have been reasonable” for paramedics to enter after 20 minutes, a different time frame from the one Smith analyzed.

Orlando’s mayor, as well as the Police and Fire chiefs, dispute that they could have done anything differently. They say it was impossible to know at the time that there was only one shooter at Pulse or that he wouldn’t resume shooting after he barricaded himself in the bathroom. It was also impossible to know whether a bomb threat he later made was real. All of that, they say, would have kept victims from getting care in time.

Williams, the fire chief, said he still believes the inside of Pulse nightclub was a “hot zone,” or a place of direct threat, which would have stopped first responders from going in.

“We’re not prepared to go in hot-zone extraction. That’s just not what we do as a fire department,” Williams said. “It was active fire, active shooting.”

Orlando Fire Chief Roderick Williams says that first responders couldn’t have safely gone in to save Pulse victims while the shooter was still active. (Cassi Alexandra for ProPublica)

But not everyone who responded that night is sure the Fire Department had done all it could. They say some victims might have had a chance had Orlando finished what it started.

Orlando Fire District Chief Bryan Davis was in charge of his agency’s response the night of the Pulse shooting. In an interview, he said his department had done active shooter drills, but it wasn’t enough.

“We didn’t have formalized training,” Davis said. “We didn’t have a policy. We didn’t have a procedure. We had the equipment [bulletproof vests]. But it was locked up in EMS in a storage closet … And unfortunately, we were a day and a dollar too late. ”

“A Wake-Up Call That, for Us, It Can Happen Anywhere”

Just after midnight on March 18, 2013, a former University of Central Florida student pulled a fire alarm in a building that housed 500 students.

He was armed with a rifle, a handgun, hundreds of rounds of ammunition and four Molotov cocktails. Three minutes later, a person in Room 308 called 911: His roommate had pointed a rifle at him.

When police entered the room, the would-be shooter was dead. After his rifle had jammed, he killed himself with his handgun.

Police found handwritten notes about his planned rampage.

“That was a near miss and that was certainly a wake-up call that, for us, it could happen anywhere,” said Orange County Fire Rescue Chief Otto Drozd, whose agency helped respond to the scene. “Everybody is susceptible.”

That year, Orange County, where Orlando is located, started holding department-wide training sessions on how to respond to such situations. It also wrote a new policy that said paramedics, guarded by sheriff’s deputies, should provide aid to victims after a shooting ends, but before a perpetrator is caught or killed.

Also in 2013, the city of Orlando Fire Department assigned Saez, an assistant chief, to create its active shooter policy.

Saez said he began by using the policy adopted by Arlington County as the backbone of his draft but stopped when he learned that another group within the Fire Department also was working on the project. When he tried to merge the two groups together, he was instead told that the other group would handle the policy.

“They were, for lack of a better term, a little gun-shy about how aggressive we were gonna get,” said Saez, who goes by JR, drinking a pint of craft beer through a grey goatee and wearing a Five Finger Death Punch T-shirt. “They started saying ‘Hey, JR’s crazy.’”

Then, in 2015, as the FBI was planning a major drill with public safety agencies, Saez said he was again asked to take the lead on the policy. At the time, Fire Chief John Miller was in the process of retiring and Williams, a longtime veteran of the department, had been named to succeed him.

“The whole active shooter thing, it wasn’t rocket science, it was common sense,” said Saez, who had a reputation for being blunt.

In March, Saez wrote an email to a group of firefighters, including the incoming chief and other high-level administrators as well as medics, “Looks Like I got a Dream Team for this Active Shooter Exercise.” In the email, he laid out a timeline for getting the policy finalized and an active shooter exercise done in April. He said he was choosing which bulletproof vests and equipment to buy and hoped to train the entire department by the end of the year.

But within a month, Williams was sworn in as fire chief and Saez was sent back to work in a fire station. (Such personnel changes are common when a new chief takes over.) The active shooter policy was given to another administrator.

Two months later, the city of Orlando’s emergency manager sent an email to Williams and other members of the Fire Department’s administration calling their attention to a Department of Homeland Security guide for responding to an active shooter. It recommended that fire personnel in bulletproof vests go into “warm zones,” places where victims may be but where a shooter is not believed to be, guarded by the police.

“It echoes our lessons learned and fixes,” the official, Manny Soto, wrote, referring to the Fire Department’s previous active shooter drills, which included practices involving rescue task forces.

In July 2015, the city of Orlando spent $33,000 on about 20 bulletproof vests, according to purchase orders obtained by WMFE. Each vest could hold enough supplies to treat 10 to 15 patients. That was enough for each of the five district chiefs working on any given shift to equip a rescue task force.

The policy was never finished, though, and on June 12, 2016, the night of the Pulse massacre, the Orlando Fire Department policy told paramedics to stay three blocks away if they felt “uncomfortable with the situation.

“To Know That He Could Have Survived Would Be Horrific.”

The “interim” memorial to honor the victims and survivors of the Pulse nightclub massacre seen on Sunday, May 20, 2018. (Cassi Alexandra for ProPublica)

The gunfire started at 2:02 a.m. on Sunday, June 12, just after last call. A request for immediate assistance brought hundreds of officers from 15 police agencies across Central Florida. When the shooting stopped eight minutes later, Officer Brandon Cornwell of the Belle Isle Police Department and three other officers went inside the Pulse nightclub to kill or arrest the shooter.

They entered through a broken window in the front of the club. The club was dark, lit by pink and blue video screens and disco balls. There was no music playing. Unfinished drinks and unpaid bar tabs littered the tables.

As they got farther inside, a woman could be heard screaming over and over again, according to police body camera video of the scene reviewed by WMFE. Sometimes she screamed for help. Sometimes she just screamed.

The scene was so chaotic, police couldn’t figure out who was screaming.

“Who the fuck is this coming from!” one of the officers shouted.

The team walked toward the gunfire and believed it had the shooter cornered in one of the club’s bathrooms. They pointed assault rifles and handguns at the doors and hallways to keep the shooter contained.

Officers then started bringing 14 incapacitated victims out of the club. Victims grabbed police officers’ ankles as they walked by, according to first responder recollections in the Justice Department report.

People — some dead, some alive — fell stacked on top of one another “like matchsticks.” Some victims played dead. Phones rang and rang.

In the ensuing minutes, body camera footage captured the discussion between officers and commanders about getting help.

At 2:23 a.m., a police command officer tried to come up with a way to get paramedics inside. He asked if the shooter’s rounds could get into the main area “if we start bringing FD to try to get some of these guys out of here?”

The officer inside responded: “He’s got a long gun, so yes, can penetrate,” but then said that he was contained in the bathroom and that they had to get the victims out.

A few minutes later, the Orlando Police Department’s dispatch logs show the police asked for the Fire Department “to go in scene secure,” meaning dispatchers were asking the Fire Department to come into the club.

This is about the time the Justice Department concluded a rescue task force could have entered the Pulse nightclub.

Still, the Fire Department did not enter.

Orlando city officials downplayed the significance of the log, saying in a written statement that it only reflected the judgment of a “single officer.”

“In this type of changing situation, this was an isolated perspective and ‘secure’ did not mean the scene was ‘clear,’ which is very important to distinguish,” the statement said. “This was still an active scene with an armed shooter and many unknown threats, like were there additional shooters or were there explosives.

“And in fact, within moments, the suspect made the threat of explosives and pledged allegiance to ISIS. Shortly after this, there were also reports of a second shooting at Orlando Health and the hospital was locked down for approximately an hour.”

At 2:50 a.m., the shooter threatened to blow up a city block with explosives in his car. Around the same time, the Orange County Fire Rescue Department, which had trained with the Sheriff’s Office beginning in 2013, brought 12 ballistic vests to Orlando Fire Department commanders on the scene.

Davis, the Orlando Fire Department district chief in charge of his agency’s response that night, said he told Orange County commanders that city firefighters and paramedics hadn’t been trained on how to use the vests — and wouldn’t use them. Davis’s account was confirmed by an after-action report by the county.

In an interview, Davis said that while his department had done active shooter drills, those hadn’t been enough. In retrospect, he said he wishes he had asked the county firefighters to send a rescue crew into the club.

“When that Orange County chief arrived, I would have looked at him and said, ‘Hey Chief, my guys are not properly trained in the use of those vests. Do you have individuals here that are?’” he said. “And if so, then we utilize those resources that were properly trained … and we assemble them into the rescue task force and move them forward into the scene.”

Orlando Mayor Buddy Dyer said vests or no vests, commanders on the ground would not have told firefighters to go inside Pulse.

“I don’t think that scene was the appropriate place to do it,” Dyer said. “Whether we had the policy strictly or not, I don’t think it affected the outcome at all.”

While paramedics didn’t enter Pulse, some victims who had left the club managed to go back in to help friends.

Jean Carlos Mendez Perez made it outside the club after the shooting, but he realized his boyfriend was still back inside. He went back in to get Luis Daniel Wilson-Leon, who everyone called Dani.

The couple was found by the entrance in the club. Wilson-Leon had wounds to his back, while Perez had wounds to his front. They both died.

“I think (Dani) was protecting Jean,” Laly Santiago-Leon, Dani’s cousin, said.

Laly Santiago-Leon lost her cousin Luis Daniel Wilson-Leon during the Pulse Nightclub Massacre in Orlando, Florida on June 12, 2016. Laly poses for a portrait in Luis’s old room in Rockledge, Florida on Monday, September 17, 2018. (Cassi Alexandra for ProPublica)

Santiago-Leon says it’s heartbreaking to learn that the Fire Department put the policy on the backburner. She said she hopes to never learn who the 16 victims with survivable wounds were.

“I’m still, as I said, I’m still angry that he’s gone,” she said through quiet tears. “But to know that he could have survived would be horrific.”

The Orlando Fire Department’s Leadership Didn’t Show Up During The Attack

Downtown City of Orlando Fire Station One (Cassi Alexandra for ProPublica)

Fire and police agencies from across the Orlando region swarmed to the scene as word of the Pulse shooting spread. Initially, they each responded independently, but sometime in the first hour they established a mobile command center to coordinate their responses. The Orlando Police Department took the lead, but it was joined by two sheriff’s offices, as well as the Florida Department of Law Enforcement and the FBI.

The Orlando Fire Department leadership wasn’t part of it.

According to department protocol, the fire chief was paged at 2:14 a.m. But the Justice Department’s report on how the police responded to Pulse said the fire chief didn’t arrive at the scene until after the shooter was dead. There was no follow-up call to make sure the page was received, the report said.

Williams declined multiple requests to explain why he didn’t show up that night, but city officials have blamed it on a faulty paging system. The policy has changed since Pulse: Now, if the fire chief doesn’t answer a page in three minutes, he or she will get a phone call.

Dyer said he views what happened as a breakdown in communication, not a lack of leadership.

“Operationally, it didn’t affect it,” Dyer said, referring to the Pulse response. “It just would have been better for the morale of the organization if the chief would have been on site.”

Firefighters had their own command system, separate from the Police Department, whose chief was present. The two sister agencies didn’t even operate on the same radio channel, the type of challenge identified more than a decade earlier after the Sept. 11 terrorist attacks. The Justice Department report said the setup outside Pulse “negatively impacted information and resource sharing, coordination, and overall situational awareness.”

Davis, the firefighter in charge of the department’s response, was four ranks below chief. Looking back, he said, he wishes that he or someone else in his department’s leadership had gone to the police command post.

Williams disputed the notion that being in the command center would have changed the department’s response or prompted officials to send in a rescue crew earlier. In a recent interview with WMFE, he said that training had been in place and that a rescue task force could have gone in if asked for.

“Those commanders on the scene made those choices,” Williams said. “We did exactly what was appropriate based on the resources that was required at the time.

But a month after the Pulse shooting, Williams gave a different response in an interview with WMFE. He said that his department was looking at active shooter protocols and vests, but that “we haven’t trained to that level.”

Smith, operational medical director for the Arlington County Fire Department, said if the Pulse nightclub shooting happened in his community, the response would have been different. With the shooter barricaded in a back bathroom, paramedics and EMTs would have put on ballistic vests and gone inside the club to pull victims out with a police escort.

While conceding that his assessment had the benefit of hindsight, Smith said the story of how Orlando responded to Pulse nightclub isn’t just about the lack of a rescue task force. It’s about the lack of communication between the Orlando Police and Fire departments.

“They had two separate command centers that were, by the way, were on opposite sides of the club” for part of the event, Smith said. “The police commander couldn’t walk outside and walk over to the fire command because they had the club in between the two of them. So there’s no integration there.”

According to Smith’s study of Pulse victims, out of the 16 victims who possibly could have lived, four died at the hospital. That leaves 12 who died either inside the club or in the triage area outside. It’s not possible to know how many of those died on the dance floor, where rescuers could potentially have reached them and provided aid, or inside the bathroom, where the shooter had barricaded himself and held them as hostages. It’s also not clear who would have survived if they had gotten help within 10 minutes of being shot. And for those who could have survived, it’s not clear how debilitating their injuries would have been.

Smith and his team previously studied 12 mass shooting events, including one at a San Diego McDonald’s in 1984 and one at the Washington Navy Yard in 2013. In those 12 incidents, an average of 7 percent of victims died with potentially survivable wounds. According to Smith’s analysis, nearly a third of victims had survivable wounds at Pulse.

Both the fire chief, Williams, and the police chief, John Mina, have a simple response to those who criticize how the Pulse nightclub shooting was handled.

“The fact of the matter is those people weren’t there,” Mina said of Smith and others who criticize the response. “So they can’t say, ‘I would have done this’ or ‘I could have done this’ or ‘I should have done this’ because they weren’t there.”

The city said the Police and Fire departments had nine joint training exercises between 2005 and 2016 on how to respond to an active shooter.

“If we had needed the Fire Department in there, we would have called them,” Mina said. “Many officers were inside the club transporting the wounded directly to the fire department feet away to their triage center.”

Mina later declined to comment further when asked about the dispatch logs showing that the that the police asked for the Fire Department to come to come inside the the nightclub. Dyer described those logs as a “random individual talking about that,” which didn’t reflect the views of police the views of police leadership.

Pulse is no longer the worst mass shooting in the U.S. history. Las Vegas took the mantle last year. Just this year, Florida saw mass shootings at Marjory Stoneman Douglas High School in Parkland and at a video game tournament in Jacksonville.

But Pulse changed the way many law enforcement agencies view the need for a rescue task force. Drozd, the Orange County Fire Rescue chief whose department brought vests to the scene, began working with the National Fire Protection Association to create a blueprint for how police and fire departments should work together to respond to active shooter incidents, which came out this year. He said he hopes fire agencies become more willing to enter “warm zones.”

“That’s where as an industry we can do the most good.”

“I Pray She Made It”

Two weeks after the Pulse nightclub shooting, the upper echelons of the Orlando Fire Department called a meeting. The topic? “Active shooter project discussion.”

Within 10 months, more vests were purchased, and all firefighters had gone through a mandatory 16-hour rescue training course modeled off of the military’s approach to field medicine, reworked for civilians. In April 2017, the mayor stood in front of a fire engine and donned a bulletproof vest with “Fire-Rescue” written in big red letters on the front and “Orlando Fire Department” on the back.

The point of the April 2017 press conference was to show off new equipment the city had purchased to help respond to future disasters like the Pulse shooting. Like the vests that had been sitting in the department’s headquarters on the night of the shooting, the vest Dyer modeled had pouches filled with tourniquets, special needles to relieve bleeding in the chest, and bandages.

Dyer and Williams also unveiled their new rescue task force policy.

“Since Columbine, all these different events happened,” Williams said at the press conference. “We realize a new norm somewhat, but our goal is to make sure our personnel is equipped to handle that new norm.”

Vests provide firefighters with an increased level of protection to ensure they can assess patients & reduce potential injury to themselves. pic.twitter.com/R8zixX9fWA

— Orlando Fire Dept (@OrlandoFireDept) April 7, 2017

Dyer said vests and helmets, which cost about $118,000 would add a layer of protection if firefighters came in the line of fire. The city now has about 150 vests, enough for each firefighter working on a shift to have one.

Those vests could have been helpful in past events, he acknowledged: “Certainly Pulse.”

Neither Williams nor Dyer mentioned the vests and helmets sitting at the agency’s headquarters untouched at the time of the Pulse shooting. Nor did they mention the years of work on an active shooter policy that hadn’t been completed.

The active shooter policy adopted in April 2017 is just two pages long. It says that firefighters working at certain stations will be called into risky situations, operating as a rescue task force, and that all firefighters may be required to do the same.

Ron Glass, president of the union representing the Orlando Fire Department, said the new policy doesn’t have enough details for emergency medical professionals treating patients. He said if another Pulse happens tomorrow, “we’re gonna do the exact same thing again.”

“We have a three-inch notebook … on every type of house fire, every type of specialty, high angle call, below-grade call, extrication call, elevator extrication call,” Glass said. “The only thing that’s not in the book is … active shooters.”

The Justice Department’s Community Oriented Policing Services office, which critiqued the police response to Pulse, has been commissioned by the Fire Department to evaluate its response.

That report is due out soon, and it could give needed closure about the department’s response to the Pulse shooting.

Saez, the assistant chief who had been charged with modernizing the department’s active shooter policy, was not on duty the night of Pulse. But when his wife, who worked for the Orlando Police Department, texted him that the shooting was the “for deal,” Saez remembers driving his hybrid Toyota more than 100 mph to get to the scene.

Saez worked with the arson squad and helped use explosives to breach the outer wall of the club before the shooter was killed. Afterwards, the police dragged a woman to him who had been shot multiple times.

“All I could do was put my hand on her chest to hold pressure and pray, hope, fuck, I hope I did something,” Saez said.

An ambulance finally did come and bring the shooting victim to the hospital. Saez doesn’t know what happened to her.

“I pray she made it,” Saez said.

Saez has filed a hostile work environment complaint with the city of Orlando’s human resources department against his immediate supervisor and the fire chief. The city of Orlando said it is “currently reviewing the facts of this case as it is active and ongoing.”

Saez said he thinks about the Pulse nightclub shooting every day, and feels responsible for not getting the active shooter protocol pushed through. He has a “sick feeling in the gut.”

Correction, October 3, 2018: This story originally misidentified the function of special needles carried in the pouch of bulletproof vests. They relieve air pressure in the chest, not bleeding. It also misidentified the role of Anibal Saez Jr. on the night of the Pulse shooting. He did not work on the explosive breach of the club.

Are you a first responder with PTSD or stress-related symptoms you believe may be related to your work? Do you have a family member or close friend who is a first responder with PTSD or who has committed suicide? We want to hear from you.

Abe Aboraya covers health care for WMFE, an NPR affiliate in Orlando. This year, he is focusing on the toll post-traumatic stress disorder takes on first responders. Email him at wmfe@propublica.org and follow him on Twitter @wmfehealthnerd.

PTSD

Five First Responders to the Pulse Massacre. One Diagnosis: PTSD.

BY Abe Aboraya

Podcast: Play in new window | Download

“My head’s still not right,” said one paramedic who responded to the Pulse nightclub shooting.

Illustration by Sonia Pulido, special to ProPublica

On the morning of June 12, 2016, police officer Omar Delgado pulled his cruiser up to his two-story townhome in Sanford, Florida, and sat in silence for 15 minutes, trying to process what he had seen during 3 1/2 hours inside the Pulse nightclub.

He stripped his bloody uniform and gear off, put them in a trash bag, and took a shower. Then, he shut the door to his bedroom, locked it and tried to sleep.

That same morning, firefighter EMT Brian Stilwell walked back to Orlando Fire Department Station 5. Working at the station just 300 feet from Pulse nightclub, Stilwell was one of the first on scene hours earlier.

In the dawn’s light, he saw a pool of coagulated blood in front of the station. It was from a Pulse patron who had been shot in the stomach and dragged to that spot. Stilwell wondered if the man survived the night. Then, with a bucket of bleach and water, he helped clean the blood off the concrete.

Down Orange Avenue, Alison Clarke and a fellow Orlando Police officer walked into a McDonald’s to use the bathroom. The restaurant had a TV with the news on, streaming live video of the scene she had just come from. People looked up from their coffee and breakfast, glanced at her and her partner, then back to the food. She used the restroom, washed up and bought two coffees. No one said anything. It was surreal.

Josh Granada and his partner drove their ambulance back across town to their Orlando Fire station. They spent the night ferrying 13 people who had been shot at Pulse to the hospital. Before showering, they threw away their uniforms.

“We were covered in just sticky, nasty — just covered in blood,” Granada said. “I’m not gonna put that much blood in the washer.”

Orlando Police officer Gerry Realin was called in from vacation on June 12 to work a 16-hour shift the morning after the shooting. He spent four or five hours of that inside the nightclub, preparing bodies to be taken to the morgue, and it wasn’t until 2:30 a.m. the following day that he came back to his home in New Smyrna Beach, an hour northeast of Orlando. He looked in on his two sleeping children. In the shower, he started wailing. Outside the bathroom, his wife heard him saying, over and over again, how sorry he was for the victims.

“I never saw myself in this position,” he would later say. “I’ve never been the same since, and I can’t go back.”

Pulse was one of the nation’s largest mass shootings, where 49 people died and at least 53 others were wounded. The invisible injuries to first responders represent another toll of the catastrophe.

For these five first responders — and many others — June 12 was the first day of their new lives, one in which they would confront post-traumatic stress disorder. Even though most had responded to gruesome scenes of murder, suicide and car accidents, that didn’t prepare them for the psychological injury of PTSD. Going forward, they would relive that day in flashbacks and nightmares, see danger behind every closed door, and become irritable and impatient with spouses and coworkers.

“There are just some events that are so horrific that no human being should be able to just process that and put it away,” said Deborah Beidel, a University of Central Florida professor who runs a clinic called UCF Restores that treats first responders with PTSD.

Some of the five also would face indifference, resistance and harassment from the departments they served. One said he was fired because of PTSD, another was fired for a mistake on the job, and a third was never cleared to return to work. They said they were subjected to retaliation for speaking up. Those three have each filed lawsuits asserting they’ve been mistreated.

The other two were offered work reassignments to seek treatment and reduce stress, and said they were satisfied with their agencies’ responses.

Orlando Police Department Chief John Mina said he’s been through counseling himself, and that officers dealing with PTSD can come forward to get treatment and request a change of assignment without affecting future promotions and transfers. Orlando Fire Department Chief Roderick Williams likewise said his department provides resources to help firefighters confronting PTSD.

But if employees disclose that they’re dealing with PTSD or mental health issues, they can be given a “fit for duty” test, both Mina and Williams said.

“We wouldn’t want someone out on the street who was having issues,” Mina said. “We may be held liable because of that, because we knew about that. But again, I’ll go back to the fact that they don’t have to come forward. They can receive treatment anonymously.”

The Nightmares Began Immediately

People visit the Pulse nightclub in Orlando, where a memorial has been set up, in May. (Cassi Alexandra, special to ProPublica)

In his bedroom alone the morning after the shooting, Eatonville Police Officer Omar Delgado had his first nightmare: He’s back inside Pulse, bodies stacked on each other on the dance floor. He’s dragging one of the victims out when the rapid gunfire starts again.

“And I’m yelling, get down, get down, get down!” Delgado said. “Not knowing if he’s shooting at us because we’re pulling bodies out, he’s maybe upset or whatever. Not knowing where the bullets were making their way. When you’re trying to pull somebody and you slip and fall and now you’re on the ground, trying to take cover because you don’t know where the shooting is coming from.”

Even though two years have passed, Delgado says he often has that same nightmare. Delgado stayed inside Pulse for more than three hours while the shooter was barricaded in a bathroom. When the smell of gunpowder, blood, death and liquor got to be too much, he tried to breathe through his mouth. Then he tasted it.

He now has flashbacks. One of his triggers: The default iPhone marimba ringtone. While Delgado was inside Pulse, phones rang and rang and rang. Sometimes he could see the caller ID. Mom, sister, friend. He saw one phone vibrate and slide away in a pool of blood.

“I hear an iPhone ring and I freeze. I pause. I’m back there a quick second,” Delgado said. “Then I realize, OK, I’m not there, I’m here, I’m OK.”

In August of 2016, Delgado told his department that he couldn’t keep working as a patrol officer. His bosses ordered him to report to the University of Central Florida’s Restores clinic.

The clinic was originally funded by the U.S. Department of Defense for post-9/11 combat veterans with PTSD. It uses virtual reality, sounds and smells to recreate the scenes of war — exposure therapy in which participants relive the events that caused their PTSD and the triggers that provoke flashbacks and nightmares. Such therapy has been shown to reduce symptoms for some, and is combined with group therapy for anger, depression, guilt and social isolation.

After Pulse, UCF Restores opened its doors to first responders. So for three weeks, Delgado sat and recounted, in vivid detail, everything that happened inside Pulse.

Near the end of the third week, his counselor took him on a field trip back to Pulse. They pulled into the Einstein Bros. Bagels parking lot across the street from the nightclub, which was used as a triage site the night of the shooting. Delgado didn’t want to get out of the car.

“I got angry,” Delgado said. “Where you’re standing, there were nothing but bodies laying around here.”

Hit play to hear Omar Delgado describe returning to Pulse as part of UCF Restores’ therapy for PTSD.

Omar-Resized — Omar Delgado, 46, credits his therapy dog Jediah for assisting him in his healing process after being diagnosed with PTSD.
Cassi Alexandra, special to ProPublica

The counselor wanted him to start at the intersection of Orange Avenue and Kaley Street, where he first pulled up to the scene, and recount what happened. To walk across the street and get close to the club.

“The icing on the cake was when I heard an ambulance or a fire truck with their sirens going off, and I couldn’t take it anymore,” Delgado said. “I dropped to my knees and started crying like a little 5-year-old on the corner of Orange and Kaley. A hundred plus degrees outside, I didn’t care. I just got overtaken. It was just way, way too much for me.”

The UCF Restores program typically lasts three weeks. Delgado spent 10 weeks going through the program. He said it was hell repeatedly reliving Pulse.

“Did it help? I don’t know. Did it make it worse? I don’t know,” Delgado said. “But I’m not well. And when you’re not well, is something working?”

In total, 26 Pulse first responders have been evaluated by or treated at the UCF Restores clinic, including the five interviewed for this story. Another 96 first responders have gone through the program for events not related to Pulse.

The clinic says that 60 to 70 percent of the people who complete the program no longer meet the diagnostic criteria for PTSD, meaning their symptoms are no longer disabling. Police and fire departments like the clinic because it’s nearby, effective and free — funded by state and federal governments. Many first responders say they like the program because it’s a neutral place to get treatment without tipping off their departments.

But some first responders like Delgado worry the clinic isn’t enough. Until this year, the UCF Restores clinic didn’t have a psychiatrist available to see patients and write prescriptions. In the first year after the shooting, the therapy was provided by a psychologist leading a team of doctoral students. With more state funding, the therapy is now done entirely by licensed, full-time clinicians.

Moreover, exposure therapy can worsen symptoms if it’s done too soon, said Beidel, who runs the clinic.

“We don’t want to do treatment in the first couple months,” Beidel said. “That can make people worse in some cases. Three to six months is the sweet spot. We want to get people into treatment before patterns of avoidance set in, before patterns of using too much alcohol to sleep set in.”

After Delgado’s 10 weeks in the UCF Restores program, the Eatonville Police Department gave him a “fit for duty” test and put him back on the road. Afterward, a citizen complained that when Delgado and his partner arrested her, Delgado told her, “I’m emotionally disturbed right now.”

In December 2017, Eatonville terminated Delgado. During a press conference that month, city officials said Delgado was terminated because of his behavior during the arrest. But in his personnel file, obtained by WMFE under Florida’s public records laws, officials cite medical reasons. Delgado says department leaders told him it was because of his PTSD. Eatonville’s mayor, chief administrative officer and the police chief at the time declined to comment for this story through the town clerk.

“I believe they [the city of Eatonville] should have stepped up and found more therapy for me,” Delgado said. “There are so many programs out there now. They looked at one and that was the end of it and they thought it was gonna be the cure for all, and it wasn’t.”

Struggling at home, and on the job

Josh Granada, 38, credits his therapy dog Jack for assisting him in his healing process after being diagnosed with PTSD. (Cassi Alexandra, special to ProPublica)

As the first anniversary of the nightclub shooting approached, Amber Granada woke up at 5 a.m. to her husband Josh searching, angrily, for a bloodstone bracelet.

He was slamming drawers. He asked if the dogs took it. He asked if Amber took it.

Then, Josh walked out of the bedroom and kicked the couch. It slid into the coffee table, knocking the glass coasters to the ground and shattering them. The couple’s two dogs scattered. Amber started crying. She handed Josh a different bracelet and told him to leave the house.

His face was red. His eyes were bulging. He screamed: “It’s not the bloodstone!”

“And I’m looking at him like, I have no idea who this is,” Amber said. “He ends up just leaving, slams the door. He leaves and I’m sitting there on my hands and knees like mopping up this shattered glass that’s all over the floor in tears because I have no idea what that was.”

This was the first time Amber realized something was wrong. Right after Pulse, Josh Granada had trouble sleeping and nightmares. His coworkers at the Orlando Fire Department also noticed his temper flare in ways they hadn’t seen before. That didn’t stop him from putting in for a promotion and being elevated to an engineer. Granada and his partner Carlos Tavares were among Florida’s firefighters of the year in 2017 for their response to Pulse.

But as the first anniversary approached, journalists sought out Granada and Tavares to ask about what they saw that night. The anxiousness he had right after the shooting returned, along with the nightmares.

Around the same time, Granada drove his ambulance by Pulse for the first time since the shooting. He looked over at the nightclub, which had become a makeshift memorial of flowers and mementos to the dead. Then he looked across the street, at the Einstein Bros. Bagels.

In his mind, he saw blood running down the driveway and into the storm drain.

“And I knew it wasn’t there, but I saw it plain as day,” Granada said. “And that’s what it was that night. The night we were there, that’s exactly what it looked like. There were so many people dying and bleeding behind Einstein that it was literally a pool that was coming down the driveway … and running into the gutters … and I just remember that image. And it still sticks with me. I can still see it.”

Hit play to hear Josh Granada explain the flashback he had driving by Pulse.

That night, survivors grabbed Granada, begging for help, and slapped the windshield of his ambulance when it was full. There were so many patients, Granada used a penlight and gauze to make tourniquets when the supplies ran out. Two patients died at the triage site and had to be placed off to the side with a makeshift curtain around them.

“I saw a guy crawling and take his last breath,” Granada said. “It was horrible.”

Granada’s home life and professional life suffered as his PTSD symptoms grew worse. The other responders interviewed for this story described similar problems.

Granada’s wife Amber told him to ask the department for help. Granada decided his family life was worth more than his pride. In June 2017, he told his lieutenant at the fire department about the flashback when he drove by Pulse.

On July 19, 2017, Lt. Gregg McLay wrote an email to the district chief in charge of health and safety at the Orlando Fire Department, recommending that Granada be given an excused absence with pay to go into the UCF Restores program.

Then, Granada waited. And waited.

Finally, in August, McLay told Granada that he had been told that a top Fire Department official had said, “PTSD is bullshit. These pussies need to man up,” Granada said.

“And the second I [was] told that, I got really depressed and stressed. I didn’t really tell anybody… but that’s when I started having suicidal thoughts.”

On August 17, Granada broke the chain of command and wrote an email directly to deputy fire chief Gary Fussell, the man he believed was blocking his access to care.

“It has been well over 2 months since I reached out to the department for help,” Granada wrote. “Two long months of waiting for something to happen while our administration has no sense of urgency or care.”

Three hours after Granada sent the email, McLay sent another email to the district chief in charge of health and safety, copying Granada. McLay seemed frustrated — both that Granada broke chain of command and at the administration’s slow response to Granada’s request.

“I will be totally honest with both of you,” McLay wrote. “Our department [takes people off shift] all the time. If a person was to ask [for] help for a substance abuse problem, he is immediately taken off shift and offered help. In this case, Josh is seeking help and the licensed mental health professional that he is seeing is recommending a beautiful opportunity for him to be with fellow workers and military to share stories and coping skills.”

“I do not think this is a true character of Josh. I believe he is struggling inside and needing some guidance to get past this hurdle.” – Lt. Gregg McLay

But Granada wasn’t taken off duty. Instead, 10 days after that email, he made a mistake that would cost him his job.

It was a routine medical call. A woman didn’t check out of the penthouse suite at the Doubletree hotel near the theme parks, and she was unresponsive. When paramedics woke her up by rubbing her sternum with their knuckles, Granada says she started yelling. Granada pulled out his iPhone, started the audio recorder, and put it back in his pocket.

The patient refused treatment and everyone left. Back at the fire station, Granada played the recording for his coworkers at the dinner table before he deleted it, a possible violation of federal and state privacy laws.

The next day, an internal investigation was started. The patient he recorded was Orlando City Commissioner Regina Hill. Granada wrote an email admitting what happened and apologizing, saying it was “not a smart idea.” Hill filed a complaint with the Orlando Police Department, alleging Granada violated her privacy.

Granada was put on light duty while internal affairs investigators spent three months looking into what happened. During that time, he was finally able to go to the UCF Restores program for PTSD therapy.

Ultimately, Granda was fired for violating two department policies and for violating state law by recording someone without consent. He is currently suing the Orlando Fire Department in the Ninth Judicial Circuit Court in Orange County for wrongful termination, and alleging that the city violated a state law that protects people who file worker’s compensation claims from retaliation. The department has denied wrongdoing, saying in a pleading in response to Granada’s lawsuit that the city “is not liable because it also had valid, legal reasons for taking the adverse employment action.”

McLay, Granada’s boss, told a reporter that he would be not be able to speak without permission from the Orlando Fire Department. The department refused, citing the lawsuit. In court documents, the city denied that an official had said “PTSD is bullshit.”

If Granada is unsuccessful in court, his firing will have very real consequences: He will not be eligible for any kind of pension.

“The second I raised my hand and said something’s wrong with me in June, they should have pulled me off shift,” Granada said. “I should have been getting help. I never should have been allowed to run those calls, day in and day out, my head was not right, I can admit. My head’s still not right.”

In a job evaluation less than a month before Granada was fired, obtained by WMFE under Florida’s public records laws, McLay wrote that Granada was “without a doubt one of the department’s sharpest medics.” But he was having spontaneous outbursts, and McLay wrote that Granada “started to unravel” when there were delays getting into treatment.

“I do not think this is a true character of Josh,” McLay wrote. “I believe he is struggling inside and needing some guidance to get past this hurdle.”

“Get Over It and Move On"

Gerry Realin, 38, credits paddleboarding for assisting him in his healing process after being diagnosed with PTSD. (Cassi Alexandra, special to ProPublica)

Unlike Delgado and Granada, Gerry Realin didn’t arrive at Pulse during the shooting or its immediate aftermath. He worked inside the club after the shooting ended, when many of those first on scene had gone home.

He was part of a small Hazmat team within the Orlando Police Department that placed bodies and body parts into bags to go to the medical examiner for autopsy and identification. The building had no air conditioning, and the smell was choking. Wearing a white hazmat suit without a helmet, Realin spent four or five hours inside the nightclub, his boots turning yellow and then red from the blood and gore.

In the weeks that followed, Realin had nightmares, flashbacks and panic attacks. He tried to work but often called out sick or left early. After about two weeks, a doctor at a walk-in clinic diagnosed Realin with “acute post-traumatic stress disorder” and wrote that he couldn’t even work a desk job. The doctor referred him to a psychiatrist.

Realin, burning through his sick time, filed a worker’s compensation claim, and in August started doing interviews with the press about his struggles. He was relieved of duty with pay, meaning the department kept sending him a paycheck as long as he kept up with paperwork. (It didn’t legally have to do this under Florida’s worker’s compensation system at the time.)

Going public, though, came with a price. His wife, Jessica Realin, said the rumor among police officers was that her husband was a faker trying to game the system. Two psychiatrists wrote in their reports that the department’s treatment of Realin likely worsened his condition.

His union warned Realin that he could be put under surveillance, so he should be careful not to do anything that would appear to contradict his diagnosis. A union official wrote that he was worried Realin was getting bad advice that could cost him a disability pension.

The department got involved in Realin’s clinical care as well. Realin’s deputy chief, Orlando Rolon, met the Realins at a gas station in early September 2016. Rolon gave him a copy of a memo: It was a direct order to report to the Restores clinic for treatment.

“Gerry, as you know, the members of the law enforcement profession are exposed to horrible situations during their careers,” Rolon wrote in the memo. “I am confident that this program, that has helped many, will address some of your needs and for this reason I’m ordering you to participate. Your wellbeing is our top priority!”

At the gas station, Realin said he told Rolon he had already been to the clinic and didn’t want to go back. Things escalated. Rolon asked Realin if he was a threat to himself or others and, according to allegations in one of Realin’s two civil lawsuits against the city, threatened to have Realin involuntarily admitted to the hospital on a psychiatric hold.

Rolon told him about responding to a scene in which a 12-year-old had hung himself in a closet. Realin “needed to get over it and move on,” Realin said Rolon told him.

“It’s exhausting, physically and mentally. But then there’s the moments you can’t control. The images or flashbacks or the nightmares that you don’t even know about, and your wife tells you the next day you were screaming or twitching all night.” - Gerry Realin

Rolon did not return phone calls or text messages for this story. Asked in an interview in September 2016 whether officers with PTSD should be eligible for worker’s compensation, he said, “I think it’s tough to be able to justify that when you are already expected to be exposed to so much that the average person may not be able to handle.”

In March 2017, Realin was ordered to report back to work for the city of Orlando. He would monitor city cameras for drivers who drift into bike lanes. Realin’s psychiatrist worried that Realin could witness fatal pedestrian accidents and recommended that he not report for the new job, so he did not.

That decision grabbed headlines: Orlando police officer with PTSD ordered back to work at City Hall — but he’s not going.

Dr. Noel Figueroa, Realin’s psychiatrist, wrote in his medical chart that, in his opinion, Realin was not able to work “at any job at this point. As far as I’m concerned, the patient is permanently unable to return to full duty.”

He continued: “The patient has been feeling ‘prosecuted’ [sic] by his employer throughout this process. The behaviors by the employer in the last 72 hours only have enhance [sic] his perceptions.”

Figueroa’s notes were included in one of Realin’s lawsuits against the city.

A year after the shooting, Realin said he hid from his children so they wouldn’t be traumatized by his rage or depression.

Hit play to hear Gerry Realin describe his PTSD symptoms and how they impact his family.

“It’s exhausting, physically and mentally,” Realin said. “But then there’s the moments you can’t control. The images or flashbacks or the nightmares that you don’t even know about, and your wife tells you the next day you were screaming or twitching all night.”

Realin’s fight with the city came to a head before Orlando’s Police Pension Fund Board in July 2017. Realin was asking for a line-of-duty pension, which would entitle him to 80 percent of his salary for the rest of his life.

Dr. Herndon Harding, one of the doctors hired by the city to perform an independent exam of Realin, wrote that Realin had a “dramatic, perhaps histrionic element to his presentation” that could have been “an attempt to demonstrate his pathology.” But he also wrote that one of the factors leading to Realin’s inability to function was “how much the role of OPD has contaminated this treatment.”

Steve McKillop, an outside attorney hired by the city of Orlando to fight the pension, argued that Realin never really wanted to get well. Getting a pension was his goal all along.

“Rather than accept the hand that has reached out to him, at every turn he’s utilized all means necessary to suit his goal of obtaining permanent, in the line of duty benefits so that he does not have to return to work as a police officer,” McKillop said to the board.

Ultimately, the board approved the disability pension, writing that Realin was permanently and totally disabled from police work in the line of duty because of PTSD. He was given 80 percent of his pay for the rest of his life: about $41,000 annually, after health insurance costs.

In one of Realin’s lawsuits against the city, filed in December 2017, he alleges that the way the department treated him worsened his condition and that the city violated a state law protecting people from being fired or threatened because they file worker’s compensation claims. In the other, he claims the city should cover his health insurance costs because he was disabled in the line of duty. The city is contesting the first lawsuit and hasn’t yet responded to the second, which was filed in May. Both suits were filed in the Ninth Judicial Circuit Court in Orange County.

In an interview with WMFE, Orlando police chief Mina wouldn’t comment on Realin’s case because of the ongoing lawsuits. But he said when an officer is injured, officials never worry about the financial burden on the city.

Hit play to hear Orlando Police Chief John Mina talk about how OPD handles officers with PTSD.

“No, any time an officer is injured or can’t perform, the financial aspect of that is never taken into consideration,” said Mina, who is a candidate for Orange County Sheriff this year. “What’s taken into consideration, by our pension board, which handles that, is was this an on-duty injury, did this happen in the line of duty, can this person go forward performing the job they were hired to do.”

Keeping It Quiet, Trying to Get Better

Brian Stilwell poses with the 1965 Mustang he’s restoring in Lakeland. Working on cars is one of his health outlets. (Cassi Alexandra, special to ProPublica)

In early 2017, firefighter EMT Brian Stilwell had requested a meeting with Orlando Fire Department Chief Williams to encourage him to commission an after-action review of the Pulse nightclub shooting and the department’s response to it.

Stilwell, as well as leaders of the firefighters’ union, thought the department needed an outside expert to come in and evaluate whether anything could have been done to reduce the death toll.

At the end of the conversation, Williams told Stilwell to take advantage of the city’s employee assistance program for free counseling if he needed it, or to go through the UCF Restores clinic. Williams said that if Stilwell needed time on light duty to go to the clinic, the department would work with him.

Stilwell was already going to the clinic. Sometimes, he’d wake up in the middle of the night and couldn’t get back to sleep because something would jar a memory of the shooting. At work, he would be shorter with patients. At home, he was curt with his wife, and would lose his temper.

“And I was like yeah, I’ve already been going to UCF, which he was kinda taken aback,” Stilwell said.

On the night of the shooting, Stilwell was one of four men inside Station 5, about 300 feet from Pulse nightclub. On any given night, they were close enough to hear the music and see the club from the dinner table. On June 12, they heard the gunfire and saw a flood of survivors running for their lives down the street.

The gunfire was so loud, the lieutenant working that night wouldn’t let them out to start treating patients until a few minutes passed and a police officer was out in front of the club with an assault rifle.

The firefighters and EMTs went to the triage area across the street, and helped the paramedics already there sort patients. Green tags meant a person was walking and stable. Yellow ones went to those who had serious injuries, but who were stable and could wait to go to the hospital. Red tags were for those people who needed to go to trauma surgery immediately or risked death. Black was reserved for those considered too far gone.

“Some of the people changed from being stable but serious to critical in front of us,” Stilwell said.

Stilwell had been open with his coworkers about getting treatment for PTSD, but he hadn’t formally told the department. In part, he says, that was because there’s no clear protocol on what happens when a first responder comes out and says he or she needs help. He wondered: If you file an injury report for PTSD, are you taken off shift to go into treatment?

Stilwell also worried about how peers would view him. If someone in his department had a heart attack six months earlier, no one would worry about whether he or she was still physically able to do the job.

“No, you go in, you fight the fire, you do whatever you have to, never crosses your mind,” Stilwell said. “But if you know a guy that had a mental breakdown or had some mental issues, the stigma is still like, ‘Oh, this guy’s weird.’”

Hit play to hear Brian Stilwell talk about the stigma of PTSD as a firefighter.

Stilwell said the meeting with the chief was productive and didn’t lead to any negative consequences at work. He completed the Restores program and says he’s doing better.

Officer Alison Clarke with the Orlando Police Department is going through the Restores program now. She also was working the triage scene at Einstein Bros. Bagels. Clarke, an openly gay female who had previously worked at Pulse as an off-duty security officer, saw a flood of survivors knock down the fence outside the club.

“Of course, they were traumatized, screaming and crying, and not knowing where they were going,” Clarke said. “At that point I started asking for ambulances, and there weren’t any ambulances that were responding at that point. So we just started loading up patrol cars and [fellow officer] Jimmy Hyland’s pickup truck and started running people to the hospital.”

Clarke was able to work through her PTSD with a counselor provided by the city’s Employee Assistance Program. She stopped working the night shift, and had gotten to the point where she was only seeing a counselor sporadically.

But then trauma hit again. In January of 2017, her boss Lt. Debra Clayton was tracking a man in an Orlando Walmart who was wanted for killing his pregnant ex-girlfriend.

Clarke heard the gunshots over the radio as her lieutenant was shot. When she got to the Walmart, she held Clayton’s hand while others performed CPR. Clarke escorted the ambulance to the hospital, where Clayton was pronounced dead.

Afterward, the anxiety and agitation came back, with a new symptom — hypervigilance. Clarke would think the worst was going to happen on each call. Knocking on a door for a noise complaint, she’d worry that someone on the other side would shoot her through the door. She went to a psychiatrist, who prescribed Prozac.

“Now I’ve seen it twice,” Clarke said. “My first look at evil was Pulse, and then my second look at evil was the day that Debra was killed. So I know it’s there. I’ve seen it. I’ve experienced it. So now my brain thinks the worst thing’s gonna happen when you’re out on the street.”

Hit play to hear Alison Clarke describe how her hyper vigilance manifests.

“It came to a choice where I could either keep suffering and ruin my home life or step forward and take the help being offered by the department. Not just the department, the whole community.” - Alison Clarke

In February of this year, she responded to what she came to believe was a man who wanted an officer to shoot him, sometimes called “attempted suicide by cop.” The man was holding his hands behind his back, acting like he had a weapon. Clarke drew her pistol. He kept yelling: “You know you want to shoot me, you know you want to shoot me.”

Ultimately, the man was subdued with a Taser, and no one was seriously hurt. He was found to be unarmed.

“The moment the handcuffs went on and I was able to take a deep breath and realize that the situation was safe, my anxiety, I just full on had just a like a huge anxiety, panic attack. I couldn’t get the adrenaline and my anxiety to calm down,” Clarke said.

As she was walking to the patrol car, she thought: This was it. I can’t be an initial responder. It was her last shift as a patrol officer.

Clarke asked to be put on light duty while she went through the Restores program, and the department agreed.

“It came to a choice where I could either keep suffering and ruin my home life or step forward and take the help being offered by the department,” Clarke said. “Not just the department, the whole community.”

How They Cope

Alison Clarke with the Orlando Police Department poses for a portrait at the Kissimmee Golf Club.

Josh Granada has been teaching classes for paramedics and EMTs since he was fired from the Orlando Fire Department. He and his wife are having trouble making ends meet, so they’re planning to sell their house and move in with Amber’s father before they fall behind on the mortgage.

He leans on his therapy dog, Jack, which he got from the Pawsitive Action Foundation, a group that provides service dogs for veterans and people with disabilities.

Omar Delgado got a dog from the same group: Jediah.

On the days when Delgado has trouble getting out of bed, shaving or brushing his teeth, the dog gives him the motivation he needs, he said. Since he was terminated from the Eatonville Police Department, Delgado has been living off the proceeds of a GoFundMe campaign. He’s stuck in limbo, waiting to see if his disability pension will be approved. Once that happens, he’ll be able to decide what’s next.

“We cut back on everything humanly possible,” Delgado said. “It’s rough. We gotta keep going. What else is there?”

Alison Clarke has accepted a position as a police department liaison to the LGBTQ community. She no longer works on patrol, and when she’s ready to put a uniform back on, she plans to finish out her career at the Orlando Airport. To help cope, she drives her Mazda Miata with the top down, or takes an hour at the driving range, hitting golf balls with her headphones on.

After policing, she plans to work as a counselor to help other officers.

“I’ll never be the same [as] before Pulse,” Clarke said. “You can recover to a certain extent. At least for me, I can recover to a certain extent. But I know that I’ll always have some type of small anxiety issue. It’s just learning how to live with it and function with it.”

To cope, Gerry Realin goes out paddleboarding and fishing. Walking ankle deep in saltwater in Webster Creek, north of Mosquito Lagoon and the Canaveral National Seashore, Realin casts out into the channel with a lure, hoping to catch redfish, jack and trout.

He sleeps better on the nights he fishes.

“I used to have pressure in my mind. I better hurry up and heal,” Realin said. “But how? How do you hurry that up? With some physical injuries, you kinda know. Tear a hamstring, you’re out six months. Sprain your ankle, couple weeks. But for this? I don’t know.”

Realin’s wife has become a crusader. After realizing that Florida’s workers’ compensation law didn’t cover lost wages for PTSD and mental conditions, Jessica Realin set out to change the law, and is running for local office. Under a law signed by Gov. Rick Scott in March, first responders will soon become eligible for these benefits.

Brian Stilwell has found healthy ways to cope. He rebuilds classic cars and plays drums. He still works for the Orlando Fire Department, but he’s been transferred away from Station 5. Now, he’s at a small station in an old Navy base, what he calls “the last stop on a trip to nowhere.” He wants to go back to Station 5.

That station, so close to Pulse nightclub, feels like home to him.

“I feel a bigger connection to that area and that community now because of that,” Stilwell said. “It feels like the station is a part of me now, not something I want to leave.”

As the two-year mark for the shooting approaches, Stilwell says he may go back to UCF Restores for more treatment. The anniversary, he says, is bringing things back to the surface again.

This article was produced in partnership with WMFE, which is a member of the ProPublica Local Reporting Network.

Abe Aboraya covers health care for WMFE, an NPR affiliate in Orlando. This year, he is focusing on the toll post-traumatic stress disorder takes on first responders. Email him at wmfe@propublica.org and follow him on Twitter @wmfehealthnerd.

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for their newsletter.