An out-of-control minivan smashed through the front of a Deer Park nail spa, shattering windows and the lives of workers and customers inside before coming to a stop in the back of the business, its allegedly drunken driver injured and semiconscious. In the minivan's wake: a trail of tragedy at the Hawaii Nail & Spa that summer afternoon last June — four dead, another nine injured.

Dominic Albanese, 3rd assistant chief of the Deer Park Fire Department, a seasoned firefighter, soon arrived.

'Like a bomb went off'

"I’ve been to some bad car accidents. That’s the worst one I’ve ever been to," said Albanese, a 17-year member of the department. "It looked like a bomb went off. There was broken glass everywhere, debris and, obviously, a lot of victims. ... I’ll never forget it for the rest of my life."

Albanese knew others wouldn't either.

"We were concerned about everybody," the chief said of his firefighters, "but we had a couple members that just graduated the night before from high school."

He then put a call out to the Suffolk County Critical Incident Stress Management Team, also known as CISM. The team of mostly first responders are trained to help firefighters and emergency medical personnel process what is often sudden and senseless tragedy.

"We wanted to make sure we got them any resources they needed to help get through this," Albanese said, "... whether they were a 20-year member or a two-month member."

Dominic Albanese, 3rd Assistant Chief of the Deer Park Fire Department, stands in front of Engine 1-4-6, Thursday.

The Suffolk CISM team, like a similar group across the border in Nassau County, is available 24/7 for firefighters and EMS personnel looking to vent but reluctant to reach out beyond the traditionally insular world of the uniformed services. According to a recent survey, first responders statewide share that reluctance but are also willing to open up about what they've witnessed if they know the person listening has witnessed something like it.

Talking about a tragedy on the job — unsuccessfully performing CPR on an infant or child, or arriving at a car crash to find dead teenagers, or putting out a house fire where not everyone gets out alive — and talking about it now, can help ease post-traumatic stress later, said Jeffrey Mitchell, who has studied the mental health of first responders since the 1970s and cofounded the International Critical Incident Stress Foundation, an Ellicott City, Maryland-based nonprofit that trained Suffolk's critical incident team.

"If you don't deal with the crisis early enough," Mitchell said, "it solidifies into something that becomes much more challenging to deal with."

'Mental cancer'

Said Evan Schatzberg, the 1st deputy chief of the Plainview Fire Department, of the consequences firefighters can face if they stay silent about what they've seen: "Everybody’s worried about cancer in the fire service. Well, this is the mental cancer."

Officials in Albany have taken notice. A recent survey of more than 6,000 first responders statewide showed peer support and counseling ranking high among mental health services respondents said they want available.

The 62-page study, funded by the New York State Division of Homeland Security and Emergency Services, breaks down the responses — from both career and volunteer responders — to a range of questions: How does their work on the job affect their mental health? What stigma-related issues and other concerns do they face when seeking assistance? What mental health services would they like made available?

Ninety-two percent of fire and EMS personnel who participated in the survey said peer support groups would help improve their mental health. Several survey participants noted "that peer-led programming, whether a workshop or peer support and counseling, is 'likely to be more impactful' than 'expert-led' programs and is the best way to guarantee culturally competent services," according to the New York State First Responder Mental Health Needs Assessment. The research was conducted by The Benjamin Center for Public Policy Initiatives at SUNY New Paltz in conjunction with the university's Institute for Disaster Mental Health.

One out of every five emergency medical responders and 14% of firefighters surveyed reported thoughts of suicide.

One of the study's authors, Robin Jacobowitz, returned last week from Tokyo, where she gave a presentation on its findings at a conference of the World Association for Disaster and Emergency Medicine and at other events addressing disaster response. Her presentation focused on "the mental health impacts ... of being a first responder" and their "barriers to seeking care," Jacobowitz told Newsday.

"We'll hopefully be presenting the results again down in D.C. this summer," added Jacobowitz, the executive director of the Institute for Disaster Mental Health at New Paltz.

A need to know

The state commissioned the study after "hearing more about the issue" of first responder mental health and learning there was no comprehensive statewide survey on the matter, said Terry Hastings, a senior policy adviser for New York's homeland security and emergency services.

"One of the big findings from this assessment was there really is a lack of culturally competent mental health professionals out there," Hastings said. "There’s a dearth of mental health professionals to begin with, but even less that focus or have experience working with first responders."

It's experience as first responders that gives the Nassau and Suffolk crisis teams their credibility, say leaders of both.

"They feel more comfortable speaking to us because they know we've been there and seen what they've seen and dealt with what they dealt with," said Vincent Papasodero, a coordinator with the Nassau Critical Incident Stress Management Team, and also a former volunteer with the Valley Stream Fire Department and retired NYPD detective.

Responders seeking mental reprieve "don't have to explain what they do," said John Fleischmann, a longtime peer counselor and co-director of the Suffolk CISM team alongside Ellen Komosinski and Kristin Gelzinis.

First responders are more at ease talking with peer counselors because "they know exactly what you're talking about," said John Fleischmann, a director of the Suffolk County Critical Incident Stress Management Team.

From the apparatuses first responders use at the scene to the abbreviations that go out over radios, Fleischmann added, "You can just get right down to business because they know exactly what you’re talking about."

Trauma leads to doubt

Two weeks after he became a firefighter and a certified EMT for the Floral Park Fire Department, Rob Gartner found himself using his training to perform CPR on his own father, who had suffered a cardiac event. Not long after, Gartner was first on the scene when a pedestrian was struck by a cargo van. He rendered aid to the pedestrian and his father. Neither survived.

Gartner recalled feeling "like I was kind of a failure" and questioning whether he and emergency service were a good fit.

Rob Gartner at the fire station on Atlantic Avenue in Floral Park, Thursday.

"As first responders, we all have a pint glass that starts to get full," Gartner said. "Mine filled up little by little. These two incidents, the glass started to overflow. I had gotten to a point where I wanted to quit the service."

Thousands of first responders reported feeling anxiety, burnout, depression and other mental health strains as a result of their duties, according to the state survey, which was released in February. When asked what aspects of their positions have caused them "distress," 64% of EMS and 58% of firefighters pointed to "traumatic events," such as motor vehicle accidents. When asked about what this distress has wrought, 37% of EMS personnel and 29% of firefighters reported post-traumatic stress disorder.

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Gartner turned to a friend and fellow firefighter for answers. Through that friend, Gartner met Steve Marsar, a coordinator of Nassau's CISM team.

Meeting confidentially one-on-one with Marsar helped him, Gartner said. But as time went on, and more calls where patients he treated "didn’t make it" tallied up, Gartner recalled, he hit a "block in the road," continuing to doubt whether he was really making a difference.

Marsar recommended Gartner talk to Michael Phillips, a Hicksville-based mental health counselor who volunteers as an EMT for the Manhasset-Lakeville Fire Department and as a peer counselor for the Nassau CISM team.

'Nothing wrong with talking'

"There’s nothing wrong with talking to somebody," Gartner said. "I’ve still been put in incidents that you would consider a critical incident, but I’ve used the tools I’ve learned to cope with them and move on."

Phillips said meeting with the CISM team can be "a good bridge" between first responders and traditional mental health services.

Suffolk County's crisis team began in 1984, and its various members have counseled more than 1,000 first responders in the years since, including some who were on the scene after TWA Flight 800 exploded in 1996 over the Atlantic Ocean just south of East Moriches. Nassau's team came into being soon after the 1990 Avianca Airlines Flight 52 crashed in a wooded area of Cove Neck Village on the North Shore and has helped hundreds of emergency personnel.

A ranking member of a fire or EMS agency must request a group intervention by calling either Nassau County Fire Communications or Suffolk County Fire, Rescue and Emergency Services, which then contact the relevant CISM team's leadership.

"If we were just to show up, we would probably be shunned," said Fleischmann, the Suffolk crisis team's co-director. "But when they reach out to us ... that starts the healing process right there, because they're recognizing that something's not right and they're looking for help."

Similar crisis teams operate nationwide. New Jersey has the Mercury Critical Incident Response Team, founded in 1984, the same year as Suffolk’s. It serves firefighters and EMS personnel, as well as police officers, emergency service communications workers and hospital and school staffs statewide. Tuscarawas County in Ohio formed a crisis team for first responders in February, spurred by a bus crash three months before that killed six and injured several others, according a report on the website of a local radio station, WJER.

At the time, taboo

Peer support services took root on Long Island at a time when discussions of mental health, especially in the first responder community, were taboo.

"When you talk about fire, police and EMS, you're talking about the John Waynes of society," said Ray Shelton, the clinical director of the Nassau crisis team, who formerly held the same position in Suffolk and served as a firefighter and paramedic.

"The concept was," Shelton added, " 'I'm not hurt unless blood and bones are showing.' ... There was no recognition of the fact that the things that we experience, the things that we see, have a very powerful effect on us."

For many years, Plainview Fire Department Chief Andrew Cohen tried to bury what he'd witnessed, including the sight of a dead child wearing the same animal-print pajamas as those his sleeping son was wearing when he said "goodbye" to him the same morning. Like many others he knew, his remedy for such internal injuries was drinking.

Plainview Fire Department Chief Andrew Cohen, center, with firefighters Lance Kozlovsky, left, and the chief's son, Brandon Cohen. Plainview firefighters met with the Nassau CISM team after responding to a fatal fire at a Plainview apartment building.

"People don’t understand, when people call the fire department, they’re not getting robots," Cohen said. "They’re getting people that have families."

But those days of drinking and suppression are over, Cohen said, especially now that his son, Brandon, is a Plainview firefighter, one of many who met with the Nassau CISM team after a particularly harrowing February 2024 fire at the Harmon Shepherd Hill apartments. While most residents got out on their own and first responders brought one occupant to safety, two people died. The chief knew the tragedy would weigh on his crew, so he called the crisis team to help them process their feelings.

"It was definitely a shot to the chest that we didn’t save everyone," Brandon Cohen, 20, said. "Speaking with our peers about it is definitely what relieved that stress ... Being in a brotherhood, that definitely helped us cope."

Both CISM teams hold one-on-one sessions, but leaders of the Nassau crew encourage group discussions.

"If you're impacted, then the other people that were on that crew or that assignment should also be impacted," said Papasodero, the coordinator with Nassau's CISM team.

Group interventions, which are confidential, can take a few forms, including something called a multistep critical incident stress debriefing, which both Nassau and Suffolk use sparingly. These longer sessions involve more probing questions and are used after calls that leave multiple responders "staring into space, or they’re crying and nobody’s talking," Fleischmann said.

Marsar refers to it as a support and education session, during which the priority is to listen — freeing up the person being counseled to share what they did at the scene and how they have dealt with it since. Mental health counselors and even clergy are on hand during these interventions. By letting the responders do the talking, the session normalizes their reactions to the abnormal event they experienced.

"We don’t critique the incident," Marsar said. "We don’t allow them to talk about what went right, what went wrong. It’s all about what did you see, what did you do and how are you dealing with it."

A firehouse chat

The peer counselors then discuss and provide handouts detailing how trauma might manifest itself in the days ahead — from hypervigilance or poor concentration to nausea or fatigue — as well as how they can cope — talking about the event with loved ones, exercising, maintaining a normal routine and recognizing fellow responders are also under stress, which is normal.

Following the release of its survey, New York's Division of Homeland Security and Emergency Services is developing a continuing education course for therapists and psychiatrists looking to work with first responders, said Hastings, the senior policy adviser.

Deer Park Chief Robert Macaluso said in the months that followed the devastating nail salon crash, the fire department "didn’t lose one member because of that incident." He credits that to the CISM team.

"You have to talk to people," Macaluso said. "You can’t hold it in. If you hold it in, it gets worse."

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