Orlando VA Healthcare System
Working Class Heroes: VA Responds to Mass Shooting
In the late afternoon of June 12 an Orlando VA Medical Center Mobile Medical Unit rolled into the Beardall Senior Center’s north parking lot. The three-story red brick Beardall, once an elementary school and now community center for Orlando seniors, sits just over a mile northwest of The Pulse Nightclub, an LGBT-favored establishment on South Orange Avenue.
As the MMU began setting up, a mobile Vet Center from Jacksonville pulled in close behind it. Within minutes medical and mental health providers from the Orlando VA Medical Center were on hand, working to organize the staff and give guidance to those just coming in. In a matter of minutes the VA stood ready to support the Beardall’s grim purpose long before the shocked and dazed families began flowing in from the hot and humid Orlando afternoon.
Nearly 12 hours before, a lone gunman had attacked revelers at The Pulse Nightclub before succumbing to police gunfire. Many were dead and injured, and the city was still in shock when the VA arrived at the Beardall to provide support and comfort to families of the slain and injured. Most who arrived there Sunday had no idea which category included their loved ones, and it would fall upon the VA and city responders to brief the families Sunday evening, and make formal death notifications Monday morning.
The MMU and Vet Center’s arrival was the first of many actions the VA undertook supporting the Orlando crisis. In the hours between the attack and VA’s arrival at Beardall a series of actions took place that launched the VA into a survivors support role that would play out on national television and around the world.
Some decisions were planned, others spontaneous; some support occurred at the Beardall, some in adjacent communities, and some in Orlando VAMC and Vet Center points of patient care. All efforts centered on supporting the city and her Veterans with world-class VA care in a dire situation, and at a moment’s notice.
Over a period of 12 days the Orlando VA Medical Center and the Veteran Health Administration’s Vet Center program supported more than 5,000 people, many of whom are Veterans, in locations that spanned central Florida. The support came in the form of deployed medical and mental health assets, family death notifications, grief and survivor counseling, coping skills, media engagement, mass communication, late-night phone calls, office visits, support groups, hugs, hands, food, water, tissues and many, many tears.
The VA stood united with Orlando; stood as part of her community as she grieved, rallied, protested, marched, healed, and ultimately survived a great tragedy. This is the VA’s story.
Sunday, June 12
For many of us the VA emergency response began in the early hours of Sunday morning. I’m an early riser and had just sat down to coffee and my laptop around 6 a.m. when I first read the reports rolling into cyberspace.
Only hours before there had been a shooting at a local nightclub frequented by our LGBT community, and I remember thinking that we were having one terrible weekend. The day previous media reported the death of singer and The Voice contestant Christina Grimmie, who’d been shot to death at Orlando’s Plaza Live, no more than four miles from the Pulse. These attacks seldom occur in Orlando so when Grimmie died the tension around the city rose palpably. Orlandoian’s agreed via social media: not here...not in Orlando...we’re not that community.
The sentiment is normally truth here. Despite the crush of tourists and international visitors each year Orlando seems to get by, and get along. In my many years of living in and being associated with Orlando the community seems to keep its magic. People smile when they arrive here, regret leaving and plan to return even before they’ve packed the car or boarded the plane. Walt Disney’s Gay Pride Days occur concurrently with Harley Week, and many claim membership in both groups. We mix easy as simply people here, be it of different purposes and beliefs, different dreams, and different lifestyles.
We’re proud to have one of the largest and most vibrant LGBT Veteran communities in Orlando and our LGBT program manager, Ms. Keri Griffin, keeps a dynamic schedule of support and service offerings, and has grown an impressive outreach for both patients and staff over the years. The Orlando VAMC employs medicine and care specifically for the LGBT community, focusing on their unique needs both in physical medicine and mental health.
So when word of the second shooting hit the tension in the city went from palpable to horrific. It spread quickly through cyberspace, suggesting that Orlando had lost her innocence of terror, and quite possibly some of her magic.
First word came to me from a local reporter and friend, Ms. Naseem Miller. Naseem has the health beat for the Orlando Sentinel and her Twitter and Facebook feeds were pulsing with activity on a situation downtown. Twenty or more casualties were reported, others very possible, and the situation fluid. A shooter, multiple deaths, and a possible terror connection spelled an all-too-common story for anywhere but Orlando, or so we thought until tragedy added us to the long list of terror-stricken communities.
News reports flooded in, and Naseem kept me updated via her social media channels. Orlando mayor Buddy Dyer went on camera around 10:30 a.m. and pronounced the situation much worse than thought: 49 were dead, and 53 injured. National media pronounced it the worst mass shooting in modern American history as Orlando VAMC employees began moving forward in support of the survivors and family members whose lives had changed drastically overnight.
That’s an important aspect to note: our people began moving forward without a phone call or recall to motivate them. Dr. Paul Deci, our Mental Health service chief, reported receiving calls from our mental health professionals early Sunday morning asking how and where they could help.
Members of our Emergency Management team reached out to other members, wondering where and when we would move forward, and with what assets. Even I received several text messages that morning from VA friends and employees. One such text said simply “I’m in – just tell me where and when to be there.”
That the LGBT community had been specifically targeted in the attack sat heavy with the Orlando VAMC. The potential for this tragedy hitting us hard was evident with our strong LGBT program, but we’d not know just how difficult it would become for more than a day. Keri Griffin’s personal phone and e-mail were buzzing as early as 6 a.m. as she sat at home and read the messages and pleas from our LGBT community, a first-hand witness to a growing horror.
“I woke early to my cell phone blowing up with alerts – calls, texts, instant messages and posts on my Facebook page,” Ms. Griffin said. “I began reading and my world tilted.”
Ms. Griffin watched her son that Sunday as her husband worked, and found herself striking a delicate and difficult balance in keeping him attended as the LGBT community sought her attention and support. The fluid social media responses threatened to consume her and the day was just beginning.
“I took countless calls, texts, and instant messages from friends & family; we were all grieving and I was trying to arrange support for my community as we found out more and more of who we may have lost, and who was injured.”
One of the first people Keri reached was Ms. Myra Brazell, the Orlando VAMC Suicide Prevention Coordinator. Ms. Brazell sped south on I-75 from the Florida Panhandle Sunday morning while working with Keri to coordinate a boots-on-the-ground mental health response team as the VA formally stepped into the role.
“I’d been in Panama City that weekend with family when I received a text from one of my LGBT friends late Sunday morning,” Ms. Brazell said. “It said simply that the Veteran was fine, and was sitting at the hospital with the family of a friend.” Perplexed Myra reread the text as her Facebook Instant Messenger rung out with the bitter news. She headed immediately south.
The Director’s 50
While Myra and Keri’s paths began converging VA Undersecretary for Health Dr. David J. Shulkin had reached out to our director, Mr. Timothy W. Liezert, to see how the Orlando VAMC could help. Under Title 38 Code of Federal Regulations, the VA may share medical resources in response to natural and man-made disasters, as well as terrorist attacks on the United States.
Among its Emergency Management assets the Orlando VAMC employs a mobile medical unit and a mobile command post, both 38-foot RV-style vehicles that deploy to augment community resources in situations where medical facilities are not readily available. Also, the Veteran Health Administration’s Vet Center Program can place mental health professionals in rural locations of the continental U.S. quickly, by using a similar fleet of Mobile Vet Centers, assigned to its Readjustment Counseling Services.
For the effort four MVCs and 27 crisis counselors were immediately available from Pasco County and Jacksonville, Fla., from Macon, Georgia, and Columbia, S.C. Each MVC comes complete with advanced communications capabilities, allowing them to operate independently anywhere in the country, and be augmented locally by counselors from adjacent VA points of patient care.
Luckily for the victims and survivors adequate medical facilities existed near The Pulse Nightclub, which certainly saved lives. Similar facilities for concentrated mental health did not. It was in the mental health and counseling role that the VA believed it could be most beneficial, especially if deployed to the Beardall Senior Center, and made available at key points in the local communities.
The decision was made to provide psychological first aid at the points of gravity where our mental health services would be most needed. The Orlando VAMC moved out quickly in that role by employing The Director’s 50, known among employees as simply “The 50.” The group consists of VA volunteers from most career fields who play an instrumental role in the speedy deployment of emergency management persons, services and assets.
As The 50 moved forward, Keri Griffin would stay behind and support an overwhelmed LGBT community, currently hanging on her words of comfort and support, from the medical center. “It hurt me not being there, not being around my tribe as they suffered and reached out for comfort,” Ms. Griffin said. “But I saw the importance of my role and did my best to meet their needs as I strived to meet those of my family too.”
“One of the hardest parts of my day was explaining to my son why I was so tearful, a conversation I was not ready to have about the evil in our world and how some people judge,” she said sadly. “I showed him that we don’t do that.”
In the coming days Keri would address hundreds of LGBT Veterans, some survivors of the attack and some family and friends to the lost and injured. She worked practically non-stop seeing scheduled and unscheduled patients, fielding phone calls, answering texts and instant messages, and posting responses to social media and secure message requests from Orlando and across the country.
She supported VA requests for information as she arranged drop-in support groups for the LGBT community, for family and friends of the slain and injured, and VA employees. She spent her off hours doing much the same from her home and in the community, riding a whirlwind of anger, frustration, hurt, heartache, grief, and anxiety that played out over a dozen difficult days.
“As a social worker my desire is to fix this, somehow make it better,” she said. “But this is something I can only help to heal...and it will leave a big scar for us all going forward.”
Beardall Senior Center
By the time Myra Brazell hit Orlando much had happened. Tim Liezert, driver Mr. Larry Brooks, and I had moved forward with the MMU to Beardall via the Lake Baldwin Outpatient Clinic. Lake Baldwin served as a staging area for the MMU and once we had confirmation on Beardall as the location for notifications we moved out. Light traffic told of street closures and detours that made it a bit difficult to get into old town Orlando, but we managed it fairly quickly.
With the MMU and first Vet Center in place, our providers worked between the Beardall and the mobiles in providing assistance. Our VA team roamed the Beardall hallways and conference rooms, talking with people as the situation began hitting home for them. Emotions flowed as family members crowded into the second floor conference room where first responders began a series of briefings to prepare them for what lie ahead.
Families were told the medical examiner and coroner were still working the aftermath of the shooting, and that they were not yet ready to provide the information they all desperately sought. The notifications, they said, could take place that evening but most would be no earlier than Monday morning. The families wandered out as dazed as they had wandered in.
By evening two more MVCs had arrived from Pasco County and Macon, and they took up positions adjacent to the Beardall. We gathered providers and responders to discuss hours and our intent for the following day, knowing how difficult that day would dawn.
Our intent remained one of support, and psychologist Dr. Mary Beth Shea took the lead in briefing the team, alluding to the possibility that our role may expand to participating in family death notifications.
A quick head count of mental health providers and families inside the Beardall showed a deficient balance...too many families, not enough community and VA providers. Myra Brazell, who had arrived on scene by 8 p.m., readily agreed that we would need more. She had been there and done that in the suicide response and prevention role, and the numbers weighed on her mind.
While on the way to Beardall Ms. Brazell and Dr. Shea put out a call to VA mental health for support. “Those people called others and by the time I arrived we had more than 100 mental health professionals willing to support our efforts...the response was amazing,” Ms. Brazell said.
We set operating hours for Monday at 7 a.m. to 11 p.m., closed the RVs at 11 p.m. when the parking lot at the Beardall emptied out, and most wandered home for a few hours of sleep. Myra, however, had stayed behind.
Earlier Sunday evening the Florida Department of Law Enforcement and Orlando Sheriff’s Detectives notified the VA they would be making some death notifications that evening, as immediacy is core in their public support role. Myra had already traveled and worked a full day, but she volunteered to stay behind and ride with the medical examiner and law enforcement as they reached out to families of the slain.
The visits began around 9:30 Sunday evening and concluded at 7:30 a.m. Monday, as Myra and law enforcement visited the homes and apartments of anxious families that held vigil into the night, hoping somehow their loved ones were not among the lost. When she and her escorts arrived with unthinkable news, the responses floored her.
“I saw a magnificent response take shape as women enclosed the ones who’d lost a loved one, and men enclosed the women in support and solidarity,” Myra said. “To me it looked like a blossom enveloping and enclosing…it was one of the most devastatingly beautiful outpourings of grief and support I have ever witnessed.”
Monday, June 13
Family notification day arrived hot and humid as the VA team rolled in. The dynamic at the Beardall had changed significantly by 7 a.m. Monday as the rush of families mixed badly with community supporters, local neighbors, lookie loos, and more than 50 national and international media outlets, all whom had come to the Beardall to experience the day first hand.
Orlando police circumnavigated the Beardall with a cordon of yellow tape to keep families in and spectators out, and stood posts at compass points to dissuade trespassing, and provide families much needed privacy.
As the day’s first briefings began our providers stood posts of their own. VA psychologists, social workers, nurses, and operations staff moved into the Beardall and its second floor conference room. As the families were called for notification our providers attached themselves to medical officials and clergy to provide support as they learned their loved one’s fate.
Nurse Iris Appenrodt and logistics supervisor Louis Hawkins took up a post at the Beardall’s south entrance – the main entrance - to catch names and offer support to our providers upstairs. Often they engaged directly with the survivors and families.
“I remember standing at the curb Monday where I saw this young man just hugging himself and crying really hard,” said Ms. Appenrodt. “I grabbed some tissues and went over to him, and he just hugged me really hard and held on while crying on my shoulder. I remember his tears soaked through my shirt as I held him until he regained his composure. It was that difficult Monday morning and I keenly felt the overwhelming need for human companionship and connection, the need to ‘be there’ for friends and families,” she said.
That afternoon Dr. Mary Beth Shea approached Iris with an urgent need for more mental health providers. She told Iris “I know you’re a nurse but you’re now mental health; go get a priest and join us in notifying families upstairs.”
“So I get this huge lump in my throat at the prospect of making an official death notification but I swallow hard and say to myself ‘just suck it up, buttercup,’ and I head in,” she said. “I grabbed a priest named Jay and he never left my side. We spent the rest of the day making notifications, providing guidance, just helping everyone get to and where they needed,” she said.
“We closed the day back at the south entrance but my role changed significantly from the morning...I had a purpose and the tools and guidance to make a difference,” Ms. Appenrodt said.
National media had set up near The Pulse early Sunday afternoon with their trucks, satellites and canopies to shield television reporters and personalities from the midday sun. By Monday most had dispatched crews to the Beardall to catch the first glimpse of families as they learned the fate of their loved ones.
They gathered first by the south entrance, just outside the cordon but close enough for a medium lens to catch the flow of people in and out of the building. Having worked with many of the local media organizations over the past four years, and many of the nationals in my career, I heard more than a few calling out and hoping to get some insight into what was happening inside.
The media conducted themselves appropriately and respectfully during the events, each showing a professional patience as the story played out. However, when the first of the notified families left the Beardall on the north side of the building, media outlets scooted around the building to engage them as they passed through the cordon.
A young woman and her family were literally engulfed by dozens of media outlets as they read a prepared statement, and stayed on to answer questions.
The media crush continued throughout the morning and afternoon, and I was stuck by the comfort and knowledge that some families had in dealing with them, whether in broadcast, radio, print, or social disciplines. Many came prepared with statements for the press, in multiple copies, and very few shunned the spotlight when given the opportunity to appear and speak.
During the day I spoke with two local media agencies and three national outlets seeking comment on VA services. Our first interview occurred with the Orlando Sentinel, as Naseem found me outside the Beardall and requested to speak with Dr. Bryan Batien, an Orlando VAMC psychologist whom had first served as an infantryman in the U.S. Army before using his G.I. Bill to attend school. Bryan also worked with the University of Central Florida in its Veterans Service Center, helping servicemen with posttraumatic stress disorder and traumatic brain injuries return to school, and was known for having done media interviews in that vein previously.
The Sentinel interview released the first information about the VA’s support of the shooting, and shortly thereafter I did a short standup with Central Florida News 13 describing our support package, which also made the noon reports. Within minutes of the Sentinel story posting online I received requests from CNN, The Huffington Post, and MSNBC to have Dr. Batien appear and discuss our efforts.
However, the openness the families displayed with the media and the announcement of President Barack Obama’s trip to Orlando later that week encouraged the news outlets to seek more direct coverage. The Sentinel story was picked by the Associated Press and echoed in outlets around the world, while pulled quotes from Dr. Batien’ s interview found their way into many other news stories. Our pitches to Spanish-speaking media outlets went initially unanswered as we tried to reach deeper into the community to ensure those needing our support knew where to find it.
Among the families, friends and providers a few activists found their way into the Beardall hoping to remain inconspicuous as they wandered from family to family, asking questions about assault weapons and the LGBT lifestyle. As one of the Public Affairs officers on site I was asked by police to intervene and find out if they were media, and I was only too happy to oblige. These were rare instances and in all cases the offending party was quietly interrogated and quickly shown the door.
By end of day Monday all but four families had been notified, and as they were the Beardall emptied out. Literally thousands of people had passed through the doors in less than two days, as had gross cases of water, endless platters and boxes of food and drink, protein bars, sweets, ice cream, and therapy dogs. At one point in the late afternoon we had more dogs in the building than those needing support, but their presence was keenly felt and greatly appreciated.
I remember encountering Journey, a Golden Retriever with a prosthetic limb, panting and smiling away as hands reached out to stroke his coat, allowing the suffering to take in his beauty and acceptance among their tragic circumstances.
The VA remained at the Beardall overnight on Monday, once again closing its services at 11 p.m. An expanded crew of mental health providers was slated for the next day, including those with Spanish-speaking skills as many of the afflicted were of Hispanic and Latino origin.
Tuesday, June 14
We arrived at the Beardall early Tuesday morning to prepare for the CNN interview that was ultimately cancelled. The difference in focus from the previous day was immediately obvious in the parking lot where most spaces remained unoccupied, and all media attention had shifted elsewhere.
Although we were thoroughly prepared for a heavy day of support the need never materialized at the Beardall, and by late morning the city had informed first responders of a developing plan to move support operations to another location, one offering increased space that was much removed from the crime scene area.
Speaking of crime scene, while the families and survivors drew the majority of the deployed VA team’s attention, our providers did an outstanding job of taking care of one another and especially the law enforcement officers who had spent more than 40 hours wading through the aftermath of the shooting. Orlando VAMC psychologist Dr. Margaret Arnott recalled an instance Tuesday of encountering an Orlando policeman outside the Beardall who had been on duty for the three days in which the attack and aftermath played out.
“He related to me, while standing in the 100+ degree temperatures, how the calls and text messages from the victims had first alerted responders to the attack at the Pulse, and how those pings and beeps continued to echo in the hands and clothing of the dead (via cell phones) when police arrived on the scene,” Dr. Arnott said. “We ensured we remained available to them, and offered our mobiles so they could escape the heat and seek some private, reflective space as they came to grips with the horrors of those moments.”
By Tuesday’s end the MMU was slated to redeploy to Lake Baldwin, but the mobile Vet Centers were just beginning to get underway in supporting the greater Orlando community in the critical coming days.
As operations at the Beardall wound down our Mobile Vet Centers were just getting started. Late Monday morning the first of our MVCs deployed to The Zebra Coalition, a well-known support center for LGBT youth located 3 miles northeast of the Beardall on North Mills Avenue. Survivors and friends of the slain had flocked there and our MVC provided much needed support and counseling as the nation became familiar with the faces and names of those lost.
That timely deployment set a modus for VA community support, as Ms. Sarita Figueroa, RCS Southeast District Director for the VHA Readjustment Counseling Service, allowed the community to determine the locations to which the MVCs would travel. For example, a makeshift memorial began forming outside the Dr. Phillips Center for the Performing Arts, located only miles north of the Beardall, so a MVC traveled to the location and provided support to mourners. Another covered central Orlando June 15 as mass rallies and candlelight vigils were attended by thousands, and were broadcast around the world.
Events, memorials, and religious ceremonies took place throughout central Florida that week, and MVCs and VA providers attended most offering support and counseling. When Florida Governor Rick Scott and Orlando City Mayor Dyer established a family assistance center at Camping World Stadium (formerly the Citrus Bowl) in Orlando, a MVC and providers were among the first on location.
The OVAMC Public Affairs officer made apt use of social media in this regard, posting the VA’s location of services as soon as they were in place on Sunday afternoon. The Orlando VAMC PA team kept its Facebook, Twitter, and public website updated as offerings and hours changed quickly in the first few days, and ensured the public knew when and where the MVCs were located as they moved to support community recovery efforts throughout Orlando.
The Vet Center providers were able to connect with both English and Spanish-speaking media outlets in their travels through Orlando, and did a brisk business of explaining the VA’s mission and extolling Vet Center benefits for Veterans and the community. There, among the public expressions of sadness and solidarity, they encountered thousands of people in need of counseling and comforting, and the Vet Center teams provided services until the memorials came to an end, and the family assistance center closed June 20.
Sadly, often it takes a tragedy to recognize the depth of an organization’s character. The attack on Orlando’s LGBT community brought to light some of our finest moments, and showcased our people as some of the best this city can offer. These are some of my personal observations during VA’s response to the shooting, some of what I believe stood out in our efforts in the best way I can understand and explain them.
Planning - that the VA had a plan, assets, resources and competent, qualified people ready to move out at a moment’s notice put us hours ahead of our peers in our ability to respond to this national special security event. The benefits of prior planning shone immediately and offered our community a most valued resource in its time of need. The dollars spent and human hours invested paid off immediately for Orlando, and the Orlando community readily welcomed those capabilities in the first critical hours and days.
Speed – was a huge mission multiplier, and our speed speaks to location, competence, capability, and most of all intent. Moving our capable response team forward, once directed, happened efficiently and effectively. Even more, the attitudes and desires of our people to help in any way possible increased our speed of response. People were leaning forward in anticipation of saving lives and bringing hope and comfort, not merely meeting a deployment order.
The Director’s 50 – put us well ahead of our peers. The best compliments I heard were the dozens of Orlando VAMC voices asking how they too could be a part of the team in the future.
Attitude – there are none better in a crisis than those looking for ways to help, and wanting to employ their talents and expertise in doing so. VA people showed up quickly and stayed late because of an aggressively optimistic attitude that seems to imbrue our organization in a crisis. That’s the best way I can describe it.
Community – it was obvious from the start that we were not “with the government and there to help.” It was never clearer to me just how much our people are part of the Orlando community than during this crisis. Consider the examples:
· A solid LGBT program and well-respected program manager who had the community reaching to her as she reached to them, able to bring comfort and support in the words and modes our LGBT community values;
· A suicide prevention coordinator (and mental health professional) able to reach out and generate overwhelming support while in transit, and then willing to climb into a squad car to deliver devastating news more than 12 hours later;
· A MMU driver willing to navigate the twisting and narrow streets of old town Orlando if it meant saving lives...and even if it didn’t;
· A Vet Center program ready, willing and able to move hundreds of miles at a moment’s notice, and then stay for more than 10 days delivering help and hope;
· A nurse and logistics supervisor unafraid of grabbing the tissues and wading in deep when it was toughest to do, just because people needed help;
· A team of top-notch physicians, psychologists, social workers, nurses, and operations staff willing to ply their expertise in the worst of circumstances if that meant bringing just a little comfort and hope to the community.
The list goes on, and in each case there is much to be proud of in considering the efforts and support VA men and women brought to this emergency response. Mara Brazell called it a horrific privilege and I cannot think of a better way to describe the efforts begun on Sunday, June 12. I hope to never experience such a tragedy again, but if tragedy strikes, I’ll be proud and fortunate to have this team of working class heroes beside me.