In February 2023, Sardis Volunteer Fire Company Chief Joe Paiano Jr. entered a burning house in Salem Township to rescue an 11-year-old boy.

The boy was among three people pulled from the fire, but he died of his injuries a few days later.

The incident affected Paiano in a way he wasn’t expecting.

“Before I had kids, I don’t know if I’d have batted an eye at that fire,” Paiano said. “But there were certain things that would really trigger me. For a while afterward, I didn’t want my kids even wearing the same color of clothing that (the boy) had on.”

State Rep. Jill Cooper said, in talking with Paiano, she came to better recognize the toll rescue work can take on first responders — particularly in cases where their efforts are ultimately in vain.

This also was evident last week, when scores of emergency workers spent 80 hours searching in a Unity sinkhole for Elizabeth Pollard, who ultimately was found dead. State police spokesman Trooper Steve Limani talked about rescue workers battling feelings of futility and failure.

“I started to realize just how much our firefighters and first responders do and what they deal with,” Cooper said.

It’s a big part of why she supported Act 121, signed into law by Gov. Josh Shapiro this fall. It changes the standard first responders must meet to establish a workers’ compensation claim for a post-traumatic stress injury.

Under the bill, firefighters, police officers, emergency medical technicians and paramedics would be entitled to benefits under the Pennsylvania Workers’ Compensation law.

These would include psychological traumas arising from individual traumatic events or cumulative highly stressful experiences from their employment, regardless of whether the trauma is accompanied by physical injuries requiring medical treatment.

“That fire was a difficult thing for all of them,” Cooper said. “Mental health is an important thing for everyone, and the attitude of ‘suck it up and handle it’ doesn’t always work when you’re dead-set on saving someone and it doesn’t work out. That’s hard on them.”

Shawn Penzera, director of special operations for Mutual Aid Ambulance, said the bill is overdue.

“It’s great,” he said. “In our area, fire companies are almost all volunteer. There are guys who leave their job to respond to a call and then head right back to work. And you sometimes have an idea what to expect based on the nature of the call, but you never know for sure. And, whether you see it on a regular basis or once in your whole life, you don’t know how it’s going to affect you.”

Penzera said he can recall driving past a particular house that was the site of a traumatic call.

“You start remembering everything about it in a very negative way,” he said.

At Mutual Aid, the organization’s district chiefs almost always are among the boots on the ground when a tough call comes in.

“Right after the call, when crews go out of service, they have a discussion with their district chief,” Penzera said. “If an employee decides they need further help, we have an assistance program where they can call a number and talk to someone right away who can start them on the path, whether it’s just talking through it, counseling or whatever the case might be.”

Paiano said each organization is a little different when it comes to handling the aftereffects of taking part in a traumatic call.

“We have a lot of programs available to us, and leadership does what they feel is appropriate to take care of their people,” he said. “For any traumatic call, we offer something called a ‘critical incident stress debriefing.’ But a lot of guys don’t take advantage of that because that’s the way a lot of us were raised.”

In some cases, post-traumatic stress doesn’t manifest right away, Paiano said.

“After the (2014) stabbing incident (at Franklin Regional Senior High School), there were a good number of firefighters who felt they couldn’t go back into that building,” he said. “Your adrenaline is going so much during an emergency that, a lot of times, you don’t think about the full scope of the situation and what you’ve seen until afterward.”

Act 121 establishes a more defined criteria for establishing a PTSI claim and will require diagnosis from a licensed psychiatrist or psychologist.

Paiano said he feels lucky his father also was a firefighter and the two are able to discuss their experiences.

“I don’t want to bring that stuff home to my wife,” he said. “I can talk to my dad, but a lot of guys bottle it up or turn to dangerous avenues like drugs or alcohol. A good support group at home or at the fire house is a big help — the challenge is getting people to take advantage.”

Paiano said he is curious to see how insurance providers interface with the new law, referencing issues he’s seen arise with the Pennsylvania Firefighter Cancer Presumption Act, passed in 2011. That law established that, when a firefighter is diagnosed with cancer after being on the job at least four years and directly exposed to listed carcinogens, it is presumed to have been caused by work-related exposure.

“I’m curious: Is there going to be the same rate of denial that we’ve had with the presumed cancer bill?” Paiano asked. “How do we document this happening to someone based on an incident that maybe took place 30 years ago? We all have had it happen, to some degree.”

Cooper said she hopes the legislation can not only help current first responders but potentially help in bringing awareness to the need many departments have for additional members.

“We expect first responders to be superhuman in all they do,” Cooper said, “and they can’t always deal with that on their own.”