Rural first responders in South Dakota are at high risk of struggling with mental health issues due to the traumatic events and high stress situations they experience, but while they are there to help the public is in need, they're left to help themselves afterwards.

For the members of the Cavour Volunteer Fire Department in east-central South Dakota, confiding and working through the trauma of a critical incident is done internally.

After following the foosteps of his volunteer firefighting father, B.J. Ball was 17 when he started volunteering at the Cavour Volunteer Fire Department in 2007.

Ball explained how the department is just now working on getting access to mental health care through their fire insurance company.

Otherwise, Ball said he and his fellow firefighters really have no other choice but to deal with it amongst themselves.

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“Because of our investigations and people involved, we can’t talk about it when we go home. What we do in our department is the next morning after a tough incident, we always hang out at the fire hall. We always talk about it and discuss ways we can improve and ways we can train for things like this stuff,” Ball said.

Last month Cavour Fire Department was one of the first to arrive at the scene of a fatal crash. One man died and two others had to be saved after the vehicle they were in lost control and rolled before landing upside down in a flooded ditch.

Ball wouldn’t comment on the fatal crash since the incident is under investigation.

“We do check on one another. We’ve got to take care of one another. We’re not the faces that the public typically see. We make sure that everyone talks about it,” Ball explained. "If they don’t want to talk, we encourage them to admit that they need to. We need to make sure that everyone is ok when they go home.”

It’s a price first responders like Ball are willing to pay, along with the time they sacrifice to do the job.

"Fireman suicides are just through the roof, the problem is there’s always a need for it and it’s something we need to do,” Ball said.

Ball said that the department typically responds to brush fires, but this year “there has been a pretty good kick of serious, stressful calls.”

About 20 men volunteer as firefighters Cavour with Ball, ranging from their 20s to 60s in age. The group is more than just a team, they’re family.

“You see your firemen family a heck of a lot more than you do your own,” Ball said.

The family of first responders who volunteer with Lennox Ambulance Service are struggling with another problem — retention.

Lennox Ambulance Service Director Allan Perry said expecting someone who is trained to perform medical work and professional work for free isn’t a sustainable model.

"You’re losing people who don’t want to dedicate that much time or effort into it when they know they’ll have to go through four months of class and spend $800 then get low to no pay,” Perry said.

“It’s a struggle to find people and it’s one of those jobs that a lot of people aren’t cut out to do.”

The 21 volunteers have paying jobs in fields such as medical, banking and military, Perry said.

Perry said that in the 3.5 years he’s been director of the ambulance service, the traumatic and immensely stressful events have been few and far between.

Local chaplain programs offer their services to first responders in Lennox and there is a hotline that volunteers can call to seek mental health support. But being a rural first responder who works with tight-knit communities within a 180-mile radius has unique difficulties. "Not every call sends people for a loop but we have those calls when it’s someone you know very closely,” Perry said.

“Unfortunately, the people you go to help are people you’ve known for years. It’s one of the job's biggest curses and one of the biggest blesses.”

To better support first responders in the state, the South Dakota Municipal League was preparing to roll out a program that provides mental health services to emergency responders that have experienced major, traumatic incidents. That program was offered to the first responders of a fatal plane crash that claimed nine lives and seriously injured three others near Chamberlain.

Calls to the South Dakota Municipality League for more information on the program were referred to Brad Wilson, who works with the municipal organization. Calls to Wilson were not returned by deadline for this publication.

The entities who responded to the plane crash did not wish to comment at this time about the program or the incident. The crash is still under investigation by the National Transportation Safety Board.