March 29, 2012 -- The emergency dispatchers who remain calm and unemotional while handling 911 calls may not witness the carnage their front-line police and firefighting colleagues encounter, but they can be just as vulnerable to post-traumatic stress disorder from all they hear and imagine, researchers report.
The men and women who field 911 emergencies hear some of the most soul-searing sounds imaginable: the anguished wailing of gunshot victims, the final words of someone they can't deter from suicide or the last thoughts of workers trapped in the Twin Towers infernos on Sept. 11, 2001. But the stresses of their experiences sometimes haven't been considered traumatic because the dispatchers haven't left their computer consoles.
"This is a population of people who are routinely exposed to events that should be considered traumatic," said Michelle Lilly, a psychology professor at Northern Illinois University in DeKalb, Ill., who co-authored a study assessing the psychological impact of the crises dispatchers experience from afar. "People think of the job as stressful, but not really traumatic."
Lilly, head of NIU's Trauma, Mental Health and Recovery Lab, and research associate Heather Pierce, a former 911 dispatcher married to a police officer, analyzed surveys completed by 171 emergency dispatchers from 24 states. The survey takers were asked to describe the worst calls they had handled. The group comprised predominantly white women just under the age of 39 with nearly 12 years on the job, according to the study published today in the Journal of Traumatic Stress.
Most said their worst experiences involved imperiled children or sending firefighters, police officers or emergency medical technicians who were friends and loved ones into harm's way.
"I was blown away by how upsetting some of (the incidents) would be for most people," Lilly said Wednesday as she described accounts of dispatchers talking parents "through CPR after they have discovered their child has drowned in the pool."
She was particularly shaken by a call involving two young siblings, one of whom had a mental health problem. The healthy child called 911 and locked himself in a room for protection, but the dispatcher "could hear the sibling trying to take the hinges off the door and intending to attack."
All the dispatcher could say was, "Help is on the way. We'll get there as fast as we can," Lilly said.
Such situations can engender feelings of fear, helplessness and horror which, when unaddressed, can set the stage for PTSD. Lilly and Pierce found that 3.5 percent of the survey respondents reported symptoms "severe enough they probably would qualify for a diagnosis of PTSD," Lilly said.
"I think this is a really important study because dispatchers are the forgotten first responders," said Francine M. Roberts, a clinical psychologist in Marlton, N.J., who treats first responders with PTSD. "They carry a high level of responsibility for coordinating the response to the incident, but they are very remote from it. High levels of responsibility and low levels of the ability to actually influence the outcome mean extremely high stress."
Unaddressed Trauma Creates Problems at Home, Work
"I have a suicidal dispatcher I'm seeing now," Roberts said.
Distraught dispatchers have the same problems as combat veterans and others with post-traumatic stress, including more workplace conflicts and problems at home.
"They begin to use alcohol and they will sometimes consider suicide," she said.
However, if dispatchers are included in the debriefings following a highly stressful incident, "we can avoid all of that."
Monica Gavio, coordinator for the Burlington County, N.J., 911 communications center, and a 30-year veteran in emergency dispatch, said proper training in stress management also can help.
As a certified instructor, Gavio talks "about the stress of the job and things that it can do to you mentally and physically if you don't take care of yourself."
She also teaches dispatchers-to-be "to recognize the symptoms of somebody being upset by a call so that they can be released from their position to take some time out to kind of regroup."
One of the biggest stressors, Gavio said, is not knowing what happens to callers after help arrives.
"We don't know the end result," Gavio said. "We don't know if they made it. There is no formal communication back to us."
Many departments continue to treat dispatchers like "second-class citizens," despite the enormous psychological burdens they carry from fielding calls where they feel powerless, said Ellen Kirschman, a clinical psychologist in Redwood City, Calif., who treats first responders and trains some of them in peer support. Just last week, she met a dispatcher who described the unbearable agony of "hearing somebody burning to death. The responders could not get in and the dispatcher tried to stay on the line reassuring this person."
Unlike police and firefighters who can "spill a little" of their excess adrenaline with all the physical activity at the scene, dispatchers are chained to their computers as they juggle tasks that few people appreciate, Kirschman said.
"They are not like switchboard operators," she said. "They work on highly technical computers. They're managing a lot of information. Not everybody can do that job at all."