911 dispatchers juggle 'worst days' of callers' lives, then struggle alone

Denise Georgian has been a 911 ambulance communications officer in Hamilton, Ontario, for 28 years, but she still remembers the first call in which she heard, she says, “someone’s love and torment through the phone.”

Georgian handled the episode with aplomb. Following protocol, she dispatched a response unit immediately, but it didn’t change the outcome of the call -- a life was lost and Georgian heard her caller’s reaction, a scream. She can not share details of the case for legal reasons, but she can describe its impact. “In this job,” Georgian says, “you’re supposed to be empathetic, but you can only take it so far. I really felt that woman’s heartbreak. And I felt useless.” Taking a break outside to collect her thoughts, she cried for about 10 minutes, then convinced herself that her reaction was silly and wouldn’t alter the facts of what had happened. So she returned to her station and “put away” what she had heard.

Perhaps inevitably, memories of that call have resurfaced over the past year during the veteran responder’s medical leave from her job. Georgian is certain that her mind and body have taken a heavy toll for the stress she has encountered in her career, and not just during the dramatic crises, but from the constant flow of adrenaline necessary to process 911 emergencies. Being a call-taker and dispatcher (EMS telecommunicators work in both roles) may require dealing with about 100 phone calls per day, usually juggling more than one at a time, each clocked by the system and held to strict standards.

Operators face several flashing computer screens on their desks and a wall of monitors displaying coded information. They routinely hear from frantic mothers of choking babies, suicidal teens, witnesses to car accidents, and women involved in domestic disputes. It's not unusual to hear someone's last breath, or to listen to someone committing suicide or murder—and some situations will present personal triggers.

Employees typically usually get 15-minute breaks every two hours and may be asked to work extra shifts if a center is understaffed. Georgian says she would never do anything else for a living— “What’s bigger than saving a life?” she asks —but wants people to know that even for someone as tough-minded as she is, being an emergency response communicator “takes a little piece out of you every day.”

The risk of developing symptoms of traumatic stress has nothing to do with being mentally strong or capable of the work. Says Georgian, “That idea is garbage.”

New research

A study published last month in the Journal of Traumatic Stress supports what 911 telecommunicators like Georgian have known for years -- the risk of post traumatic stress disorder (PTSD) in the profession is high, even higher than previously reported. Michelle Lilly, PhD, Assistant Professor of Psychology at Northern Illinois University first published a study on this topic in 2012. In that case, she found that 3.5% of 911 telecommunicators she interviewed about the worst calls of their career had developed symptoms characteristic of PTSD after the event. In the subsequent study, she used a much larger sample group and changed the metric for measuring PTSD. The methodology for the second study was much stronger, says Lilly, and the prevalence of PTSD was significantly higher: 18-24%. 

Unfortunately, health policies in emergency call centers across North America have not kept up with what scientists have learned about distress and trauma, say many experts. Lisa Rouse is one of the RCMP dispatchers in Moncton, N.B., who sent police to the scene where Justin Bourque murdered three officers last year. In a recent interview with CBC television, she said she’s been dealing with the psychological aftereffects of that tragedy ever since. Rouse suffers from survivor’s guilt, has days when she’s stuck in negative feelings, and is afraid she’ll never feel normal again. 911 operators need more support to deal with PTSD, she says, and they need to know that it’s okay to ask for it—that their jobs will be safe.

Acknowledging and treating PTSD

The reasons 911 telecommunicators don’t always self-report psychological concerns are both cultural and structural. The attitude toward stress in this profession is coloured by “a John Wayne mentality that says ‘Suck it up, this is part of your job’,” says Vince Savoia, founder and executive director of Tema Contor Memorial Trust, an organization that provides services to emergency, corrections, and military personnel with stress injuries. Savoia says the belief that first responders should rise above horrific incidents mentally unscathed is slowly becoming outdated in Canada, at least in relation to paramedics, police, or firefighters, 22 of which have died by suicide since the beginning of 2015. Still, those answering emergency calls aren’t always perceived to be vulnerable to trauma, he says, because they still face an attitude that says, “Well, you weren’t there, so how could you need help?” It’s a double bind.

“I tell people that 911 dispatchers can develop stress disorders even though they weren’t at the scene, because they were at the scene,” says Dave Larton, an associate editor for 9-1-1Magazine.com who also worked in emergency services for 35 years. Larton, a former dispatcher and trainer in California, explains that a 911 operator must stay on the phone until the medics or police arrive, all the while feeding information about what they’re hearing to the front-line first responders. The operator feels a responsibility in the situation but has a limited ability to help. In real time, he says, “we’re hearing the sound of a domestic dispute and we have the realization that there's nothing we can do physically,” says Larton. “We can't reach through the phone and take action; all we can do is listen, and that creates a lot of stress for us.”

Making matters worse, emergency phone operators usually work alone, says Ty Wooten, education director of the U.S.-based National Emergency Number Association. All other first responders work as partners or within teams, so they tend to decompress to some degree, right after a crisis, just by talking over coffee with colleagues or standing around the station. In big cities, a phone operator is expected to move on to the next call within seconds, not knowing how a crisis ends. “They don’t have the opportunity to have that cathartic discussion,” says Wooten, “and they need to go into something else.

“Remember, people call 911 on the worst days of their lives. And it’s one day after another for the operators, and that’s when we start to see an accumulation of stress,” he says. 

Flawed support

To be sure, 911 communicators in Canada are informed about the mental health risks associated with the work. Most emergency centers require that new applicants have a college education in emergency services communication or related certification. New employees also take a rigorous training course with the employer—whether that is the RCMP, a provincial ministry of health, or a city-run 911 center— before ever taking a call. This means that young people entering the field are aware that the burnout rate is high. An Ontario college instructor told Yahoo! that students learn about proper nutrition, exercise, and the benefits of meditation. Larton teaches trainees to use combat breathing (four counts to breathe in, four counts holding that breath, four counts to breathe out) during a call. 

New recruits are also taught to recognize signs of stress, whether the symptoms are physical (examples include sleep issues, chest pains, or gastrointestinal problems); emotional (which might mean feelings of guilt, grief, anger, or anxiety); cognitive (flashbacks, denial, short-term memory loss, lack of concentration) or behavioural (increased drug use, crying spells, a loss of interest in work or family.) Through role-playing scenarios, trainees learn about personal triggers and are encouraged to discuss their emotional reactions.

A college diploma is not always mandatory across the country, however, says Savoia, and neither is suicide prevention training, though some 911 call centers require both. The RCMP says that its 911 operators are given a psychological assessment before being hired and are assessed every two years, but Savoia says that most responders at other call centers are offered a talk for a couple of hours when they start the job, “and then it’s on them to stay healthy.” He’d like to see extensive training mandated at a federal level for all 911 employees and wants families to be invited to at least one session about the hazards of stress. “When things go off the rails, it often happens at home first. Somebody is left holding the bag, not understanding what's going on and not knowing who to turn to for help,” he says.

Telecommunicators who do speak up will most likely be directed to an employee assistant program, but Savoia reports that most plans are insufficient. They usually cover about $500 in expenses, or two therapy sessions, he says. When implemented early, PTSD treatment can be highly effective, but with a few months of regular treatment, not weeks.

Peer counsellor programs are another standard precaution used by emergency agencies, but Savoia and his team have found that 911 dispatchers might not be matched with someone in their position. The peer supporter might be a front-line police officer or paramedic, he says. Being heard by someone who’s been in your chair is crucial.

Related stories:

Moncton shooting RCMP dispatcher calls for more PTSD support

PTSD has compounding effect, speed of treatment could help: expert

Manitoba first in country to offer PTSD coverage to all workers

Finally, psychological debriefings after high-stress events like a mass murder are a common form of mental health intervention for emergency personnel; the formal talks give those involved a chance to process their feelings and prepare to return to “the new normal of home life,” says Larton. However, 911 operators are often not invited to debriefings because the perception is that they weren’t really on the call, he adds. Savoia points to yet another flaw with debriefings in Canada: they’re not always led by a social worker or psychologist but instead directed by an employee who has taken a three- or four-day Critical Incident Stress Management course. “Psychological debriefing should only be facilitated by mental health professionals and the unfortunate reality is, that’s not what's happening across the country,” he reports. Poorly led debriefings can easily make a person feel worse.

New attitudes

Despite the shortcomings with current health policies, Savoia is optimistic about the rate of change in Canada. He senses that awareness about this issue is fast-growing and there’s a sense of urgency around the problem. Georgian agrees and argues that more people are at least talking about health or psychology on the job—there’s less of a stigma, but it’s still there.

She has seen young people “new to the floor,” stay active and involved with their families, which she applauds. She has also met novice operators who will avoid any conversation about a bad call or certain nightmare situations that tend to recur. “I still worry that issues get ignored,” she says, “because that’s when things sneak up on you. It’s the calls you never gave a second thought to that return when you don’t expect it.” 

Her essential advice to newcomers: be honest with yourself about what you're experiencing, ask for that extra break when you need it, and reach out to someone—your doctor, a trusted colleague, or a counselor—as soon as you notice that you don't feel like yourself. Don’t wait.