MANAGEMENT: 911 for Emergency Dispatchers

Duty-related trauma is part of the job [PM Magazine, May 2019]

ARTICLE | May 3, 2019
By Audrey Fraizer

Life and death. They are something that emergency dispatchers deal with every day.

They don’t directly witness the tragic or dangerous events, but the emotions related to the trauma occurring on the other end of the phone put dispatchers at risk for developing a host of such mental and emotional health problems as anxiety, post-traumatic stress disorder (PTSD), burnout, and depression.

The distressing and upsetting calls that place emergency dispatchers in the line of duty-related trauma can come at any time. The most stressful calls are the unexpected injury or death of a child, suicidal callers, officer-down reported on scene, and calls involving the unexpected death of an adult.1

While emergency dispatchers do not see the traumatic incidents, they are every bit as vulnerable to PTSD as first responders. The more of those types of calls an emergency dispatcher handles, the more they are put at risk for PTSD, according to Michelle Lilly, associate professor of clinical psychology at Northern Illinois University.2

The rate of PTSD across emergency dispatch personnel is somewhere between 18 percent and 24 percent; this percentage reports enough symptoms of PTSD that the individuals affected would likely receive a diagnosis if they were seen by a psychologist and were formally evaluated, according to Lilly.3

Notably, PTSD can have a delayed onset, developing years after an initial exposure and sometimes in reaction to later trauma exposure. Emergency dispatchers and call takers are at greater risk of PTSD with greater cumulative exposure to traumatic events.

Work Factors and Health Outcomes

Lilly’s recent study, in collaboration with Kim Turner, communication manager of the San Bernardino County, California, sheriff’s department, examined the impact of work-related factors (e.g., work/life balance, burnout, work conditions) on health-related outcomes (e.g., satisfaction with life, depression/anxiety, physical health).4

Findings were drawn from 833 call takers and dispatchers voluntarily participating in the study through a survey available online to all law enforcement communication centers in California.

According to the study, a better understanding of work-related factors can lead to improved prevention and intervention to alleviate health-related factors (such as depression and anxiety) adversely affecting satisfaction with life and physical health.5

An imbalance between life and work is a major stressor for anyone and the 911 work environment is characterized by a number of challenging – and potentially stressful – conditions (overtime, shift rotation, extended stationary periods). The study found that consequent burnout was strongly associated with stress and had a significant direct effect on all health-related outcomes.

So, what can be done to succeed in an environment where stress is predominant?

Factors include mutual respect, between coworkers and management and the agencies relying on the work performed in emergency communications, and valuing emergency dispatchers to an extent that recognizes the stress that comes with the job. The ability to recognize the symptoms coupled with programs emphasizing the critical and life-saving role performed by dispatchers, which may enhance dispatchers’ sense of purpose and meaning, may help to reduce the prevalence of burnout in the 9-1-1 workplace.6

Opportunities for skill development, active use of information to support decision making, collaboration, open communication, a shared can-do approach, and freedom from physical and social harm are also attributes contributing to a healthier communication center. There also needs to be a willingness to perform as a community, participating in core values that unify coworkers and provide a sense of pride in the work accomplished.

The ability to “leave work at work” and develop meaningful hobbies and relationships outside of the work environment may be especially protective for dispatchers, according to Lilly’s and Turner’s research findings. A related study (Ramos and colleagues 2015) suggested that reducing conflict and enhancing balance may affect not only health functioning, but other job-related factors.7

Critical Need for Performance Standards

Generally accepted standards have been publicly available since 1994, when the National Institutes of Health published an emergency medical dispatch position paper citing standards explicit in International Academies of Emergency Dispatch® (IAED™) established benchmarks. Agencies must implement protocols with which emergency dispatchers can collect the relevant information for the case, accurately differentiate high- and low-priority calls, and ensure appropriate, timely dispatch, as well as accurate and immediate relay of critical and safety information to responders. In addition, agencies must apply a structured program of quality assurance and quality improvement to ensure that dispatchers comply with protocols and standards.8

The absence of such standards (i.e., an evidence-based process) can lead to adverse outcomes resulting from insufficient assistance; giving unsuitable or potentially injurious pre-arrival instructions; providing the caller false assurance, including telling the caller help is on the way when the response has not been dispatched; or sending response to an incorrect location.

These are the types of mistakes that lead to lawsuits in 
the dispatch center, as identified in research conducted by the IAED.

To conduct the study, Litigation and Adverse Incidents in Emergency Dispatching, an IAED research team scanned publicly available records and databases for dispatch-related litigation, selecting 82 cases, dating from 1980 to 2015, and categorized them by type (e.g., medical, police, fire), and the dispatch-related issue. The date and place of occurrence were also noted. Legal outcomes were identified, when available from city, state, and federal court databases.

With each case, courts increasingly applied generally accepted and disseminated standards of care when reaching their decisions; the failure to meet clear and enforceable standards on the part of the defendant led to adverse findings against the individual or agency.

As the IAED study authors concluded, “Agencies without the recommended practices in place should be prepared to defend their practices in court—and in the court of public opinion.”9

The costs of legal problems to the workplace go beyond damages and fines. Emergency communication agencies that engage in problem behaviors lose the trust and support of their communities and local governments. Chicago, for example, has been sued regarding dispatch issues 12 times since 1987, paying millions in settlements and damages and causing increasing ill will between the city’s emergency services and its citizens.10

Emergency dispatch standards set by such organizations as IAED—protocol, certification, training, and accreditation—are important steps in energizing and cultivating effective emergency communications. A mindset that perceives the importance of the work performed by the first link in the chain of emergency care also supports an effective emergency communications environment.

As Turner points out, it’s a matter of treating people in emergency communications as professionals—and not someone just doing a job. Dispatchers are a critical component of EMS. “Everybody needs to know what a professional dispatcher does,” she said.

And research is certainly a direct way of getting there.

Audrey Fraizer is managing editor, Journal of Emergency Dispatch, International Academies of Emergency Dispatch, Salt Lake City, Utah (audrey.fraizer@prioritydispatch.net).

 

Endnotes and Resources

1 Pierce H, Lilly M. “Duty-related trauma exposure in 911 telecommunicators: Considering the risk for posttraumatic stress.” Journal of Traumatic Stress. 2012; March 29. (accessed Dec. 12, 2018).

2 Raskin A. “PTSD and Emergency Communicators.” Journal of Emergency Dispatch. 2016; July 7. (accessed Feb. 19, 2019).

3 See Note 2.

4 Lilly M, Turner K. “Impact of Work-Related Factors on Stress and Health among 9-1-1 Call-takers and Dispatchers in California.” Annals of Emergency Dispatch and Response. 2019: 7.1.

5 See Note 4.

6 See Note 4.

7 Ramos R, Brauchli R, Bauer G, Wehner T, & Hammig, O. “Busy yet socially engaged: Volunteering, work-life balance, and health in the working population.” Journal of Occupational and Environmental Medicine. 2015; Feb. (accessed March 25, 2019).

8 Clawson JJ, Cady GA, Martin RL, Sinclair R. “Effect of a comprehensive quality management process on compliance with protocol in an emergency medical dispatch center.” Annals of Emergency Medicine. 1998; November. (accessed March 26, 2019).

9 Clawson J, Jorgensen D, Gardett I, et al. “Litigation and Adverse Incidents in Emergency Communications.” Annals of Emergency Dispatch & Response. 2018; Sept. 20. (accessed Feb. 15, 2019).

10 See Note 9.

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