Emergency Telecommunicators and PTSD

EMERGENCY TELECOMMUNICATORS AND PTSD

Emergency Telecommunicators and PTSD

Laura Chase

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This paper provides information that examines PTSD as it relates to emergency

telecommunicators. This population is extremely understudied and the lack of empirical

literature is astounding. By examining current literature focused on emergency

personnel such as police and firefighters, assumed causes and resolutions for PTSD in

emergency telecommunicators were found. The need to for further research and

implications are also discussed.

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Emergency telecommunicators may be required to answer 911 calls, dispatch

law enforcement to dangerous calls, give fire personnel safety information as they enter

a burning building, or any other number of tasks. The job of emergency

telecommunicator is not always chaotic and stressful, but has the potential to be without

warning. This stress and the traumatic phone calls or radio transmissions these

employees must deal with daily can have a profound affect on their mental health.

Posttraumatic stress disorder (PTSD) may be more commonplace for this population

than one realizes. There is a lack of information about this specific disorder and how it

affects emergency telecommunicators. However, various causes and resolutions may

have been found. Gaining insight into this issue could have positive global implications.

Problem Statement

An enormous hole exists in the literature regarding emergency

telecommunicators and the way they process stressful and traumatic phone calls and

radio transmissions. Although emergency telecommunicators do not normally

experience the call by seeing it, they experience the call by hearing it. The

telecommunicators are the first people to speak to those in need; individuals who are

difficult to understand, hysterical, crying, angry, confused, scared, or suicidal. The

telecommunicators have a responsibility to provide assistance to these people in their

time of need and often experience stress from this heavy burden.

There is very little empirical research on the effects of trauma suffered by

telecommunicators when handling stressful telephone and radio calls. Emergency

dispatchers’ PTSD and their depressive symptoms were examined (Lilly & Pierce,

2012). A vast amount of PTSD research is available, which leaves a basis of

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information to use. One study examines anxiety sensitivity as it relates to PTSD (Wald

& Taylor, 2008). DiCecco (2011) summarizes the disorder with a concentration on

pathophysiology, care, and legal issues. Wong, Kennedy, Marshall, and Gaillot (2011)

examine PTSD in survivors of injury, and the treatment of PTSD is discussed by

Couineau and Forbes (2011).

There are many avenues for researchers to go down, but examining the

relationship between PTSD and telecommunicators seems to be the best one. The

disorder certainly plagues some telecommunicators, but just how many is unknown.

The effects of PTSD on these emergency service providers could have affects that

range from local to global; therefore, understanding the disorder and its effects is

crucial.

Critical considerations that may relate to this problem include globalism, diversity,

social change, and ethics. Gaining insight into an understudied public safety population

could benefit the public not only nationally but also globally. The United States is not

the only country with an emergency telecommunication system in place. Several other

nations have adopted a three-digit emergency number for law enforcement, medical,

and fire emergencies (Emergency numbers around the world, 2006). The same

benefits that could be gained in the United States could be gained globally.

Emergency communication centers may be comprised of a diverse group of

employees with different cultural backgrounds, different religious beliefs, and different

ethnicity. The diversity within communication centers can bring about challenges for

researchers. PTSD may affect people in different ways. For instance, a young man

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may become angry and withdrawn, whereas a new mother may become depressed and

have difficulty sleeping at night. Researchers must keep these differences in mind.

Social change is possible if PTSD in emergency telecommunicators is examined

by possibly allowing these individuals to obtain better health care and social awareness.

These telecommunicators provide a public service, and if they are not functioning

properly it could mean the safety of countless citizens. The research touches on this a

bit but not nearly enough.

Critical Resource Review

Lilly and Pierce (2012) have ventured into a territory in which little is known.

They examine depressive symptoms and PTSD in 911 telecommunicators as well as

how that relates to world assumptions and peritraumatic distress. With such an

enormous hole in the literature about the 911 telecommunicator population, this study is

a small glimpse at an area that needs much more attention. Variables measured in this

study were PTSD symptoms, depressive symptoms, benevolence of the world, self-

worth, controllability, and peritraumatic distress. Lilly and Pierce (2012) argue that

PTSD and depressive symptoms are positively correlated with peritraumatic distress.

They also argue that benevolence of the world and self-worth are negatively correlated

with symptoms of PTSD. Although controllability was measured, no significant

relationship was present with depressive or PTSD symptoms. Last, the authors found

that there was no significant relationship between benevolence of the world and

controllability with peritraumatic distress, although there was a significant relationship

between self-worth and peritraumatic distress.

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Although only 29% of the sources used by Lilly and Pierce were within the

American Psychological Association (2010) suggested five-year time frame, many of

their sources provided a history of PTSD in police officers and firefighters as well as an

overview and examples of other variables, such as peritraumatic distress and

benevolence of the world. In fact, much of the background provided the reason and

understanding needed to tie in world assumptions with the rest of the study. These

sources proved to be quite beneficial and informative. However, the authors used

outdated sources for statistical information about PTSD and depressive symptoms in

police officers and firefighters. Current sources related to these topics were available at

the time and should have been used instead of the outdated sources. For instance,

LaFauci Schutt and Marotta (2011) examine predictors of PTSD in emergency

management professionals, Marshall, Schell, and Miles (2010) examine PTSD

symptoms and general distress relationships, and Smith et al. (2011) discuss PTSD in

firefighters as it relates to mindfulness.

Although this cross-sectional study attempts to show a relationship between

PTSD and depressive symptoms and other variables in 911 telecommunicators, it lacks

the depth and information a longitudinal study may provide. No study exists that

examines 911 telecommunicators and how the process of PTSD affects them long-term.

Lilly and Pierce (2012) also found that emotion and cognition may also be predictors of

PTSD in 911 telecommunicators and would be worth studying, especially cognitions

related to control. They highlight that controllability was significantly related to PTSD

symptoms and distress in a way they did not anticipate. Results reflect that the more

perceived control a 911 telecommunicator had, the higher the correlation with PTSD

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symptoms and distress. Perhaps this is because the 911 telecommunicator questions if

he or she could have done something differently and may believe he or she is

responsible for an inability to gain control of the call or the results of the call.

This study reveals a factual and very serious problem for the 911

telecommunicator population as well as a potential problem for society. The authors

based their study on fact, not opinion, and could analyze the data obtained as a result of

their study in a clear and concise manner making it easy for the reader to understand.

Because there is almost no empirical research on this population, there is difficulty

when trying to compare and contrast this study with others that are similar. This fact

further solidifies the need for additional research.

Rutkow, Gable, and Links (2011) examine the protection of first responder’s

mental health and discuss reasons they may be hesitant to obtain mental health

screening or any assistance with mental health problems. The majority of the authors’

sources are current, and the article provides a different view on the mental health

aspects of emergency personnel. Various articles examine mental health of emergency

personnel, but some are geared more toward the consequences of PTSD and other job-

related stressors. Bacharach, Bamberger, and Doveh (2008) examine alcohol use in

firefighters, whereas Hruska, Fallon, Spoonster, Sledjeski, and Delahanty (2011)

examine alcohol use and how it moderates the relationship between PTSD and

avoidance coping mechanisms. Both studies provide a different view of alcohol and

how it may fit into the study of PTSD in 911 telecommunicators because the articles

help fill in a hole in the literature.

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McFarlane, Williamson, and Barton (2009) review the literature associated with

the general consequences of traumatic events experienced by emergency personnel.

This literature gives a glimpse of the need for further research, but interjects too much

opinion into the article. McCarley, Prager, and Sherry (2006) examine PTSD and

burnout in first-responders, but the information provided is from a presentation at the

Rocky Mountain Psychological Association Conference and lists no references. Finally,

Marmar et al. (2006) examine PTSD predictors in first-responders, which can help

explain predictors in 911 telecommunicators.

Other resources will be examined to gather a better understanding of the

research needed for such an understudied population. Because very little empirical

research exists, the holes are plentiful, and there is difficulty in choosing which specific

area to focus on. However, the consequences of PTSD in any type emergency services

employee may be detrimental to the employee, his or her department, and society.

Therefore, further examination of consequences and preventative measures will be

assessed.

Literature Review

Empirical research on the emergency telecommunicator population is extremely

scarce. However, an abundant amount of information is available on the law

enforcement and fire fighter populations. Telecommunicators are exposed to stress and

trauma through telephone calls and radio transmissions every day, so one can reason

that they may be more at risk for posttraumatic stress disorder (PTSD) than individuals

who do not work in the public safety realm. The consequences of PTSD can be quite

negative (Lilly & Pierce, 2012; Rutkow, Gable, & Links, 2011), and when those negative

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outcomes are coupled with a responsibility to maintain public safety, the effects could

be deadly.

Literature was reviewed in relation to the effects of PTSD on public safety

personnel, and legal and ethical issues. The literature was gathered from various

databases in the Walden Online Library using keywords such as emergency, PTSD,

and public safety. These articles were chosen because they contain information about

the consequences of PTSD and how some of those consequences affect the lives of

public safety personnel.

Alcohol

The four articles focus on public safety personnel and different problems

associated with their mental health. Various consequences are examined, such as

alcohol abuse, legal considerations, and how worldviews affect stressful outcomes.

Alcohol consumption is a common theme in the world of law enforcement, firefighters,

and other first responder jobs (Violanti et al., 2011; Bacharach, Bamberger, & Doveh,

2008). Some individuals use drinking as a coping mechanism to relieve stress caused

by job-related trauma, whereas others are slowly integrated into a culture of consuming

alcohol as a social norm. The use of alcohol may have several negative consequences

as some authors point out. Backarach, Bamberger, and Doveh (2008) state alcohol

abuse can impair a subject's behavior and cognitive ability, which can affect his or her

daily job performance. They go on to say using alcohol as a coping mechanism may be

partially caused by experiencing helplessness and horror on the job. Although the

authors are focusing on firefighters, 911 telecommunicators also experience instances

of horror and helplessness on the job through telephone calls and radio transmissions.

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Outcomes

The articles examined various outcomes from job-related stressors and PTSD as

well. Clearly, public safety is the biggest issue; however, other issues such as suicide,

depression, anxiety, and productivity are also examined. Rutkow, Gable, and Links

(2011) examine stress-related outcomes that affect job performance and how worker's

compensation fits into that picture. Not every state has worker's compensation laws that

support first responders who suffer from PTSD or other mental health issues caused by

on-the-job trauma. All of the articles examined in this review state depression may be a

symptom the trauma experienced while on the job of public safety personnel.

Emergency Telecommunicators

Although the only article is specifically related to emergency telecommunicators,

each article contains information about individuals who work in the public safety realm.

Firefighters, police officers, first responders, and others who respond to disasters or

traumatic incidents share the increased risk of PTSD or other stress-related symptoms.

Emergency telecommunicators are likely no different. Although there is not enough

empirical research to confirm this theory, the literature that is available points to this

conclusion. Another area of concern, in addition to an increased risk of PTSD, appears

to be a potential risk for alcohol abuse. Clearly, more research is required to confirm

these theories, and others related to emergency telecommunicators.

Critical Analysis

Four main causes of PTSD were found while examining current literature on

police, firefighters, and other emergency personnel. The first, and possibly most obvious

cause is the experience of critical incidents. Police and fire personnel respond to motor

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vehicle crashes, suicides, violent incidents, and other traumatizing events. Emergency

telecommunicators interact with the callers hearing, witnessing, or experiencing these

events. These critical incidents can have a significant impact on the onset of PTSD

(Declercq, Meganck, Deheegher, & Van Hoorde, 2011). The severity of the critical

incident may also have a bearing upon the onset of PTSD and the ways in which these

subjects cope (Bacharach, Bamberger, & Doveh, 2008).

Another cause of PTSD in emergency personnel is the response to the critical or

traumatizing incident. Some responses involve anger, horror, fear, or helplessness

(Declercq, Meganck, Deheegher, & Van Hoorde, 2011). Kleim, Ehlers, and Lucksman

(2012) show a relationship between the type of response to a traumatic event and

PTSD and depression. Helplessness was found in both studies to be a factor for

predicting PTSD. Anger was found to be both a risk factor for PTSD and an effect of

the disorder in police officers (Meffert et al., 2008).

The third cause of PTSD is world assumptions and peritraumatic distress. Lilly

and Pierce (2012) found world assumptions in telecommunicators to predict PTSD

significantly. For example, if one believed the bad in the world outweighed the good

and experienced a traumatic call, this combination was significant in predicting PTSD.

World assumptions of self-worth were also significantly related to PTSD (Lilly & Pierce,

2012).

The fourth main cause of PTSD was perceived social support. Although only one

source listed this specific cause, there were other associated relational predictors found

in other sources such as stress and self-blame. For instance, firefighters reporting high

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self-blame and perceiving social support as low showed a significant risk for PTSD and

other related symptoms (Meyer, Zimering, Daly, Knight, Kamholz, & Guliver, 2012).

From these causes, four main effects of PTSD and the traumatic events

associated with the disorder were found. Alcohol or substance abuse, depressive

symptoms, burnout, and public safety were all significant effects of PTSD in emergency

personnel. Four articles showed alcohol use and PTSD commonly co-occurring

(Bacharach, Bamberger, & Doveh, 2008; Hruska, Fallon, Spoonster, Sledjeski, &

Delahantym 2011; Kamena, 2012; Violanti, Slaven, Charles, Burchfiel, Andrew, &

Homish, 2011). The traumatic events experienced by emergency personnel

significantly increase the risk of alcoholism.

Another effect of PTSD is depression. Depression and depressive symptoms are

strongly related to PTSD, as was shown by several studies (Kleim, Ehlers, &

Glucksman, 2012; Lilly & Pierce, 2012; Levin, Besser, Albert, Smith, & Neria, 2012;

Violanti et al., 2011). After experiencing a traumatic event, emergency personnel may

have feelings of hopelessness or negative self-appraisals coupled with PTSD

symptoms.

The third effect was burnout. Studies indicate emergency personnel

experiencing burnout may be experiencing a symptom of PTSD after a traumatic

incident (McCarley, Prager, & Sherry, 2006). Although LaFauci Schutt and Marotta

(2011) show a significant predictive value, burnout is clearly related to PTSD as not only

an effect but also as a cause.

The fourth effect of PTSD in emergency personnel is the issue of public safety.

The effects of the disorder are negative and with those negative effects come negative

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consequences for the public. Alcohol abuse while on the job certainly can have

detrimental effects on the public, as can anger issues in police. Physical health issues

such as cardiovascular problems and general sickness have been linked to PTSD and

can affect public safety (Violanti, Andrew, Burchfiel, Dorn, Hartley, & Miller, 2006;

Young, 2009).

Studies show a variety of causes and effects of PTSD in emergency personnel.

Although limited information is available for telecommunicators, one could presume the

same or similar causes and effects apply. With a proactive approach to PTSD in

emergency personnel, some of these causes and effects could be prevented. One

specific cause cannot be labeled as the most important in leading to the problem.

Instead, understanding how they all intertwine is the key to prevention. This

understanding can also bring about resolutions.

Resolutions

PTSD in emergency telecommunicators is a problem that has many possible

resolutions. Certain populations such as law enforcement and firefighters have a higher

occurrence of the disorder, likely from the trauma they are exposed to on a regular

basis (Lilly & Pierce, 2012). Learning about signs and symptoms is the first step to a

proactive resolution. When emergency telecommunicators take high stress calls or are

involved in a particularly stressful situation on the radio, coworkers and supervisors

should be aware of any unusual behavior. However, because the effects of the incident

may not appear for months after it has happened, a preventative approach may be

more effective.

Employees who suffer from job-induced stress or PTSD should have an

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opportunity to receive help. An employee assistance program (EAP) or critical incident

stress debriefing (CISD) can be used to alleviate some of the stress from the job by

speaking with a therapist or counselor. The program should also allow employees to

remain anonymous. Some employees may feel uncomfortable or embarrassed about

seeing or speaking to someone for help. The EAP focuses on providing counseling

services to employees experiencing any form of personal or work-related stress

(Magyar & Theophilos, 2010). An advantage of the EAP is that employees can utilize it

for both work and personal stress, which often result in larger problems such as PTSD

when combined. A disadvantage may be the programs lack of encouragement and

promotion. If employees are unaware such programs exist, they will be less likely to

benefit from it.

A disadvantage to using CISD is that its purpose is to prevent PTSD, which is

experienced only by a fraction of employees (Jeannette & Scoboria, 2008). Therefore,

there may be little to no benefit for the other employees involved in the incident.

However, research has also showed success with CISD. For instance, 56% of the

individuals involved in a Los Angeles fire department incident reported a reduction of

symptoms after attending the debriefing (Magyar & Theophilos, 2010).

Challenges and barriers may arise when attempting to implement such programs

as well. A proper CISD should include all individuals involved in the incident.

Emergency telecommunicators and other emergency personnel typically work in shifts

and must maintain a minimum staffing level to ensure public safety. Every employee

involved in the incident may not be available at the same time for the CISD.

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Summary

One can assume that telecommunicators struggle with PTSD more than the

general population. With the lack of empirical data available about this group, one must

substantiate preliminary assumptions about the causes and effects of PTSD with data

about other emergency personnel whose jobs have similar exposure to trauma. The

problem of PTSD in the public safety field is clear and can have detrimental effects to

the individual who suffers, the organization for which he or she works, and society in

general. Further research would clarify misconceptions, generate understanding and

resolutions to the problem, and extend knowledge in a way that may have a positive

global effect.

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Emergency Telecommunicators and PTSD

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