ThesisPDF Available

Peer Support Programs- Mitigating the Emotional Effects of Vicarious Trauma Experienced by 911 Dispatchers



Public safety telecommunicators, often referred to as 9-1-1 dispatchers, experience a significant compassion fatigue and secondary traumatic stress. Their job duties include listening to highly emotional callers provide specific details on current, tragic, and often horrific critical incidents in volatile working conditions. This paper focuses on a systemic review of research that identifies the working conditions and responsibilities of 9-1-1 dispatchers and the subsequent emotional effects of sustained exposure to vicarious trauma. The research recognizes a minimal amount of documentation regarding the stress 9-1-1 dispatchers' experience which supports a fundamental need for comprehensive, longitudinal studies in this job classification. This review also seeks to prove the lack of intervention programs employed to reduce or mitigate the emotional effects of vicarious trauma, compassion fatigue, and secondary traumatic stress, thereby resulting in the irrefutable need for workplace peer support programs to combat these conditions felt by public safety telecommunicators.
© 2020 Melissa Alterio
Peer Support Programs: Mitigating the Emotional Stress of
Vicarious Trauma Experienced by 9-1-1 Dispatchers
Melissa A. Alterio
August 3, 2020
Presented to the
Department of Leadership Studies
Mercer University
In Partial Fulfillment
of the Requirements for the Degree of
Master of Science
Public safety telecommunicators, often referred to as 9-1-1 dispatchers, experience a
significant compassion fatigue and secondary traumatic stress. Their job duties include
listening to highly emotional callers provide specific details on current, tragic, and often
horrific critical incidents in volatile working conditions. This paper focuses on a
systemic review of research that identifies the working conditions and responsibilities of
9-1-1 dispatchers and the subsequent emotional effects of sustained exposure to vicarious
trauma. The research recognizes a minimal amount of documentation regarding the
stress 9-1-1 dispatchers’ experience which supports a fundamental need for
comprehensive, longitudinal studies in this job classification. This review also seeks to
prove the lack of intervention programs employed to reduce or mitigate the emotional
effects of vicarious trauma, compassion fatigue, and secondary traumatic stress, thereby
resulting in the irrefutable need for workplace peer support programs to combat these
conditions felt by public safety telecommunicators.
I would first like to thank my Graduate Program Coordinator and academic
advisor Dr. Stephen Ruegger of the College of Professional Advancement for Criminal
Justice and Public Safety Leadership at Mercer University. The door to Dr. Ruegger’s
virtual office was always open whenever I had a question or needed some guidance. He
consistently provided valuable input and leadership advice while allowing me to think
and work independently.
I owe my deepest appreciation to Associate Professor Dr. Lynn Tankersley
whose passionate enthusiasm for academic research lit a fire in my creative soul. I am
gratefully indebted for her inspiration, encouragement, and direction. It was a privilege
and honor to have her as a mentor and study under her guidance. I would also like to
thank her for her witty sense of humor and lasting friendship.
My sincere thanks goes out to my fellow classmates, 9-1-1 colleagues, and alumni
of CPE06 for the stimulating discussions, thoughtful conversations, and unwavering
support to get in the arena and dare greatly. I would also like to express my profound
gratitude to Jim Marshall and Ryan Dedmon of the 9-1-1 Training Institute for providing
me with constant motivation, unfailing support, and all the tools and resources needed to
implement a Peer Support Program at our agency.
Thank you to the City of Roswell (GA) for funding my admission through this
program, allowing me to achieve the next level of professional development. In addition,
many thanks go out to my 9-1-1 staff, the greatest team a leader could ask for. They
inspired this research topic, and therefore this final thesis is dedicated to them as a
reminder to be brave, be authentic, and have courage to fulfill their dreams.
Finally, I must convey my very genuine gratitude to my family and to my cousin,
Alex Perrone, for his steadfast encouragement and inspiring me to follow through on the
5-year plan. Heartfelt thanks to my Mom who is my constant cheerleader and best friend.
My warmest appreciation to my dearest friends, my 9-1-1 circle, and my sister squad for
the unconditional love and support and allowing me to engage in wholehearted living.
This accomplishment would not be possible without them.
Table of Contents
Chapter 1 ..............................................................................................................................1
Introduction ....................................................................................................................1
Background ............................................................................................................. 2
911 Facts…………………………………………………………………………..4
Definition of Terms................................................................................................. 6
Chapter 2: Review of the Literature .....................................................................................8
Overview ........................................................................................................................8
Stress Factors .......................................................................................................... 8
Workplace Conditions .................................................................................... 11
Burnout, Retention, and Attrition ................................................................... 14
Next Generation Technology .......................................................................... 18
Vicarious Trauma.................................................................................................. 23
Compassion Fatigue ........................................................................................ 24
Secondary Traumatic Stress ............................................................................ 27
Peer Support .......................................................................................................... 28
Chapter 3: Discussion, Recommendations, and Conclusion .............................................36
Discussion ....................................................................................................................36
Recommendations ................................................................................................. 39
Conclusion ............................................................................................................ 40
References ..........................................................................................................................41
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Chapter 1
A research study conducted in 2015 at a national dispatch conference reported
17% of 205 participating public safety telecommunicators experienced symptoms of
acute stress disorder (ASD) during their careers, a notably higher percentage than the
general population (Trachik et al., 2015). Public safety telecommunicator (PSTs),
(referred to in this document also as 9-1-1 dispatchers, 9-1-1 professionals, or emergency
dispatchers) have a significant risk of exposure to secondary trauma due to experiencing
critical incidents unfold through 9-1-1 callers descriptive information about traumatic
scenes while in a highly emotional state of panic and distress (Rigden, 2017). Further
research has shown that PSTs suffer from post-traumatic stress disorder (PTSD), with a
significant correlation to peritraumatic stress, showing PSTs do not need to be physically
present during a traumatic event for it to negatively impact their wellbeing (Pierce &
Lilly, 2012). The frequency with which PSTs are subjected to highly emotional calls,
paired with the presence of PTSD symptoms, can seriously jeopardize a PST’s everyday
judgment and decision-making abilities on the job (Pierce & Lilly, 2012). Studies have
shown peer support in the workplace minimizes distress and angst experienced by
emergency service workers as a result of trauma and those who suffer post-stress related
reactions following a critical incident (Scully, 2011).
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In the early morning hours of September 11, 2001, Fire Department of the City of
New York (FDNY) dispatcher Gloria A. (personal communication, June 30, 2020) began
her shift shortly after 6:30 a.m., arriving earlier than scheduled. Her specific assignment
was dispatching Emergency Medical Services (EMS) units for the city (Dispatcher G.A.,
personal communication, June 30, 2020). With her partner calling in sick, Gloria was
assigned the dispatching duties for all of Manhattan on this particular morning. As a
military veteran turned public safety dispatcher, Gloria felt a strong purpose to serve the
community she loved (Dispatcher G.A., personal communication, June 30, 2020). Her
Fire/EMS family was part of that community, formulating a deep bond and connection
among each other that was rarely seen in other public safety agencies (Dispatcher G.A.,
personal communication, June 30, 2020). One particular individual Gloria recalls fondly
was a field lieutenant who normally patrolled the downtown Manhattan area. The two
exchanged messages back and forth via the mobile data terminal (MDT), often keeping
the conversations friendly, light, and with a bit of a sarcastic tone (Dispatcher G.A.,
personal communication, June 30, 2020). At approximately 8:40 a.m., Gloria received a
message from him via the MDT that stated a Cessna had just hit the World Trade Center
(WTC). Assuming it was their normal jest, she responded to him in kind, telling him to
stop messing around. Seconds later, he called her on the phone (Dispatcher G.A.,
personal communication, June 30, 2020).
At this point during the interview, Gloria explains the scene in the dispatch
Center. She was wearing a dual headset, completely engrossed in her computer and the
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status of her EMS units for all of Manhattan, requiring a significant amount of multi-
tasking and attention to detail (Dispatcher G.A., personal communication, June 30, 2020).
Dispatching for FDNY EMS was a massive undertaking for a city that large, even though
they had assigned boroughs. Two people were normally responsible for maintaining the
status of approximately 50 EMS units. Breaks were scheduled and required every 90
minutes (Dispatcher G.A., personal communication, June 30, 2020). This day, Gloria was
the sole dispatcher responsible for their normal number of daily units, and her
recollection of any break was nonexistent. When the lieutenant’s voice rang in her
headset, Gloria’s demeanor immediately changed (Dispatcher G.A., personal
communication, June 30, 2020). His voice was different. She heard sheer panic: a mix
of fear and tears as he stated that he was not kidding, repeating that a Cessna just hit the
World Trade Center (Dispatcher G.A., personal communication, June 30, 2020). Gloria
recalls that, in that moment, the citywide phone lines began to light up like a Christmas
tree. She and her public safety family would forever be changed (Dispatcher G. A.,
personal communication, June 30, 2020).
At 7:00 p.m., Gloria’s captain came over to her console, informing her in a direct
but empathetic tone that she had to get up and go home (Dispatcher G.A., personal
communication, June 30, 2020). She looked around at what had become a dispatch
Center full of people, dispatchers and command staff alike, with computer screens
displaying endless amounts of units and several scattered papers containing various notes
she scribbled throughout the day. She realized that almost 12 hours had passed
(Dispatcher G. A., personal communication, June 30, 2020). When Gloria stepped
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outside the building, she became immediately overwhelmed with the smell in the air, and
the veracity of what had transpired became real (Dispatcher G.A., personal
communication, June 30, 2020). A piece of paper with a charred, jagged edge appeared
right in front of her, floating in the air and eventually landing in her open hands. She
turned it over to see the name of Cantor Fitzgerald, a company headquartered in the
WTC, and a rush of feelings threatened to choke her (Dispatcher G.A., personal
communication, June 30, 2020). Gloria somberly recollects, “I had never seen a war-torn
country but I felt like I had been in one – like I experienced the same trauma(Dispatcher
G.A., personal communication, June 30, 2020). Gloria admits it was not until years later
that she realized what she had subsequently experienced the days, weeks, months, and
even years after the incident was the effects of PTSD (personal communication, June 30,
9-1-1 Facts
In the United States, approximately 240 million 9-1-1 calls are made annually
according to 2018 statistics, with at least 80% received from wireless devices (NENA:
The 9-1-1 Association, n.d.). 9-1-1 professionals are the first point of contact in an
emergency. These individuals are trained to obtain essential information from the caller,
provide appropriate calming and reassurance techniques, make effective decisions, send
the correct emergency responders to the right location, and provide instructions that often
result in preservation of life or property (9-1-1.Gov, n.d.). No two calls are alike for an
emergency dispatcher. For instance, one call may be processed regarding a suicidal
teenager, and the very next call comes from an emotional mother reporting her baby
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choking. There is rarely any break in between, just constant exposure to heightened
emotions (MacLellan, 2015). With the critical nature of this work, it is not abnormal for
a 9-1-1 professional to listen to a caller take their last breath or hear the frantic screams of
someone facing their murderer (MacLellan, 2015).
Specific responsibilities of an emergency dispatcher may differ from one public
safety agency to another; however, the duties are typically the same. They may include,
but are not limited to, answering emergency and non-emergency calls, dispatching and
maintaining the status of police, fire, and EMS units, delivering vital medical or safety
instructions, allocating resources, accessing secure local and national databases, and
completing several other tasks associated with the public’s safety (Bass, 2017). The
totality of their job responsibilities is such that the very significant work of 9-1-1
professionals can immensely influence the outcome of any emergency situation,
including the safety of the responders and the citizens they serve. The questions they ask,
the decisions they make, and the actions they take profoundly impact the safety of others
directly or indirectly (Bass, 2017). In fact, public safety telecommunicators are
sometimes referred to as the first of the first responders, as they can largely impact the
effectiveness of police officers, firefighters, and EMS workers (Baseman et al., 2018).
The safety of the public is dependent on the cognitive and emotional resources available
for public safety telecommunicators to perform several intricate tasks at once and make
accurate life/death decisions in a timely manner while maintaining a seemingly unruffled
composure (Baseman et al., 2018). It is not uncommon for 9-1-1 professionals to feel
directly accountable for the public’s safety. They also feel a significant responsibility for
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the safety of the emergency responders dispatched to an incident they processed
(Baseman et al., 2018). The weight of that responsibility was felt on 9/11 when Gloria
dispatched EMS units to a scene from which they never returned. While she was not
directly or physically exposed to Ground Zero, the weight of guilt and distress for having
made the decision to send in her crews to a tragic and final fate nearly overcame her for
yearsalong with the sheer mass destruction her public safety family had experienced
(G.A., personal communication, June 30, 2020).
Most public safety studies regarding PTSD, secondary stress, vicarious trauma
and compassion fatigue have focused primarily on police officers and firefighters
(Meischke et al., 2018). Recently, researchers documented a relationship between these
various stress reactions affecting public safety telecommunicators (Meischke et al.,
2018). As a result of minimal research on the effects of trauma-related stress in PSTs,
suggestions to effectively reduce or mitigate the effects of emotional stress are alarmingly
Definition of Terms
Acute stress disorder: The “diagnostic criteria from the DSM-IV include re-
experiencing of trauma, avoidance, anxiety and hyper-arousal, and impairment in
functioning” (Trachik et al., 2015, p. 28).
Compassion fatigue: This occurrence is known as “a traumatizing state
experienced by those people in distress” (Rigden, 2017, Definition section, ¶ 3).
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Peritraumatic stress: The phrase peritraumatic stress refers to “the emotional and
physiological distress experienced during and/or immediately after a traumatic event”
(Bunnell, Davidson, & Ruggiero, 2018, p. 8).
Post-traumatic stress disorder: This disorder is known as “a debilitating condition
often follows a terrifying physical or emotional event, causing the person who survived
the event to have persistent, frightening thoughts and memories, or flashbacks of the
ordeal” (Rigden, 2017, Definition section, ¶ 4).
Public safety telecommunicator: The Association of Public Safety
Communications Officials (APCO) Institute defines public safety telecommunicator as
“communications professionals who perform emergency and non-emergency call-taking
and dispatching duties” (APCO, 2016, p. 1-1).
Secondary traumatic stress: This type of stress is known as “behaviors and
emotions resulting from knowledge about a traumatizing event that was experienced by
another person and the desire to help that person” (Meischke et al., 2018, p. 2).
Vicarious trauma: Negative changes in views of oneself and the world after
repeated, long exposure to trauma-related stories and thoughts (Quitangon, 2019).
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Chapter 2: Review of the Literature
This report includes a formal and comprehensive review of literature to provide a
basis for the scope of work. The literature review will consist of theoretical perspectives
and previous research findings related to mitigating the emotional stress of 9-1-1
dispatchers. The review provides a focus for the report and will include the important
concepts and data associated with stress and trauma experienced by 9-1-1 dispatchers.
The assessment will include an overview of post-traumatic stress, vicarious and
secondary trauma, and compassion fatigue exposure in public safety telecommunicators.
A variety of resources will be utilized for reviews of literature pertinent to this report and
to support the thesis statement. Textbooks, professional periodicals and journals, online
databases, and other reference materials will be the tools used to gather the data for the
review of the literature. Computerized databases will be used, such as Google Scholar,
PsychInfo and ProQuest, journal articles, books related to 9-1-1 dispatcher stress,
dissertations, web site articles, and research studies in preparing the synthesis of the
literature collected. The literature review is divided into three broad topics: stress factors
for 9-1-1 dispatchers, vicarious trauma, and peer support for emotional trauma exposure.
Stress Factors
From the first moment a 9-1-1 call is received, the 9-1-1 professional must gather
information from the caller, triage that information, prioritize and allocate resources, and
provide the caller with instructions prior to the arrival of emergency responders. To the
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untrained eye, these multiple tasks performed by a 9-1-1 professional are well
choreographed through a variety of activities (Kashani, Sanko, & Eckstein, 2018). The
conditions under which a 9-1-1 professional must work are second in priority to the calls
they process. The totality of those conditions include shift work, mandated overtime,
poor eating habits and overall work-life balance. Jim Marshall and Tracey Laorenza
(2018) provided the 9-1-1 industry with a comprehensive guide for surviving stress in a
9-1-1 Center. The book is a fundamental resource for this research report, as it assists
with delivering an accurate picture of the experiences and stresses of 9-1-1 professionals.
Their research identifies the critical role of a public safety telecommunicator as the
person who connects the pillars of a distressed, critical, and panic-stricken reality with
the official emergency response world via a 9-1-1 phone call (Marshall & Laorenza,
2018). They often have to filter through chaotic conversations, emotional screams, and
fear-stricken rants to assess and identify the nature of the emergency and translate it into
a specific problem type so that it can be dispatched to emergency responders (Marshall &
Laorenza, 2018). The authors carefully and skillfully explain the urgency with which
these public safety telecommunicators have to sift through complex information affecting
life and death conditions. They further identify that public safety telecommunicators
often perform these tasks under less than perfect conditions to include being short-
staffed, having limited breaks, experiencing burnout, and the feeling of being invisible to
the rest of the world (Marshall & Laorenza, 2018).
The Resilient 9-1-1 Dispatcher, published in 2018, is an important contribution in
the 9-1-1 industry so it is relevant to note how this research and subsequent book came
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into fruition (Marshall & Laorenza, 2018). Mr. Marshall is a psychotherapist whose
sister worked in a 9-1-1 Emergency Communications Center. His fascination with the
mental wellness of public safety telecommunicators began one evening during clinical
psychology graduate school when his sister invited him to do a sit-along in the 9-1-1
Center to observe what her job was all about (Marshall & Laorenza, 2018). Jim
monitored a 9-1-1 call where the caller complained about a neighbor’s dog defecating in
her yard. Resisting the urge to laugh, he watched his sister process this incident with
ease, obtaining all relevant information to dispatch a patrol unit to handle the complaint
(Marshall & Laorenza, 2018).
The next several minutes went by with relative calm, so the two of them began
engaging in a conversation about Jim’s graduate work. The conversation was interrupted
as another 9-1-1 call came in. Jim observed a visible change in his sister’s posture
adjusting from a relaxed pose to a stiff, serious one. The caller was a highly emotional
female screaming into the phone, her fear-afflicted words barely understandable. Jim
observed his sister calm the caller into a more rational state while receiving answers to
several questions she was rapidly firing off at the same time (Marshall & Laorenza,
2018). A few moments later, witnessing his sister continue to soothe the caller, Jim was
shocked to hear her tell the distraught woman that officers were arriving on scene and she
should go talk with them now. He did not realize she was simultaneously entering all the
information into the computer aided dispatch (CAD) system for the responding officers,
having determined the caller was reporting a domestic violence incident. The call was
released, and his sister turned back to him to continue their conversation. It was at that
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moment he realized the extreme dynamic of a 9-1-1 dispatcher’s role in public safety as
the true first responder (Marshall & Laorenza, 2018).
Over the next few years, Jim began to examine the traumatic effects of working in
a 9-1-1 Center, identifying the need for stress resilience training for public safety
telecommunicators. After classroom curriculum was created and several classes
instructed, Jim partnered with his co-author, public safety communications coordinator
Tracey Laorenza, to write their book for not only the 9-1-1 community but also for the
public to understand and support those behind-the-scenes heroes. They conducted
research on the psychological stress of vicarious trauma, compassion fatigue, and post-
traumatic stress experiences of several 9-1-1 dispatchers pairing it with psychotherapy
counsel on how to emotionally survive the type of stress that occurs from working in a 9-
1-1 Center (Marshall & Laorenza, 2018).
Duty-related trauma is a critical element of stress, specifically focusing on various
call-types and critical incidents (see the section on Vicarious Trauma). However, it
cannot be understated that there are several contributing factors involving the workplace
conditions that result in psychological distress experienced by 9-1-1 professionals. Stress
factors in public safety telecommunicators are broadly defined in this report, and shall be
broken down into the following sub-topics: workplace conditions, burnout, retention,
attrition, and next-generation technology.
Workplace Conditions
The conditions inside a 9-1-1 Center are unique to each agency. There is
research, however, that identifies a similar trend of stress factors stemming from
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workplace conditions. Challenges faced by 9-1-1 professionals often include rotating
shifts, mandated overtime due to poor staffing levels, weekends and holidays scheduling,
and long hours at the console without a break (Turner, Lilly, Gamez, Kressler, 2019).
Researchers identified a substantial gap in the research showing the correlation between
the multiple workplace conditions and the resulting unfavorable outcomes. Thus, their
study was directed towards tying in specific work-related factors and their effects on
physical health (Turner et al., 2019). They discovered that scheduling dispatchers to
work long hours and mandating overtime may generate an increased level of anxiety and
depression along with a decrease in physical health. In addition, it has been reported the
overnight shift workers experience exhaustion from diminished sleep cycles resulting in
poor physical health and depression symptoms (Turner et al., 2019).
Shift schedules have been discovered to associate with increased risks of various
health-related issues such as cardiovascular disease, diabetes, obesity, and metabolic
syndrome (Lilly, London, & Mercer, 2015). An examination of 758 public safety
telecommunicators with a minimum of at least one year experience was conducted to
evaluate physical and psychological health. Physical health assessment included BMI
and health complaints, while psychological components involved depression and
substance abuse (Lilly et al., 2015). Indeed, the researchers discovered the obesity rates
were high in this occupation. Of the 758 participants surveyed, only 17% were
categorized as normal weight while 29% were classified as overweight and 53.4% as
obese (Lilly et al., 2015). Consequently, 52.2% had an increased weight within a 3-
month period (Lilly et al., 2015). An essential discovery of this research also showed that
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BMI was higher the longer individuals remained in this occupation (Lilly et al., 2015).
Researchers discovered other ailments such as headaches, heartburn, itchy or watery
eyes, back pain, and sleep difficulties which correlated with the work environment (Lilly
et al., 2015). For instance, PSTs utilize several computer screens which may generate
headaches and itchy or watery eyes, remaining sedentary for long periods (inability to
take a break due to call volumes) can result in back pain, and sleep disruption can occur
with rotating shift schedules (Lilly et al., 2015).
When 9-1-1 professionals are required to work long hours and sometimes
unpredictable shift schedules, it becomes difficult for them to balance their personal life.
Mandated hours may interfere with a pre-planned family engagement; diminished sleep
conditions might result in irritability which puts a strain on personal relationships;
handling difficult calls may result in the inability to keep emotions in check while
interacting with family (Turner et al., 2019).
Elizabeth Hayes conducted research in 2017, studying various stress effects of
nine 9-1-1 dispatchers from a 9-1-1 Center in the Midwest (Hayes, 2017). She collected
data regarding stress levels on working days versus non-working days, any health related
issues associated with stress negative effects of stress on personal lives, and she identified
different stress-related symptoms throughout the study (Hayes, 2017). She conducted
three quantitative surveys with the participants: a daily assessment which asked specific
questions regarding their stress-related symptoms on work days, and subsequent related
call types, an intake assessment for the purpose of obtaining demographic information,
and an exit assessment in which an additional four questions were asked of the
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participants seeking information regarding the impacts of stress on their life, professional
stress-relief programs, etc. (Hayes, 2017). The results of this study are significant,
proving the need for a peer program designed specifically for 9-1-1 dispatchers. Ms.
Hayes learned that stress was indeed more prevalent on working days versus non-
working days and that factors such as poor eating habits and lack of sleep also
contributed to that stress. More importantly, although certain call types were likely to
generate some higher stress levels, it became evident that no two dispatchers yielded the
same stress response to identical critical call types. Thus, it was concluded in this study
that 9-1-1 dispatchers do in fact experience varying degrees of stress, although further
investigation was deemed necessary in a long-term study to identify precise details of the
effects of job-related stress (Hayes, 2017).
Adverse work conditions in the 9-1-1 Center have proven to directly affect the
health and wellness of 9-1-1 professionals. It is evident the combined elements of stress-
related workplace conditions with critical incidents and work-life balance, generate a
significant amount of stress. However, that still does not cover the extensiveness of the
emotional trauma experienced by 9-1-1 professionals. An additional identifying stress
factor discovered by Turner et al. (2019) as having a negative impact on health is job
Burnout, Retention, and Attrition
Stress in 9-1-1 dispatchers involves burnout and the overall feeling of being
misunderstood and underappreciated. Researchers conducted a quantitative analysis in
2019 involving 9-1-1 personnel from multiple cities (Linos, Ruffini, & Wilcoxen, 2019).
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The study involved a two-part research challenge. The first method surveyed 9-1-1
personnel from the Los Angeles Police Department, housing one of the largest 9-1-1
Center’s in the country. The researchers used the Maslach Burnout Inventory (MBI)
Human Services Survey with the intent of evaluating burnout on three disparate scales to
include exhaustion, depersonalization, and individual accomplishment (Linos et al.,
2019). The results showed the surveyed participants to be approximately 40 years of age
with a tenure as a 9-1-1 dispatcher on an average of 13 years. Researchers determined 43
percent of the participants exhibited high levels of burnout on all three scales and
particularly elevated on emotional exhaustion and depersonalization. The researchers
documented this result as being significantly higher than other comparable frontline
occupations (Linos et al., 2019).
Linos, Ruffini, and Wilcoxen (2019) took this first study a step further, asking the
Los Angeles participants whether or not they felt a level of social belonging and social
support. The researchers identified a correlation between social belonging and burnout:
…a dispatcher’s perception of whether they are valued and understood is
significantly negatively correlated with burnout. […] It is noteworthy that
perceptions of how police officers view them is a stronger predictor of dispatcher
burnout than perceptions of how peers view them. This suggests that being in a
low-status role may be crucial to the link between workplace identity threat and
burnout. (Linos et al., 2019, p.9).
Although the results of this first study method yielded proof that a relationship exists
between feeling a sense of belonging and being valued with job burnout, the researchers
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could not identify an underlying link between social belonging and burnout (Linos et al.,
2019). Therefore, the researchers moved to a second study method involving a controlled
experiment in nine mid-sized cities in the United States. The details of this study will be
further examined in the section Peer Support as it involves measuring results of an
intervention program in these 9-1-1 Centers.
In his doctoral dissertation, Malcolm Sotebeer (2011) sought to provide the 9-1-1
industry with documented analysis of the contributing factors of absenteeism and
turnover in 9-1-1 Centers. Turnover in a 9-1-1 Center represents the approximate
percentage of employees who have been separated from the organization either
voluntarily or through disciplinary action (Sotebeer, 2011). A valuable resource
published by APCO called Project Retains (Responsive Efforts To Address Integral
Needs in Staffing) stated that approximately 97 percent of public safety
telecommunicators would not achieve longevity in their career, eliminating any
retirement benefits opportunity. Project RETAINS cited stress as the contributing factor
for 9-1-1 professionals not following through with this career path (“HR, Staffing, &
Retention,” n.d.). The role of a 9-1-1 professional is instrumental in the safety of the
public, therefore a reduction in staffing due to absenteeism or turnover can prove
detrimental during life and death scenarios. Call answer times may increase while the
quality of service decreases resulting in a break of public trust (Sotebeer, 2011). In his
research, Sotebeer (2011) specifically measured the patterns of absenteeism and turnover
with the intensive demands of the job, extreme fatigue, and pessimism. With public
safety telecommunicators being on the lower end of the pay scale spectrum, staffing
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shortages are certainly challenging for 9-1-1 leaders to conquer. According to statistics
from the U.S. Bureau of Labor Statistics and NENA, the median annual salary in 2017
for a 9-1-1 professional was listed at $39,640 (Mission Critical Partners, 2019).
The reasoning behind an employee’s departure is instrumental in figuring out how
to combat the extreme turnover rates. Therefore, Sotebeer included an examination of
positive motivational factors such as leadership support, autonomy, and appropriate
resources that would likely reduce turnover (Sotebeer, 2011). Significant job demands
can be draining, leading to physical and psychological issues that ultimately result in
absenteeism. Conversely, when job resources such as employee engagement, support,
empowerment, and motivation are present, dispatchers are more apt to remain at their
place of employment, reducing the amount of turnover (Sotebeer, 2011). Surveys were
conducted with a diverse collection of agencies, resulting in 216 participants. The
research approach was extremely forward-thinking for 9-1-1 industry standards because
of the factors considered for study were rarely assessed previously. Sotebeer (2011)
supplied the participants with six research questions that sought to measure a relationship
between excessive absenteeism with turnover, adding in variables that included the
demands of the job and the resources provided. The findings of his research suggested
that job demands indeed may be correlated with excessive absence. Similarly, job
resources may also be contributing to the reasoning why an employee leaves the
organization (turnover intention). Sotebeer (2011) ultimately concluded that
relationships between job demands with absenteeism and job resources with turnover
intention are rather frail. However, the fact that 9-1-1 Centers suffer from the challenges
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of high turnover rates and extreme absenteeism proves the need to further study the cause
(Sotebeer, 2011). One final argument made by Sotebeer (2011) indicates the need for
further development of the argument that psychological and emotional stress may lead a
9-1-1 professional to leave the career altogether.
Next Generation Technology
The job of a 9-1-1 professional is proven to be multi-fold with a substantial
amount of intellectual processing and “emotionally-infused data” (Marshall & Laorenza,
2018). Technology also plays a fundamental role in the job of a 9-1-1 professional and
the way an incident is processed. It is a common misconception that location information
is automatically displayed as soon as an individual dials 9-1-1. While most 9-1-1
agencies employ automatic number identification (ANI) and automatic location
identification (ALI), also known as enhanced-9-1-1, there are still some jurisdictions
across the country that do not (Kashani et al., 2018). Further, ANI/ALI information is
only displayed when an individual calls from a landline phone. With the major increase
in wireless devices, obtaining exact location information from a 9-1-1 caller can be
problematic (Kashani et al., 2018). Investigative reporter Brendan Keefe blew the
whistle on a monumental glitch for wireless 9-1-1 calls when he conveyed the very tragic
story of 31-year-old newspaper delivery team member Shanell Anderson (Keefe & Kish,
In the early morning hours of late 2014, Ms. Anderson was delivering newspapers
on a route that was unfamiliar to her (Keefe & Kish, 2015). It was still dark out when she
made a right turn out of a neighborhood onto what she assumed to be Batesville Road
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(Keefe & Kish, 2015). Instead, she drove her vehicle straight into a pond in the front of
the community she attempted to exit (Keefe & Kish, 2015). She called 9-1-1 from her
cellular phone, explaining to the 9-1-1 dispatcher that her doors would not open and that
she had no tools to break the windows (Keefe & Kish, 2015). She advised her location,
but shockingly, the 9-1-1 dispatcher was not able to pinpoint the location in her computer
system and kept asking Ms. Anderson to repeat it (Keefe & Kish, 2015). For one minute
and 38 seconds, Ms. Anderson continued to repeat her location while the vehicle sank
farther into the water (Keefe & Kish, 2015). The 9-1-1 dispatcher was unable to see this
address in her system because the cellular call pinged on a cell tower inside a different
jurisdiction (Keefe & Kish, 2015). This problem occurs frequently, clearly indicating a
fundamental flaw in 9-1-1 systems technology (Keefe & Kish, 2015).
Several minutes went by before the originating 9-1-1 Center realized that Ms.
Anderson was in the next county over (Keefe & Kish, 2015). Once the correct
emergency responders arrived to the location, Ms. Anderson’s vehicle was completely
submerged (Keefe & Kish, 2015.) Sadly, Ms. Anderson succumbed to her injuries from
that fateful night (Keefe & Kish, 2015). Her story has resonated in the 9-1-1 industry,
driving legislation to improve the location accuracy of wireless devices and push the next
generation of 9-1-1 technology forward. Calling 9-1-1 from a cell phone provides the
location of the cell tower, not the location of the cell phone itself. Additionally, each 9-1-
1 Center has their own mapping systems that are exclusive to their jurisdictions with clear
boundary lines (Keefe & Kish, 2015). Figuring out the precise location of a wireless 9-1-
1 call is extremely challenging and often times through no fault of the 9-1-1 dispatcher
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attempting to obtain the information. Understandably, the technology obstacles are
contributing to the already elevated stress levels in 9-1-1 dispatchers. Approximately
80% of 240 million 9-1-1 calls come from wireless devices (Kashani et al., 2018).
Modern technology is far more advanced than many 9-1-1 Center’s current technology
capacity. The technology pitfalls in the 9-1-1 industry have received national attention
resulting in a push to completely overhaul the 9-1-1 infrastructure in a movement called
Next Generation 9-1-1 (Clark, 2020).
Next Generation 9-1-1 (NG9-1-1) gained significant traction in 2016 when the
NG9-1-1 NOW Coalition presented a plan for implementation over the next 4 years
(DeMar, 2017). This initiative of modern 9-1-1 technology will allow the public to send
digital information such as text messaging, pictures, and videos directly to the 9-1-1
Center via a secured network (DeMar, 2017). The advancement of this technology would
allow 9-1-1 dispatchers to have a more accurate account of exactly what is occurring at
the scene when processing a 9-1-1 call. In his Master’s Thesis, Jeremy DeMar (2017)
coined the term incident related imagery (IRI), providing the industry with specific
research regarding the impact of such technology on 9-1-1 professionals:
Still images, pre-recorded video, and streaming media, […], sent by the 9-1-1
caller to the 9-1-1 telecommunicator during an emergency incident will invariably
compound the amount of stress to which these professionals are exposed (DeMar,
2017, p. xii.).
His research question was simple and to the point, seeking to address what the effect
would be on 9-1-1 professionals once the NG9-1-1 initiative introduced video, images,
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and streaming media via 9-1-1 calls (DeMar, 2017). The research was remarkable and
unique in the 9-1-1 industry, as most of the information regarding NG9-1-1 previously
involved the actual tools and equipment. DeMar (2017) delved into the concerns of 9-1-1
leaders across the country by addressing the precise impact of IRI on the frontline
telecommunicators as individuals. The mental and emotional well-being of 9-1-1
professionals are essential in order to successfully fulfill their responsibilities. They are
already stressed with the calls they receive and process, which requires adapting and
listening to in-progress tragedies such as: a mother screaming over the death of her child,
talking a suicidal caller into safety, or a violent domestic disturbance. Research has
established that PTSD rates are increasing in 9-1-1 professionals, even though they are
not directly on the scene of a traumatic incident (Frazier, 2019). The expectation of
stress is categorically higher for 9-1-1 professionals when you add in the images and/or
streaming video component from a scene as it unfolds, prior to emergency responder’s
arrival (DeMar, 2017).
The historic research of IRI further explains the challenge of receiving live-
streamed footage into the 9-1-1 Center. Most 9-1-1 policies require an emergency
dispatcher to remain on the phone line with a caller during a critical incident, so a steady
relay of information can be provided to emergency responders while they are en route to
the scene and as the situation is unfolding (DeMar, 2017). Therefore, it shall be expected
for these policies to remain the same when an individual is sending a streaming video of
the scene in real-time (DeMar, 2017). While this live footage and information may be
extremely beneficial to law enforcement and fire/EMS personnel, the burden of increased
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exposure to vicarious trauma by 9-1-1 professionals cannot be understated (DeMar,
To help combat the stress effects of IRI, it is suggested that stress resilience
training should begin as soon as a 9-1-1 dispatcher is hired (DeMar, 2017). Further, since
most 9-1-1 professionals are hired needing only a high school diploma, the
recommendation is to increase those requirements to include more technological skills
(DeMar, 2017). Training is also a fundamental component to the work of a 9-1-1
professional, and it is a perpetual task for training staff. With the onslaught of NG9-1-1,
training will likely need to intensify in topics such as data interpretation and emergency
preparedness. DeMar’s research recommendations insist that training begins now while
the 9-1-1 industry is currently proceeding with the NG9-1-1 movement (2017). There are
several pieces of NG9-1-1 that must be mastered before it ends up in the 9-1-1 Center.
For example, infrastructure is being revamped and advanced, existing 9-1-1 systems are
being overhauled and modernized, and funding is being discussed at the federal level
(DeMar, 2017). That said, DeMar concludes his recommendation with the following:
…proactive monitoring of personnel viewing objectionable material is beneficial
when it comes to mitigating the effects of secondary trauma and compassion
fatigue. To bolster this effort, enrolling all communications personnel in a stress
or trauma awareness program and encouraging co-workers to watch out for one
another may reduce the likelihood of a traumatized worker going unnoticed
(DeMar, 2017, page. 80).
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To date, DeMar’s research on incident related imagery still remains the only one of its
kind. The NG9-1-1 deployment in this country has commanded a lot of attention, as
there is no doubt a situation like Ms. Anderson’s tragic fate just four days after Christmas
in 2014 would be prevented with this modern technology in place (Keefe & Kish, 2015).
However, with the implementation of this technology, there must be a resilience and
support plan in place for the 9-1-1 professionals in an effort to mitigate the experiences of
vicarious trauma, secondary traumatic stress, and compassion fatigue that occurs as a
result of incident related imagery (DeMar, 2017).
Vicarious Trauma
Extensive research uncovers emotional stress experienced by 9-1-1 dispatchers
including vicarious trauma, secondary stress, compassion fatigue, and post-traumatic
stress. A peer-reviewed article in the Annals of Emergency Dispatch and Response
(AEDR) Journal in 2015 analyzes the rates of acute stress disorder (ASD) involving
secondary traumatic stress and occupational burnout in 205 emergency dispatchers
(Trachik et al., 2015). The authors identifiy that while many studies conducted on post-
traumatic stress disorder (PTSD) in first responders include emergency dispatchers, in
actuality, there is more of a need to examine the effects of secondary traumatic stress
(STS) and factors on the job that contribute to burnout. Their study includes
investigating, “…the effects of STS and functional impairement on job satisfaction and
burnout” (Trachik et al., 2015, p.28). The authors specifically call attention to functional
impairement of 9-1-1 dispatchers as an indication of prolonged exposure to traumatic
events (Trachik et al., 2015). An exploratory study investigated whether there is a
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correlation between stress, compassion fatigue, and quality of life of public safety
telecommunicators. The researchers discovered certain types of calls increase stress
reactions, leading them to conclude emergency dispatchers are at-risk for secondary
trauma related to job burnout and functional impairement (Trachik et al., 2015).
Evidence has shown 9-1-1 professionals experience vicarious trauma even though they
are not directly exposed to a scene. Adding to that stress are overall feelings pertaining
to lack of power and control, as there is rarely any closure for a 9-1-1 professional,
leading to an increased risk of compassion fatigue (Golding et al., 2017).
Compassion Fatigue
Resarchers Fiona Cocker and Nerida Joss (2016) examined the role of
compassion fatigue in emergency workers, mostly healthcare nurses, and the interrelation
of secondary traumatic stress. They identified a significant connection between
compassion fatigue in frontline emergency workers amidst prolonged exposure to
traumatized individuals. The purpose of their research specifically focused on the role of
an intervention program to help combat the negative effects on the mental, physical, and
overall well being of this population being repeatedly subjected to this type of trauma
(Cocker & Joss, 2016). Although the researchers directed their concentration on
emergency workers which gives an impression of a broad perspective, it is included as a
profound section of this literature review because 9-1-1 dispatchers are often referred to
as members of frontline emergency workers classification. Published research in the
Annals of Emergency Dispatch & Response support this standpoint by stating,
“emergency work in general, whether on the front lines or working as a dispatcher, is
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often characterized by several common requirements: working under pressure, multi-
tasking, making rapid and effective decisions, working in shifts with 24/7 coverage, and
managing difficult emotions” (Turner et al., 2019, as cited by Halpern, 2009).
Public safety telecommunicators are not direct witnesses to a traumatic incidents,
however; the calls they process are often from highly emotional, stressed, and anxious
individuals – and often in rapid succession of one another. The indirect exposure to
trauma is of great concern in the 9-1-1 profession. No two calls are alike, and the
incidents that are most stressful involve a child-related death, suicide, shooting situations,
etc (Frazier, 2019). Cocker and Joss (2016) identified compassion fatigue as a stressor
caused by being in contact with traumatized individuals, not the actual trauma. It was
shown that compassion fatigue can generate behaviors that range from irritability, anger,
and depression to extreme bouts of exhaustion and diminished job satisfaction or burnout
(Cocker & Joss, 2016).
The research conducted by Cocker and Joss (2016) included measuring the effects
of a workbased intervention program to help overcome compassion fatigue. They
discovered a positive improvement on the mental health and wellbeing of the
occupational group involved. However, they noted with great importance the significance
of a minimal amount of evidence-based research in this area, suggesting further studies
are necessary to support their claims. While this research only involved nurses as
participants, the researchers noted this genrealization of their findings can affect other at-
risk emergency workers such as police officers, fire fighters, and paramedics (Cocker &
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Joss, 2016). This claim is also significant to public safety telecommunicators as they are
often categorized with the at-risk emergency service population.
The Compassion Fatigue Project contends that caregivers, or those working in a
cargiving environment, are the most susceptible to experiencing a high amount of
compassion fatigue (2020). These workers are continuously exposed to distressing,
highly emotional situations and may experience symptoms such as feelings of depression,
irritability, isolation, substance-abuse, sleep disorders, etc. Compassion fatigue has also
been linked to high rates of absenteeism and turnover, causing additional stress on peers
in the workplace (Compassion Fatigue Project, 2020).
The most compelling evidence regarding compassion fatigue and secondary
traumatic stress experienced by 9-1-1 professionals is found in the types of calls that are
handled more than the environment they are subjected to. This occupation is put in the
same classification as other caregiving professions, therefore, experiencing symptoms
that are classified as PTSD are not uncommon. In Trachik et al’s research, they
identified that 38% of PTSD cases now include “witnessing and hearing about a trauma”
(2015). The significance of these findings is profound. It is reported that the DSM
criteria has been updated regarding PTSD, adding the specific experience of first
responder’s repetitious exposure to unpleasant details of traumatic events (Trachik et al.,
2015). Dispatchers are often required to suppress emotional responses as they handle
multiple calls, becoming absorbed into the tragedy listening to hysterical or panic-
stricken callers. Secondary traumatic stress experienced by 9-1-1 professionals has been
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hypothesized to occur at a higher rate than that of other first responder populations,
although research and literature still remain scarce (Trachik et al., 2015).
Secondary Traumatic Stress
Research in the Journal of Traumatic Stress studying the post-traumatic stress
disorder (PTSD) symptomatology in public safety telecommunicators, identified being in
direct proximity to a critical incident location is, in fact, not a requirement of PTSD
(Pierce & Lilly, 2012). The authors found past research has been conducted correlating
PTSD symptoms with traumatic exposure in police officers and confirmed research is
needed to associate traumatic distress and PTSD in 9-1-1 dispatchers (Pierce & Lilly,
2012). They conducted their study of 171 PSTs, surveying their reactions of various
types of 9-1-1 calls that have the potential to be traumatizing. As a result, the researchers
connected a relationship between traumatic calls and secondary traumatic stress (Pierce
& Lilly, 2012).
Further research conducted by Lilly and Allen (2015) sought to examine the
emotional well-being of 9-1-1 professionals, specifically focusing on the indirect trauma
exposure and how it affects this population. A total of 808 PSTs completed their study,
with years of experience ranging from 1 to 42 years (Lilly & Allen, 2015). The measures
in this study were self-reporting and involved a survey that took approximately 108
minutes to complete (Lilly & Allen, 2015). The researchers utilized the Traumatic Life
Events Questionnaire (TLEQ) which examined extensive exposure to 23 different
traumatic events, the Peritraumatic Distress Inventory (PDI) examining distress involving
the participants worst duty-related traumatic incident, and the Peritraumatic Dissociative
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Experiences Qustionnaire (PDEQ) to identify any dissociative experiences from a duty-
related traumatic event (Lilly & Allen, 2015). There were other response quesstionnaires
utilized that focused primarily on general feelings with overall data being analyzed using
descriptive statistics (Lilly & Allen, 2015). To no surprise, the results drew colossal
conclusions, proving that public safety telecommunicator’s psychological encumbrances
while employed in this line of work are substantial. Additionally, PTSD symptoms were
shown to be greater in this population than others, calling specific attention to these
symptoms building over time instead of being triggered by one event (Lilly & Allen,
2015). The conclusion of Lilly and Allen’s research included an austere message to the
9-1-1 industry expressing that the well-being of 9-1-1 professionals should be a “top
public health priority” (2015).
Peer Support
Quite a few peer-reviewed articles have been authored or co-authored by Dr.
Michelle Lilly on the topic of stress-related trauma in 9-1-1 dispatchers since her first
2012 publication referenced above. One such article focused on creating an intervention
program to help reduce the stress experienced by 9-1-1 dispatchers through repeated
exposure to secondary trauma situations (Meischke et al., 2018). The research proposal
has been approved and is currently in progress. However, the details are relevant to this
literature analysis.
The researchers drew upon previous reports identifying a correlation between
secondary stress and PTSD in 9-1-1 dispatchers. With this previously documented
information, their intent is to study the effectiveness of creating a program specifically
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for public safety telecommunicators to reduce their stress (Meischke et al., 2018). The
study will be longitudinal and consist of a random experiment to examine how effective a
web-based mindfulness training would be in reducing stress for 9-1-1 professionals. To
start, participants would complete a stress survey to establish a baseline and then split
into two different groups: one receives the mindfulness training, and the other does not
(Meischke et al., 2018). The goal is to identify whether the telecommunicators who
received the mindfulness training reported a decrease in stress symptoms versus those
who did not experience this training. The proposal concludes by stating the objective,
which is to increase the amount of research in the 9-1-1 industry that would help reduce
the stress of 9-1-1 professionals by providing workplace resources such as mindfulness
training (Meischke et al., 2018). The pattern is becoming clear in that stress is
unmistakably proven to be prevalent in the 9-1-1 industry, yet the intervention necessary
to mitigate the devastation of vicarious trauma remains limited.
Traumatology published an original research article explaining the need for peer
supporters to assist emergency workers with the negative psychological effects of
prolonged trauma exposure (Scully, 2011). This research focused on presenting an
alternate solution to employee assistance programs and critical incident stress
management, claiming that neither of these models provide individual support for
extended stress (Scully, 2011). The article examines individual and group crisis
intervention showing they focus mostly on a single traumatic event, thereby identifying
the need for a program that provides opportunities for support whenever necessary, not
just after a specific incident (Scully, 2011). The methodology approach the researcher
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used examined previous literature that studied the effects of debriefings, emergency
assistance programs, and single-trauma interventions. The analysis showed emergency
service workers cope with the demands of the job every day in considerably different
ways, suggesting a need for a new framework of support to include trained peers (Scully,
2011). The researcher proceeds to identify the benefits of a peer support model, to
include support for the day-to-day operations, traumatic events, and personal life status.
Another great benefit to this model indicates that a peer supporter is usually known to the
person seeking support, encouraging workers to proactively seek assistance (Scully,
Peer support is simply that – support from peers. Peer support is more adequately
defined as “offering and receiving help, based on shared understanding, respect and
mutual empowerment between people in similar situations” (Mead et al., 2001, as cited
by Repper, 2013). When individuals share a personal comprehension of the stressors
faced in the workplace, they can assist each other by being able to identify such feelings
and share coping experiences. Additionally, the variables that link peers together assist
with fostering elements of trust, empathy, and compassion (Repper, 2013). Studies are
beginning to pop up regarding intervention or prevention programs in the workplace.
A two-part study was conducted by researchers who wished to examine whether a
mindfulness-based intervention program would help mitigate the effects of emotional and
vicarious trauma (Marks, Cunningham, & Bowers, 2018). This team of researchers
identified and documented a profound problem in the 9-1-1 industry. In the introduction
portion of their research proposal, they explained the difference between military PTSD
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prevention efforts with that of emeregncy dispatchers. While prevention programs are
already in place for the military, the researchers suggested a special program may need to
be designed that is specifically tailored for 9-1-1 professionals (Marks et al., 2018). They
explained that soldiers’ trauma exposure is direct and includes multiple senses including
olfactory, auditory, visual, and tactile; whereas, a 9-1-1 dispatcher’s exposure to trauma
is entirely indirect and involves mostly the auditory sense (Marks et al., 2018). Of
course, as technology continues to improve at its current pace, emergency dispatchers
will be faced with visual sensory exposure as well.
Both studies conducted by Marks et al. (2018) intended to understand the
correlation between present perceived control, quality of life, and secondary traumatic
stress. Their analysis proved that individuals with a higher level of perceived control will
likely experience a decreased amount of secondary traumatic stress. The researchers
concluded with recommendations for training that focuses on how emergency dispatchers
can develop present perceived control when they are handling critical incidents (Marks et
al., 2018). They further suggest mindfulness intervention programs to assist with
reducing stress and improving the well-being of emergency dispatchers. They posited
that emergency dispatchers are unable to control the past 9-1-1 calls they have received
or the calls they will handle in the future. However, with mindfulness training and
intervention, they may be able to control the influence of disturbing thoughts during a
current emergency incident, which would ultimately reduce the subsequent secondary
stress reactions (Marks et al., 2018).
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Researchers Linos, Ruffini, and Wilcoxen’s work was discussed previously in this
report regarding dispatchers feeling unappreciated or undervalued which led to stress and
burnout (2019). Part of their long-term study involved weekly emails being sent to a
select amount of participants by someone in a supervisory role. The intention of the
emails was mainly to provide support, advice, and encourage dispatchers to ruminate on
their work experiences. It also served as a motivator for the recipients to deliver that
same type of assistance to newer dispatchers, essentially resulting in peer-to-peer support
(Linos et al., 2019). This study supplies instrumental evidence for the 9-1-1 industry as it
proves a correlation between intervention programs and a decreased amount of stress
among the participants, suggesting further research is necessary to support the benefits of
implementing peer-based programs to reduce stress and burnout (Linos et al., 2019).
Ryan Dedmon, Outreach Director for the 9-1-1 Training Institute, wrote an article
for Law Enforcement Today that highlighted the newly implemented peer support
program at St. Joseph’s County 9-1-1 Center in Mishawaka, Indiana (2019). This agency
is fortunate to have a team of proactive leaders focused on the well-being of their 9-1-1
professionals. The Executive Director supported a request to implement a Peer Support
Team, and so their Operations Chief set out to develop a team that included formal
training and partnership with the 9-1-1 Training Institute (Dedmon, 2019). The founders
of the Peer Support Team included members that had 40+ years of combined service in
public safety (Dedmon, 2019). They all sought the same goal – to assist and provide
support for their dispatchers to ensure they remain physically and mentally healthy.
More importantly, they intended to change the future for their dispatchers (Dedmon,
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2019). Having experienced an extreme amount of stress from past traumatic events and
understanding the uniqueness of the job, they had a strong desire to make sure their
dispatchers have the care and assistance that was absent for them throughout their careers
(Dedmon, 2019).
Training was provided to the St. Joseph’s County 9-1-1 team by the 9-1-1
Training Institute, tailored specifically for 9-1-1 professionals. The team reports the
training as powerful and emotional, opening up the release of their own emotions from
previous incidents (Dedmon, 2019). They also identified this training as pivotal in being
able to heal from their past trauma-related experiences so they can better assist their peers
(Dedmon, 2019). Dedmon quotes Cindy Foster, Peer Support Team Member and Shift
coordinator who states, “Things like Employee Assistance Programs are good, but many
don’t completely understand the work of a 9-1-1 dispatcher; who better to understand
than a peer who does the same job as you” (2019). A Peer Support Team becomes a
resource for employees to utilize for all types of issues, including those that are non-work
related. It is designed to supplement resources such as Critical Incident Stress Debriefing
(CISD) and Employee Assistance Programs (EAP), not replace them (Dedmon, 2019). In
fact, they are also considered a vital link to additional professional resources if the
dispatcher’s need is beyond their scope of counseling.
The team at St. Joseph’s County 9-1-1 received national attention when they
publicized the launch of their peer support program and uniquely-designed, agency-
specific poker chips that were distributed to all their dispatchers with the inscription ‘No
One Fights Alone.’ The purpose of the poker chips were two-fold: to remind the
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dispatchers that they have a support system, and to turn their chip into a peer support
member as notification that they are presently in need of that assistance (Dedmon, 2019).
St. Joseph County 9-1-1 is one of many agencies in the country that has taken the time to
invest in the health and wellness of their emergency dispatchers, clearly recognizing the
lasting impact peer support program will have on the future of 9-1-1.
Gloria, the FDNY dispatcher whose story this report presented in the background
section of Chapter 1, claimed it was several years before she could admit she was
traumatized (Dispatcher G.A., personal communication, June 30, 2020). In fact, she had
no concept of what post-traumatic stress disorder even was (Dispatcher G.A., personal
communication, June 30, 2020). Gloria admitted she was unable to tear herself away
from watching non-stop TV for weeks after 9/11, as the news media replayed the horrific
scenes over and over again (Dispatcher G.A., personal communication, June 30, 2020).
After that, she felt like she was in full survival mode, simply existing in the world that
had been torn apart right in front of her (G. A., personal communication, June 30, 2020).
Gloria explains her feelings of anger, guilt, and denial that threatened to engulf her and
went unaddressed for at least 10 years after the incident. She never felt that her trauma
and emotions were an issue because she had a strong desire to continue to help others
(Dispatcher G.A., personal communication, June 30, 2020). Yet it was not until recently
that she came to the realization she suffered from PTSD and finally sought to work
through her emotions of that fateful day. “Peer support would have made a big difference
in me being able to talk about it, and not being in self-denial about my feelings,” (
Dispatcher G. A., personal communication, June 30, 2020).
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Chapter 3: Discussion, Recommendations, and Conclusion
While there are a number of studies regarding PTSD in military personnel and
public safety first responders, the data is still considerably limited regarding the effects of
incident-related trauma in 9-1-1 dispatchers. These public safety professionals are on the
frontlines of critical incidents, dealing with emotionally charged callers in the midst of
their worst crises, in a fast-paced and crucial decision-making environment. A 9-1-1
dispatcher experiences far more emotional stress in one shift than the civilian population
experiences in the course of a year. Research has proven the fundamental importance of
the 9-1-1 dispatch profession by identifying the mitigating factors resulting in emotional
stress without being directly exposed to the physical location of a critical incident. This
systemic analysis of literature also discovered job burnout and turnover rates that suggest
9-1-1 Centers have minimal programs in place for reducing secondary traumatic stress
responses in their dispatchers. The stress-reducing effects of peer spporters in the
workplace can have a significant impact on the overall mental well-being of 9-1-1
The analysis confirms the existence of vicarious trauma, secondary traumatic
stress, and compassion fatigue being prevalent in the 9-1-1 profession. The implications
of these types of stress factors are clear in identifying the detrimental effects of prolonged
exposure to trauma experienced by emergency dispatchers. The research demonstrates a
correlation between the extensive trauma exposure and issues such as depression and
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anxiety, obesity, sleep disruption and chronic fatigue, irritability, job disassifaction, and
burnout. The 9-1-1 industry is managing significant progress involving recognition for
emergency dispatchers as equal to that of other first responders. There is far more
research located today on the emotional effects of vicarious trauma in this profession
versus even just five to seven years ago. It is being discussed at conferences, in training
classes, on professional websites, and in forums such as podcasts and webinars.
Standards are currently evolving nationally that shall equip the 9-1-1 industry with the
core components of stress resilience with comprehensive stress and crisis management
planning. These findings should be taken into account when 9-1-1 leadership considers
policies, processes, and programs in the next-generation technology movement.
Leadership is a fundamental element to overcoming the burnout, turnover, and
attrition issues that challenge the operations and administration of 9-1-1 Centers. In fact,
a leader who genuinely cares about the people they choose to lead may successfully
combat all the distress and hardships that 9-1-1 dispatchers experience due to workplace
conditions and vicarious trauma. Adam Timm’s new book, People-Driven Leadership:
How the Best 9-1-1 Centers Inspire Positive Change, specifically discusses why the 9-1-1
industry is in need of people-driven leaders to solve the most demanding concerns that
require bold changes (2020). The majority of the issues facing the 9-1-1 industry were
reviewed in this research report because they all center around one major component: the
9-1-1 professional. Leaders are expected to inspire and motivate a positive work
environment. They are expected to actively listen and engage with their staff to identify
the principal needs, intrinsic and extrinsic as they may be, that 9-1-1 dispatchers require
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to function in their jobs satisfactorily, both physically and emotionally. The St. Joseph’s
County 9-1-1 Executive Director sets a great example for other leaders to follow when he
listened, supported, and encouraged the implementation of a peer support program for his
Poor leadership in 9-1-1 Centers will have catastrophic implications on the future
of the 9-1-1 industry. Research findings already show high rates of turnover and job
burnout. With poor physical health conditions that result from the increase of post-
traumatic stress among 9-1-1 professionals, hope for positive mental and emotional
health in this industry is bleak. Public safety leaders must band together to form a broad
and comprehensive plan for providing stress resilience training, intervention processes,
and peer support programs to their emergency dispatchers. Further, justifications for
budget and finances should be explored specifically for trauma-related support programs.
It is imperative that funds be allocated so that mental health and wellness care can be
provided to 9-1-1 personnel to effectively mitigate any negative effects of workplace and
stress conditions.
The limitations of this systemic research analysis were two-fold. While research
has improved over the years regarding the proliferation of PTSD in 9-1-1 dispatchers,
there was a substantial lack of data about resilience training and workplace intervention
programs. There is still far less research on the stress topics in the 9-1-1 profession than
there are in other public safety professions such as law enforcement, firefighting, and
emergency medical services. However, this current review of literature and research does
contribute a much clearer understanding of the types of stress factors surrounding 9-1-1
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professionals. Minimal peer-reviewed research was discovered regarding intervention
and support programs specifically for the 9-1-1 profession. Therefore, the existing
amount of studies cannot confirm the positive effects peer support programs would have
on mitigating the emotional effects of vicarious trauma experienced by 9-1-1
Further research is a necessity regarding the impacts of incident related imagery
spawned from next-generation 9-1-1 technology. The emotional health of 9-1-1
professionals simply cannot be sacrificed for innovation and cutting edge systems. The
9-1-1 industry must include their frontline telecommunicators in the discussions and
implementations of technological advancements while ensuring the safety and protection
of their well-being.. Additionally, it is recommended that further studies be conducted
with 9-1-1 professionals on the positive effects of mindfulness practices and peer support
programs in their organizations. Specifically, researchers should attempt to correlate the
implementation of such programs with a reduction in unfavorable work conditions such
as turnover, job burnout, and employee attrition. Leadership in 9-1-1 must also be
scrutinized in an effort to document the relationship between people-driven leaders and
positive organizational cultures.
The rates of PTSD, vicarious trauma, compassion fatigue, and secondary
traumatic stress are at an all-time high in the 9-1-1 profession. Emergency dispatchers
are exponetially considered an at-risk population for these stress conditions. Research
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© 2020 Melissa Alterio
studies must continue for this extraordinary profession to further highlight the numerous
factors that generate emotional distress and the subsequent mitigating evolutions.
This research analysis aimed to identify whether peer support programs would
help mitigate the emotional effects of vicarious trauma experienced by 9-1-1
professionals. Based on the extensive review of literature, it can be concluded that 9-1-1
professionals suffer a significant amount of stress caused by a wide-range of issues.
Further, the review proves that workplace intervention and programs such as critical
incident stress management, EAP programs, and peer support can positively effect the
mental well-being of public safety personnel.
Emergency dispatchers have been suffering with incident-related trauma distress
for several years. They are the first point of contact in every crisis, emergency, and
critical incident. For too many years, they have been excluded from any discussions
regarding public safety responders, especially when it involves PTSD. Times are
changing, and the continued increase in research proves the crucial demand to improve
the attention, value, and welfare of 9-1-1 professionals. Portions of next-generation
technology has already made its grand entrance into the 9-1-1 industry and there are
many more insurmountable segments of that technology on the horizon. 9-1-1
professionals must be taken care of now, more than ever. What better way to ensure the
emotional well-being of this amazing and unique profession than creating and
implementing a support program made up entirely of peers who know, understand, and
empathize with the impacts of stress and trauma.
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... Even as "9-1-1" has become enhanced with automated location identification, there have been many cases of litigation where 9-1-1 failed to be responsive (Gibson, contributing to attrition at 25-30% (Gibson, 2020;Wahlgren et al., 2020). Subsequently, the profession is plagued by 9-1-1 centers that are understaffed (Kelley, 2020) because job resources have not evolved as diligently as job demands (Alterio, 2020). ...
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High job demands mean high turnover for public safety telecommunicators (also known as “9-1-1 call operators” or “emergency dispatch”). Personnel turnover place 9-1-1 call centers in an understaffed situation, which reduces operational effectiveness and increases risk to communities. Though public safety telecommunicators experience work�related stress due to job demands, organizational commitment, and operational impacts, the impact of job demands and its influence on organizational commitment is under�researched. The purpose of this qualitative study was to understand job demands and the resources that influence organizational commitment of public safety telecommunications. The classical organizational theory of scientific management, or Taylorism, was theoretical framework. As such, the research questions emphasized perceptions of job demands and the organizational commitment experienced by public safety telecommunicators. Individual interviews served as the data source from participants in New Orleans, Louisiana. Purposeful sampling resulted in 13 individual interviews. The participant interview transcript data were coded and led the themes of (a) emotional demands, (b) mental demands, (c) physical demands, (d) work overloads, (e) bureaucracy, (f) team atmosphere, (g) person–job fit, and (h) availability of tools, which influence mostly the affective commitment of public safety telecommunicators. With these perspectives that further describe the life-or-death protective nature of the work, the implications for positive social change include understanding the reasons for turnover, which can lead to improved retention and operations as well as support for reclassification and innovation of the profession.
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Background: Emergency dispatchers serve as a unique population to examine the impact of exposure to trauma given their continuous indirect exposure to stressful and traumatic calls. Furthermore, the unique experiences of emergency dispatchers warrants consideration of preventative measures to mitigate the negative outcomes associated with the job. Methods: Due to the continuous stress and exposure to trauma, present perceived control is offered as a variable of interest. Present perceived control (PPC) is examined in two studies by the present researchers in relation to quality of life, exposure to traumatic events, and symptoms of PTSD. Results: Results of study one indicate quality of life corresponded with and predicted more secondary traumatic stress, and PPC corresponded with and predicted less secondary traumatic stress. In contrast to the offered hypothesis, PPC did not buffer the effects of stress or increase quality of life. In response, the researchers assessed if PPC serves as a buffer against additional life stressors on symptoms of PTSD. Study two revealed more exposure to traumatic life events corresponded to increased PTSD symptom severity, and more PPC corresponded to lower PTSD symptom severity. Further PPC was identified as a significant moderator of the relationship between stressors and PTSD symptom severity. Conclusions: Both studies shed light on the potential usefulness of incorporating mindfulness-based prevention among emergency dispatchers. By focusing on what dispatchers can control during 911 calls, the impact of exposure to trauma on quality of life and symptoms of PTSD may be alleviated.
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Burnout, an increasingly important challenge in modern workplaces, has been associated with negative health outcomes, high turnover, and poor organization performance. Yet, we have limited causal evidence about how to mitigate its risk. We posit that workers are more susceptible to burnout if they feel undervalued in their roles. Drawing on evidence from educational psychology, we hypothesize that increasing social belonging and support within the undervalued group may reduce workplace identity threat and subsequently affect burnout and turnover. Consistent with these hypotheses, we first find that worker burnout is significantly correlated with feeling undervalued. Second, in a multi-site field experiment (n=536), we find that a six-week intervention that primes social belonging within the low-status group significantly reduces burnout by about 8 points (0.4 SD) and resignations by more than half (3.4 percentage points). Our findings suggest that light-touch belonging-affirmation exercises can improve worker and organizational well-being. Introduction:
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Background: Nationwide, emergency response systems depend on 9-1-1 telecommunicators to prioritize, triage, and dispatch assistance to those in distress. 9-1-1 call center telecommunicators (TCs) are challenged by acute and chronic workplace stressors: tense interactions with citizen callers in crisis; overtime; shift-work; ever-changing technologies; and negative work culture, including co-worker conflict. This workforce is also subject to routine exposures to secondary traumatization while handling calls involving emergency situations and while making time urgent, high stake decisions over the phone. Our study aims to test the effectiveness of a multi-part intervention to reduce stress in 9-1-1 TCs through an online mindfulness training and a toolkit containing workplace stressor reduction resources. Methods/design: The study employs a randomized controlled trial design with three data collection points. The multi-part intervention includes an individual-level online mindfulness training and a call center-level organizational stress reduction toolkit. 160 TCs will be recruited from 9-1-1 call centers, complete a baseline survey at enrollment, and are randomly assigned to an intervention or a control group. Intervention group participants will start a 7-week online mindfulness training developed in-house and tailored to 9-1-1 TCs and their call center environment; control participants will be "waitlisted" and start the training after the study period ends. Following the intervention group's completion of the mindfulness training, all participants complete a second survey. Next, the online toolkit with call-center wide stress reduction resources is made available to managers of all participating call centers. After 3 months, a third survey will be completed by all participants. The primary outcome is 9-1-1 TCs' self-reported symptoms of stress at three time points as measured by the C-SOSI (Calgary Symptoms of Stress Inventory). Secondary outcomes will include: perceptions of social work environment (measured by metrics of social support and network conflict); mindfulness; and perceptions of social work environment and mindfulness as mediators of stress reduction. Discussion: This study will evaluate the effectiveness of an online mindfulness training and call center-wide stress reduction toolkit in reducing self-reported stress in 9-1-1 TCs. The results of this study will add to the growing body of research on worksite stress reduction programs. Trial registration: Registration Number: NCT02961621 Registered on November 7, 2016 (retrospectively registered).
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Emergency dispatchers are exposed to potentially traumatic events at rates that likely exceed that of emergency first responders. Although not physically present at the time of the incident, it is likely that this repeated exposure in concert with highly stressful work conditions could lead to potentially negative emotional and physical outcomes. To date few studies have examined rates of stress related pathology and subsequent impairment in emergency dispatchers. The following study takes an initial step to investigate rates of Acute Stress Disorder, Secondary Traumatic Stress and Occupational Burnout. 205 emergency dispatchers completed a survey while considering their occupational experiences and recent dispatch call history. Although the results of this study are exploratory, rates of these three outcomes exceeded that of the general population and were related to several job-specific factors that could potentially be modified to reduce dispatcher stress. Additional emergency call specific factors were also examined to uncover the potential contribution to negative stress-related outcomes.
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Compassion fatigue (CF) is stress resulting from exposure to a traumatized individual. CF has been described as the convergence of secondary traumatic stress (STS) and cumulative burnout (BO), a state of physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment. Professionals regularly exposed to the traumatic experiences of the people they service, such as healthcare, emergency and community service workers, are particularly susceptible to developing CF. This can impact standards of patient care, relationships with colleagues, or lead to more serious mental health conditions such as posttraumatic stress disorder (PTSD), anxiety or depression. A systematic review of the effectiveness of interventions to reduce CF in healthcare, emergency and community service workers was conducted. Thirteen relevant studies were identified, the majority of which were conducted on nurses (n = 10). Three included studies focused on community service workers (social workers, disability sector workers), while no studies targeting emergency service workers were identified. Seven studies reported a significant difference post-intervention in BO (n = 4) or STS (n = 3). This review revealed that evidence of the effectiveness of CF interventions in at-risk health and social care professions is relatively recent. Therefore, we recommend more research to determine how best to protect vulnerable workers at work to prevent not only CF, but also the health and economic consequences related to the ensuing, and more disabling, physical and mental health outcomes.
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Background: This study aims to: (1) examine rates of obesity and physical health complaints among 911 telecommunicators; and (2) document the role of emotion dysregulation, psychological inflexibility, duty-related distress and dissociation, and psychopathology in predicting obesity and physical health complaints in this population. Methods: The sample consisted of 911 telecommunicators from across the country (N = 758). Participants completed an online survey assessing their mental and physical health functioning. Results: A total of 82.5% of the sample reported a body mass index that fell within the overweight or obese category and an average of 17 physical health complaints within the past month. Peritraumatic reactions (distress and dissociation), emotion dysregulation, and psychological inflexibility had effects on physical health largely through psychopathology (alcohol abuse, post-traumatic stress disorder, and depression). Conclusion: Development of adapted prevention and intervention efforts with this population is needed.
There are 240 million 9-1-1 calls in the United States every year. The burden of managing these emergencies until first responders can arrive is on the dispatchers working in the 5806 public safety answering points, more commonly known as dispatch centers. They are the first link in the chain of survival between the public and the remainder of the health care system. Dispatchers play a critical role in the early identification of emergencies, assignment of appropriate emergency resources, and provision of life-sustaining interventions like dispatcher-assisted cardiopulmonary resuscitation and disaster management.
Peritraumatic distress is defined as the emotional and physiological distress experienced during and/or immediately after a traumatic event and is associated with the development and severity of posttraumatic stress disorder (PTSD) and related psychological difficulties. The Peritraumatic Distress Inventory (PDI) is a widely-used self-report measure for which psychometric evaluation has been limited. This study sought to assess the factor structure and predictive validity of the PDI with a clinical sample of 600 traumatically injured patients admitted to a Level I trauma center, 271 of whom completed a phone-based PTSD screening ∼30-days post-injury. The results confirmed previously proposed one- and two-factor solutions for the PDI. PDI scores predicted PTSD severity and positive PTSD screens (i.e., clinically elevated vs. non-elevated). Data suggested an optimal cutoff score of 23 (sensitivity = 71%; specificity = 73%) for predicting clinically elevated PTSD 30-days post-injury. This study provides further evidence supporting the PDI as a valid and reliable measure of peritraumatic distress and a useful clinical tool with significant prognostic value.
Following a brief overview of alternative Employee Assistance Programs (EAPs), this article proposes a comprehensive model of care for emergency service personnel. The pivotal element of the multilayered model is the Peer Support Officer (PSO) component providing early support to ambulance personnel following exposure to potentially traumatic events. After initial recruit training, peer supporters engage in professional supervision and annual psychological first aid education and counseling skill development workshops. The model is embedded within the workforce and is available to personnel for both work-related and personal matters. The success of the EAP relies on collaboration between the employer, professional counselors, and the trained peer support officers as well as extensive education and resilience building for employees. This article proposes that the model outlined offers high-profile, well-trained, and well-supervised peer support officers as an effective alternative to the more common approaches of the past, such as debriefing. Self-report, usage, and archival data collected across 18 years indicate the model offers significant benefits to employees and to their family members.
Peritraumatic distress may increase the risk for posttraumatic stress disorder (PTSD) in police officers. Much less is known about emotional reactions and PTSD symptomatology in 911 telecommunicators. The current study assessed duty-related exposure to potentially traumatic calls, peritraumatic distress, and PTSD symptomatology in a cross-sectional, convenience sample of 171 telecommunicators. Results showed that telecommunicators reported high levels of peritraumatic distress and a moderate, positive relationship was found between peritraumatic distress and PTSD symptom severity (r = .34). The results suggest that 911 telecommunicators are exposed to duty-related trauma that may lead to the development of PTSD, and that direct, physical exposure to trauma may not be necessary to increase risk for PTSD in this population.