emergency telecommunicators and ptsd
DESCRIPTION
This paper provides information that examines PTSD as it relates to emergency telecommunicators. This population is extremely understudied and the lack of empirical literature is astounding. By examining current literature focused on emergency personnel such as police and firefighters, assumed causes and resolutions for PTSD in emergency telecommunicators were found. The need to for further research and implications are also discussed.TRANSCRIPT
EMERGENCY TELECOMMUNICATORS AND PTSD
Emergency Telecommunicators and PTSD
Laura Chase
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EMERGENCY TELECOMMUNICATORS AND PTSD
This paper provides information that examines PTSD as it relates to emergency
telecommunicators. This population is extremely understudied and the lack of empirical
literature is astounding. By examining current literature focused on emergency
personnel such as police and firefighters, assumed causes and resolutions for PTSD in
emergency telecommunicators were found. The need to for further research and
implications are also discussed.
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EMERGENCY TELECOMMUNICATORS AND PTSD
Emergency telecommunicators may be required to answer 911 calls, dispatch
law enforcement to dangerous calls, give fire personnel safety information as they enter
a burning building, or any other number of tasks. The job of emergency
telecommunicator is not always chaotic and stressful, but has the potential to be without
warning. This stress and the traumatic phone calls or radio transmissions these
employees must deal with daily can have a profound affect on their mental health.
Posttraumatic stress disorder (PTSD) may be more commonplace for this population
than one realizes. There is a lack of information about this specific disorder and how it
affects emergency telecommunicators. However, various causes and resolutions may
have been found. Gaining insight into this issue could have positive global implications.
Problem Statement
An enormous hole exists in the literature regarding emergency
telecommunicators and the way they process stressful and traumatic phone calls and
radio transmissions. Although emergency telecommunicators do not normally
experience the call by seeing it, they experience the call by hearing it. The
telecommunicators are the first people to speak to those in need; individuals who are
difficult to understand, hysterical, crying, angry, confused, scared, or suicidal. The
telecommunicators have a responsibility to provide assistance to these people in their
time of need and often experience stress from this heavy burden.
There is very little empirical research on the effects of trauma suffered by
telecommunicators when handling stressful telephone and radio calls. Emergency
dispatchers’ PTSD and their depressive symptoms were examined (Lilly & Pierce,
2012). A vast amount of PTSD research is available, which leaves a basis of
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EMERGENCY TELECOMMUNICATORS AND PTSD
information to use. One study examines anxiety sensitivity as it relates to PTSD (Wald
& Taylor, 2008). DiCecco (2011) summarizes the disorder with a concentration on
pathophysiology, care, and legal issues. Wong, Kennedy, Marshall, and Gaillot (2011)
examine PTSD in survivors of injury, and the treatment of PTSD is discussed by
Couineau and Forbes (2011).
There are many avenues for researchers to go down, but examining the
relationship between PTSD and telecommunicators seems to be the best one. The
disorder certainly plagues some telecommunicators, but just how many is unknown.
The effects of PTSD on these emergency service providers could have affects that
range from local to global; therefore, understanding the disorder and its effects is
crucial.
Critical considerations that may relate to this problem include globalism, diversity,
social change, and ethics. Gaining insight into an understudied public safety population
could benefit the public not only nationally but also globally. The United States is not
the only country with an emergency telecommunication system in place. Several other
nations have adopted a three-digit emergency number for law enforcement, medical,
and fire emergencies (Emergency numbers around the world, 2006). The same
benefits that could be gained in the United States could be gained globally.
Emergency communication centers may be comprised of a diverse group of
employees with different cultural backgrounds, different religious beliefs, and different
ethnicity. The diversity within communication centers can bring about challenges for
researchers. PTSD may affect people in different ways. For instance, a young man
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EMERGENCY TELECOMMUNICATORS AND PTSD
may become angry and withdrawn, whereas a new mother may become depressed and
have difficulty sleeping at night. Researchers must keep these differences in mind.
Social change is possible if PTSD in emergency telecommunicators is examined
by possibly allowing these individuals to obtain better health care and social awareness.
These telecommunicators provide a public service, and if they are not functioning
properly it could mean the safety of countless citizens. The research touches on this a
bit but not nearly enough.
Critical Resource Review
Lilly and Pierce (2012) have ventured into a territory in which little is known.
They examine depressive symptoms and PTSD in 911 telecommunicators as well as
how that relates to world assumptions and peritraumatic distress. With such an
enormous hole in the literature about the 911 telecommunicator population, this study is
a small glimpse at an area that needs much more attention. Variables measured in this
study were PTSD symptoms, depressive symptoms, benevolence of the world, self-
worth, controllability, and peritraumatic distress. Lilly and Pierce (2012) argue that
PTSD and depressive symptoms are positively correlated with peritraumatic distress.
They also argue that benevolence of the world and self-worth are negatively correlated
with symptoms of PTSD. Although controllability was measured, no significant
relationship was present with depressive or PTSD symptoms. Last, the authors found
that there was no significant relationship between benevolence of the world and
controllability with peritraumatic distress, although there was a significant relationship
between self-worth and peritraumatic distress.
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EMERGENCY TELECOMMUNICATORS AND PTSD
Although only 29% of the sources used by Lilly and Pierce were within the
American Psychological Association (2010) suggested five-year time frame, many of
their sources provided a history of PTSD in police officers and firefighters as well as an
overview and examples of other variables, such as peritraumatic distress and
benevolence of the world. In fact, much of the background provided the reason and
understanding needed to tie in world assumptions with the rest of the study. These
sources proved to be quite beneficial and informative. However, the authors used
outdated sources for statistical information about PTSD and depressive symptoms in
police officers and firefighters. Current sources related to these topics were available at
the time and should have been used instead of the outdated sources. For instance,
LaFauci Schutt and Marotta (2011) examine predictors of PTSD in emergency
management professionals, Marshall, Schell, and Miles (2010) examine PTSD
symptoms and general distress relationships, and Smith et al. (2011) discuss PTSD in
firefighters as it relates to mindfulness.
Although this cross-sectional study attempts to show a relationship between
PTSD and depressive symptoms and other variables in 911 telecommunicators, it lacks
the depth and information a longitudinal study may provide. No study exists that
examines 911 telecommunicators and how the process of PTSD affects them long-term.
Lilly and Pierce (2012) also found that emotion and cognition may also be predictors of
PTSD in 911 telecommunicators and would be worth studying, especially cognitions
related to control. They highlight that controllability was significantly related to PTSD
symptoms and distress in a way they did not anticipate. Results reflect that the more
perceived control a 911 telecommunicator had, the higher the correlation with PTSD
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EMERGENCY TELECOMMUNICATORS AND PTSD
symptoms and distress. Perhaps this is because the 911 telecommunicator questions if
he or she could have done something differently and may believe he or she is
responsible for an inability to gain control of the call or the results of the call.
This study reveals a factual and very serious problem for the 911
telecommunicator population as well as a potential problem for society. The authors
based their study on fact, not opinion, and could analyze the data obtained as a result of
their study in a clear and concise manner making it easy for the reader to understand.
Because there is almost no empirical research on this population, there is difficulty
when trying to compare and contrast this study with others that are similar. This fact
further solidifies the need for additional research.
Rutkow, Gable, and Links (2011) examine the protection of first responder’s
mental health and discuss reasons they may be hesitant to obtain mental health
screening or any assistance with mental health problems. The majority of the authors’
sources are current, and the article provides a different view on the mental health
aspects of emergency personnel. Various articles examine mental health of emergency
personnel, but some are geared more toward the consequences of PTSD and other job-
related stressors. Bacharach, Bamberger, and Doveh (2008) examine alcohol use in
firefighters, whereas Hruska, Fallon, Spoonster, Sledjeski, and Delahanty (2011)
examine alcohol use and how it moderates the relationship between PTSD and
avoidance coping mechanisms. Both studies provide a different view of alcohol and
how it may fit into the study of PTSD in 911 telecommunicators because the articles
help fill in a hole in the literature.
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EMERGENCY TELECOMMUNICATORS AND PTSD
McFarlane, Williamson, and Barton (2009) review the literature associated with
the general consequences of traumatic events experienced by emergency personnel.
This literature gives a glimpse of the need for further research, but interjects too much
opinion into the article. McCarley, Prager, and Sherry (2006) examine PTSD and
burnout in first-responders, but the information provided is from a presentation at the
Rocky Mountain Psychological Association Conference and lists no references. Finally,
Marmar et al. (2006) examine PTSD predictors in first-responders, which can help
explain predictors in 911 telecommunicators.
Other resources will be examined to gather a better understanding of the
research needed for such an understudied population. Because very little empirical
research exists, the holes are plentiful, and there is difficulty in choosing which specific
area to focus on. However, the consequences of PTSD in any type emergency services
employee may be detrimental to the employee, his or her department, and society.
Therefore, further examination of consequences and preventative measures will be
assessed.
Literature Review
Empirical research on the emergency telecommunicator population is extremely
scarce. However, an abundant amount of information is available on the law
enforcement and fire fighter populations. Telecommunicators are exposed to stress and
trauma through telephone calls and radio transmissions every day, so one can reason
that they may be more at risk for posttraumatic stress disorder (PTSD) than individuals
who do not work in the public safety realm. The consequences of PTSD can be quite
negative (Lilly & Pierce, 2012; Rutkow, Gable, & Links, 2011), and when those negative
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EMERGENCY TELECOMMUNICATORS AND PTSD
outcomes are coupled with a responsibility to maintain public safety, the effects could
be deadly.
Literature was reviewed in relation to the effects of PTSD on public safety
personnel, and legal and ethical issues. The literature was gathered from various
databases in the Walden Online Library using keywords such as emergency, PTSD,
and public safety. These articles were chosen because they contain information about
the consequences of PTSD and how some of those consequences affect the lives of
public safety personnel.
Alcohol
The four articles focus on public safety personnel and different problems
associated with their mental health. Various consequences are examined, such as
alcohol abuse, legal considerations, and how worldviews affect stressful outcomes.
Alcohol consumption is a common theme in the world of law enforcement, firefighters,
and other first responder jobs (Violanti et al., 2011; Bacharach, Bamberger, & Doveh,
2008). Some individuals use drinking as a coping mechanism to relieve stress caused
by job-related trauma, whereas others are slowly integrated into a culture of consuming
alcohol as a social norm. The use of alcohol may have several negative consequences
as some authors point out. Backarach, Bamberger, and Doveh (2008) state alcohol
abuse can impair a subject's behavior and cognitive ability, which can affect his or her
daily job performance. They go on to say using alcohol as a coping mechanism may be
partially caused by experiencing helplessness and horror on the job. Although the
authors are focusing on firefighters, 911 telecommunicators also experience instances
of horror and helplessness on the job through telephone calls and radio transmissions.
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EMERGENCY TELECOMMUNICATORS AND PTSD
Outcomes
The articles examined various outcomes from job-related stressors and PTSD as
well. Clearly, public safety is the biggest issue; however, other issues such as suicide,
depression, anxiety, and productivity are also examined. Rutkow, Gable, and Links
(2011) examine stress-related outcomes that affect job performance and how worker's
compensation fits into that picture. Not every state has worker's compensation laws that
support first responders who suffer from PTSD or other mental health issues caused by
on-the-job trauma. All of the articles examined in this review state depression may be a
symptom the trauma experienced while on the job of public safety personnel.
Emergency Telecommunicators
Although the only article is specifically related to emergency telecommunicators,
each article contains information about individuals who work in the public safety realm.
Firefighters, police officers, first responders, and others who respond to disasters or
traumatic incidents share the increased risk of PTSD or other stress-related symptoms.
Emergency telecommunicators are likely no different. Although there is not enough
empirical research to confirm this theory, the literature that is available points to this
conclusion. Another area of concern, in addition to an increased risk of PTSD, appears
to be a potential risk for alcohol abuse. Clearly, more research is required to confirm
these theories, and others related to emergency telecommunicators.
Critical Analysis
Four main causes of PTSD were found while examining current literature on
police, firefighters, and other emergency personnel. The first, and possibly most obvious
cause is the experience of critical incidents. Police and fire personnel respond to motor
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EMERGENCY TELECOMMUNICATORS AND PTSD
vehicle crashes, suicides, violent incidents, and other traumatizing events. Emergency
telecommunicators interact with the callers hearing, witnessing, or experiencing these
events. These critical incidents can have a significant impact on the onset of PTSD
(Declercq, Meganck, Deheegher, & Van Hoorde, 2011). The severity of the critical
incident may also have a bearing upon the onset of PTSD and the ways in which these
subjects cope (Bacharach, Bamberger, & Doveh, 2008).
Another cause of PTSD in emergency personnel is the response to the critical or
traumatizing incident. Some responses involve anger, horror, fear, or helplessness
(Declercq, Meganck, Deheegher, & Van Hoorde, 2011). Kleim, Ehlers, and Lucksman
(2012) show a relationship between the type of response to a traumatic event and
PTSD and depression. Helplessness was found in both studies to be a factor for
predicting PTSD. Anger was found to be both a risk factor for PTSD and an effect of
the disorder in police officers (Meffert et al., 2008).
The third cause of PTSD is world assumptions and peritraumatic distress. Lilly
and Pierce (2012) found world assumptions in telecommunicators to predict PTSD
significantly. For example, if one believed the bad in the world outweighed the good
and experienced a traumatic call, this combination was significant in predicting PTSD.
World assumptions of self-worth were also significantly related to PTSD (Lilly & Pierce,
2012).
The fourth main cause of PTSD was perceived social support. Although only one
source listed this specific cause, there were other associated relational predictors found
in other sources such as stress and self-blame. For instance, firefighters reporting high
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EMERGENCY TELECOMMUNICATORS AND PTSD
self-blame and perceiving social support as low showed a significant risk for PTSD and
other related symptoms (Meyer, Zimering, Daly, Knight, Kamholz, & Guliver, 2012).
From these causes, four main effects of PTSD and the traumatic events
associated with the disorder were found. Alcohol or substance abuse, depressive
symptoms, burnout, and public safety were all significant effects of PTSD in emergency
personnel. Four articles showed alcohol use and PTSD commonly co-occurring
(Bacharach, Bamberger, & Doveh, 2008; Hruska, Fallon, Spoonster, Sledjeski, &
Delahantym 2011; Kamena, 2012; Violanti, Slaven, Charles, Burchfiel, Andrew, &
Homish, 2011). The traumatic events experienced by emergency personnel
significantly increase the risk of alcoholism.
Another effect of PTSD is depression. Depression and depressive symptoms are
strongly related to PTSD, as was shown by several studies (Kleim, Ehlers, &
Glucksman, 2012; Lilly & Pierce, 2012; Levin, Besser, Albert, Smith, & Neria, 2012;
Violanti et al., 2011). After experiencing a traumatic event, emergency personnel may
have feelings of hopelessness or negative self-appraisals coupled with PTSD
symptoms.
The third effect was burnout. Studies indicate emergency personnel
experiencing burnout may be experiencing a symptom of PTSD after a traumatic
incident (McCarley, Prager, & Sherry, 2006). Although LaFauci Schutt and Marotta
(2011) show a significant predictive value, burnout is clearly related to PTSD as not only
an effect but also as a cause.
The fourth effect of PTSD in emergency personnel is the issue of public safety.
The effects of the disorder are negative and with those negative effects come negative
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consequences for the public. Alcohol abuse while on the job certainly can have
detrimental effects on the public, as can anger issues in police. Physical health issues
such as cardiovascular problems and general sickness have been linked to PTSD and
can affect public safety (Violanti, Andrew, Burchfiel, Dorn, Hartley, & Miller, 2006;
Young, 2009).
Studies show a variety of causes and effects of PTSD in emergency personnel.
Although limited information is available for telecommunicators, one could presume the
same or similar causes and effects apply. With a proactive approach to PTSD in
emergency personnel, some of these causes and effects could be prevented. One
specific cause cannot be labeled as the most important in leading to the problem.
Instead, understanding how they all intertwine is the key to prevention. This
understanding can also bring about resolutions.
Resolutions
PTSD in emergency telecommunicators is a problem that has many possible
resolutions. Certain populations such as law enforcement and firefighters have a higher
occurrence of the disorder, likely from the trauma they are exposed to on a regular
basis (Lilly & Pierce, 2012). Learning about signs and symptoms is the first step to a
proactive resolution. When emergency telecommunicators take high stress calls or are
involved in a particularly stressful situation on the radio, coworkers and supervisors
should be aware of any unusual behavior. However, because the effects of the incident
may not appear for months after it has happened, a preventative approach may be
more effective.
Employees who suffer from job-induced stress or PTSD should have an
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EMERGENCY TELECOMMUNICATORS AND PTSD
opportunity to receive help. An employee assistance program (EAP) or critical incident
stress debriefing (CISD) can be used to alleviate some of the stress from the job by
speaking with a therapist or counselor. The program should also allow employees to
remain anonymous. Some employees may feel uncomfortable or embarrassed about
seeing or speaking to someone for help. The EAP focuses on providing counseling
services to employees experiencing any form of personal or work-related stress
(Magyar & Theophilos, 2010). An advantage of the EAP is that employees can utilize it
for both work and personal stress, which often result in larger problems such as PTSD
when combined. A disadvantage may be the programs lack of encouragement and
promotion. If employees are unaware such programs exist, they will be less likely to
benefit from it.
A disadvantage to using CISD is that its purpose is to prevent PTSD, which is
experienced only by a fraction of employees (Jeannette & Scoboria, 2008). Therefore,
there may be little to no benefit for the other employees involved in the incident.
However, research has also showed success with CISD. For instance, 56% of the
individuals involved in a Los Angeles fire department incident reported a reduction of
symptoms after attending the debriefing (Magyar & Theophilos, 2010).
Challenges and barriers may arise when attempting to implement such programs
as well. A proper CISD should include all individuals involved in the incident.
Emergency telecommunicators and other emergency personnel typically work in shifts
and must maintain a minimum staffing level to ensure public safety. Every employee
involved in the incident may not be available at the same time for the CISD.
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EMERGENCY TELECOMMUNICATORS AND PTSD
Summary
One can assume that telecommunicators struggle with PTSD more than the
general population. With the lack of empirical data available about this group, one must
substantiate preliminary assumptions about the causes and effects of PTSD with data
about other emergency personnel whose jobs have similar exposure to trauma. The
problem of PTSD in the public safety field is clear and can have detrimental effects to
the individual who suffers, the organization for which he or she works, and society in
general. Further research would clarify misconceptions, generate understanding and
resolutions to the problem, and extend knowledge in a way that may have a positive
global effect.
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