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Emergency Telecommunicators and PTSD Laura Chase
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.
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
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
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, selfworth, 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.
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
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 jobrelated 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.
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
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.
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
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
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
EMERGENCY TELECOMMUNICATORS AND PTSD 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
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.
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.
EMERGENCY TELECOMMUNICATORS AND PTSD
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