IN THE STRESS OF TIMES
November 18, 2013
By Jim Lanier
How did you become so invested in the issue of 9-1-1 stress and resiliency?
Like many others 25-plus years ago, I came from the old school of public safety stress management: Suck it up and move on. As a field responder, 9-1-1 dispatcher, and calltaker, I got my fair share of mental bumps and bruises and often gritted it out because it was all I knew how to do. I did not know the manifestations of the symptoms related to stress, nor did my colleagues, nor our bosses. We did not talk about it because to talk about it was to acknowlednge it. To acknowledge it meant to confront it, and it was easier not to confront something that scared us because we felt we had little control over it (which is difficult when your entire career is built around being able to control situations).
I went over the “burnout” cliff twice in my career and both times scratched and clawed my way back to level ground. It’s in our DNA to put others first, so you keep the lid on that nasty box of memories and experiences and move on to the next situation.
I never lost sight of my personal experiences with stress despite my good fortune of promotion (OK, of being shoved) into Public Safety Answering Point (PSAP) management. I noticed that when employees exhibited behaviors that were out of the norm for them, there was a pattern there, and often, the culprit was stress (which may be cumulative or specific-incident related, or even due to external challenges such as family stressors).
What do you see as the stressors unique to the work of the telecommunicator?
The nonvisual environment is a unique stressor because the telecommunicator combines what is heard (or not heard) and what is said (or not said) into a mind’s eye visual of the situation. Mentally visualized traumatic situations don’t always go away; there’s the inherent risk of situations coming back to mind—the classic “I want someone to hear this” as the caller commits suicide. This may change to a degree if live video is placed in the PSAP, but the majority of requests for service will still be nonvisual.
Another unique stressor is situations when the telecommunicator is essentially handcuffed from being able to assist, even though there is a dire need for intervention and the tools (International Academies of Emergency Dispatch protocols) are available for changing the outcome. For example, most of us have answered a call from a frantic parent about an injured child, and then the parent drops the phone and, consequently, is unable to follow Pre-Arrival Instructions.
Lack of closure is another PSAP stressor. An intense call can result in emotional and mental baggage compounded by its unknown outcome. More than once, I and other 9-1-1 telecommunicators have checked the newspaper’s obituary section to find out whether the cardiac arrest patient survived.
Exclusion, intentionally or not, from the public safety team is a stressor. While this has improved immensely, there are still occasions after a significant event when first responders are brought in for Critical Incident Stress Management and yet the 9-1-1 telecommunicator taking the initial call is left out.
There is also a tendency for task saturation combined with the lack of downtime. Calltakers and dispatchers are often so busy for extended periods of time that they keep pushing through until they are mentally spent.
What have you seen over the years supporting your concerns of stress in the PSAP?
Outside of my own experiences with compassion fatigue (CF) and burnout in the field and in the PSAP, I saw fellow caregivers who were stellar and model employees go through a spiral of decline in their attitudes to the point where they got terminated from or quit a job that previously had been their dream job. I had one co-worker who kept it bottled inside until making the ultimate cry for help with a self-inflicted GSW to the temple. In retrospect, several co-workers had noticed the multiple cries for help along the way, but no one chose to acknowledge them (which goes back to acknowledgement of what is being exhibited in someone else is acknowledging it in us, so keep the lid on it and ignore it).
On the flip side, I have been in situations in which we’ve recognized early or late signs of burnout and CF and, because we knew what to look for, we were able to get the individual appropriate assistance. Some bounced right back to the console while others left the profession, although at least they left it healthier as opposed to those who compounded the problem of being so burned out and fatigued that it caused them to quit without having a psychological “Yellow Brick Road” to lead them back.
What is leadership’s role in fostering resilience among calltakers/dispatchers?
Our personnel are by far our most valuable resource, and to be an effective leader, you have to take a holistic approach to employee support, which includes recognition of the impacts of stress inside and outside the PSAP. A leader has the responsibility to absorb (and prevent) as much stress as possible with an emphasis on colleagues’ wellness and resiliency.
The secret to resiliency is considering past intangibles compared to current tangibles relative to wellness and job satisfaction. We must acknowledge the good and create an environment of continued support and that it’s OK to ask for help before the situation gets out of hand. For example, how much time is unnecessarily spent supervising an employee who can do the job well instead of mentoring and forming more of a personal co-worker and coach relationship? Chain of command is important, but I would offer that a chain of support and communication is critical to a healthy and resilient 9-1-1 workforce.
Do you think that Next Generation 9-1-1 will add to this stress?
Text messaging will bring stressors, not only the nonvisual nature of the message, but because of limited options to interpret unclear messages. For example, a caller on the phone will have different voice inflections and tones contributing to communications, but with a text there are only words. “Please help me” via texting does not tell us much.
Also, the industry must be wary of the temptation to assume that just because a technology (such as streaming video into the PSAP) is available and “cutting edge,” that it should be automatically integrated into the PSAP without due diligence on the impact (operationally and mentally) to front-line staff.
Done right, there are aspects of NG9-1-1 that could reduce stressors for the 9-1-1 telecommunicator. In any event, the industry needs to welcome and integrate suggestions from front-line personnel and take advantage of the unique and exciting opportunity to incorporate stress management and wellness programs in the PSAP.
Where do you think the 9-1-1 industry needs to go to fully address 9-1-1 stress risks and ensure resilience of our frontlines as we go forward?
As the PSAP becomes more complex, so does the need to make sure that we are taking care of our personnel. The National Emergency Number Association (NENA) Stress Standard is an excellent place to start, and if the standard seems intimidating or a daunting task, look for the proverbial low-hanging fruit and see which portions you can implement now and strategize the next steps.
The blueprint to strategically plan our approach is very worthwhile. It is the right thing to do and, in the long run, this will make stress relief and resiliency part of the 9-1-1 culture. This increase in wellness will increase job satisfaction and have other benefits (a happier and healthier workforce which means less stress on 9-1-1 administrators).
You and your wife Sharon began presenting at NAVIGATOR on the issue of compassion fatigue some 10 years ago. What experience compelled you to address it?
Sharon had recognized that when hospital caregivers were exhibiting problematic behaviors, there was often a root cause related to the stress created (or compounded) by caring for others. Often these behaviors were rubber-stamped as “burnout.” She saw this not only at the hospital as a registered nurse and ombudsman, but also in ambulance/EMD dispatch center personnel also employed by the hospital. Ironically, it was a discussion of similar behaviors (extreme outbursts of anger after a frustrating 9-1-1 call) in two different PSAPs that started the discussion of how CF has been recognized in the hospital setting, and many of the same stressors and symptoms are present in the PSAP.
From research, we realized that burnout is a symptom of CF and that there are ways to intervene and assist the person before he or she hits the wall of burnout. Just as importantly, there is support available to bring individuals back from burnout.