IN PURSUIT OF A BLUEPRINT FOR 9-1-1 WELLNESS
November 18, 2013
By Jim Marshall
The history of our nation’s failure to care for our warriors returning from war is hard to face. Even now we are playing a dangerous game of catch up—even as researchers have finally begun connecting the dots between escalating rates of service-related post-traumatic stress disorder (PTSD) and suicide.1 But in case you are assuming I am anti-military or a pessimist about to blather on critically, let me offer some assurance: I am not a pessimist or an extremist on a rant. In fact, I’ve been accused more than once of being a “psychotic optimist.”
But my dogged optimism and bent toward hopefulness is well founded—a gift from my courageous trauma clients. Over the years as a mental health clinician, I have witnessed so many survivors fight their way through horrendous memories and rise like a phoenix from the ashes. The point in bringing up our nation’s abysmal shortcoming in recognizing and treating our warriors’ PTSD is that we will repeat this failure in the 9-1-1 community if we don’t systematically evaluate and proactively address the impacts of 9-1-1 stress on our front-line telecommunicators.
The problem is real
In Roberta Troxell’s 2008 study of 497 Illinois telecom-municators, 16.3% acknowledged symptoms consistent with Compassion Fatigue (CF)2—a condition in which a person experiences struggles with traumatic stress symptoms and burnout. In 2012, former dispatcher Heather Pierce and Northern Illinois University researcher Michelle Lilly released widely publicized findings from their study of telecommunicators, indicating significant heightened risk for PTSD among 9-1-1 telecommunicators; in fact, as high as 9–10% of their subjects reported symptoms consistent with PTSD.3
The good news
We are making progress in safeguarding our 9-1-1 pros’ resilience in the face of traumatic stress, but we’ve only just begun and our long-term success will require stakeholders from all sectors to join in building what I call a Blueprint for 9-1-1 Wellness in the Next Generation PSAP.
Let me offer in a nutshell the gains we’ve made so far, where we need to go from here, and how you can help.
In 2010, the National Emergency Number Association (NENA) launched the NENA Working Group on 911 Stress. NENA leaders joined by mental health professionals and representatives from APCO International, the APCO Institute, the U.S. government, and the commercial sector all chose to acknowledge and take responsibility for facing the 9-1-1 stress risks revealed by Troxell, Pierce, and Lilly. The result was realized on Aug. 6, 2013, when the NENA Executive Board approved the new Standard on 9-1-1 Acute/Traumatic and Chronic Stress Management.
The adoption of this standard is promising; it represents a major first step for the 9-1-1 industry toward fostering 9-1-1 resilience, optimal well-being, and health-driven performance. Now our nation’s PSAP leaders must implement the standard and that will require active and expert support.
Anticipating this need, the 911 Wellness Foundation (911WF) was established in 2011. It is devoted exclusively to ensuring the mental (and physical) health of our 9-1-1 professionals. Subject Matter Experts (SME) from 9-1-1 and the mental health field joined together to advance resilience research, education, policy, and intervention. In support of the 911 Wellness Foundation’s work, the IAED™ Board of Trustees has established a formal alliance between the two agencies.
The IAED has guided a systematic evolution of dispatch from an unstructured, medically uninformed practice to a research-driven science. 911WF is in the early stages of a similar task-contributing science to advance 9-1-1 resilience and wellness. The Model for Evaluation and Achievement of 9-1-1 Wellness (see Figure 1) is one of many tools providing a rigorous methodology to achieve this task. The model implies that by evaluating needs and ensuring resources to address them, PSAP leaders can empower telecommunicators to assume full personal responsibility for their wellness.
In Figure 1, we can see that there are two pure stressors, two pure buffers, and four work “variables”—aspects of work that can serve either as stressors or stress buffers depending on how they are shaped in relation to six conditions. To ensure optimal well-being or “wellness,” we must systematically manage conditions by countering stressors and optimizing buffers and variables.
Planning effectively for optimal 9-1-1 wellness also involves answering specific questions. For example:
•What is the status of Condition 1 pertaining to Stressor (A or B), and how can we optimize this condition to buffer the stress?
•What is the status of Buffer (A or B) and how can we optimize this buffer? (Reflect on each condition pertaining to this buffer.)
•What is the status of Variable (A–D) related to each condition, and how can we optimize that condition?
•Reflect on the interactions between specific stressors/buffers/variables: How do we need to factor for these?
With such a quick first immersion into The Model for Evaluation and Achievement of 9-1-1 Wellness, you might feel as if you were pitched in a dump tank and then dangled over the edge of the Grand Canyon by your belt loop. It’s a lot to take in all at once without more explanation. But the model is introduced as an example of one key tool offered by 911WF to help 9-1-1 stakeholders carefully evaluate 9-1-1 stress. By joining together using such tools, we can build a Blueprint for 911 Wellness that will ensure the health and performance of the very first responder in the Next Generation PSAP. γ
1U.S. Department of Veterans Affairs. http://www.ptsd.va.gov/public/pages/ptsd-suicide.asp. Accessed Sept. 16, 2013.
2Troxell, R. (2008). Indirect Exposure to the Trauma of Others: The Experience of 9-1-1 Telecommunicators. http://gradworks.umi.com/3335425.pdf. Accessed Sept. 9, 2013.
3Pierce, H.A., & Lilly, M.M. (2012). Duty-related trauma exposure in 911 telecommunicators: Considering the risk of Posttraumatic Stress Disorder. Journal of Traumatic Stress, 25, 211-215. doi: 10.1002/jts.21687. This percentage was based on using a symptom cut-off score associated with PTSD in clinical samples.
25 Years In Emergency Communications
James Tabron has seen and heard a lot
Freedom House Lifts From The Past
Once destined to fade, a book and paramedic bring it back to life