The caller was sobbing into the phone. Her baby was not breathing. “Please don’t let her die. Please,” she pleaded. The emergency dispatcher began CPR instructions. She assured the caller the ambulance was on the way and reassured herself that this was small-town Indiana and the ambulance would arrive within five minutes of dispatch.
The call ended when paramedics entered the home and took over the infant’s care. The baby was not transported. The emergency dispatcher, Amy Seidler, left the console momentarily to catch her breath and returned to answer the second, third, and each successive call.
This was Seidler’s first 911 call in a career that spanned 14 years. The infant had died. The mother had lost her baby to SIDS.
Seidler cried herself to sleep that night, returned the next day, and resumed where she had left off without the benefit of a debriefing afforded to the responding ambulance crew and firefighters.
Seidler was 19 years old. A 911 dispatcher straight out of high school, the path led from the small town of Brownsburg, Indiana (USA), to the Indianapolis Airport Authority, and, finally, to Monroe County Central Dispatch, Indiana. After more than a decade as a dispatcher, and later as a shift supervisor, she left for a position in customer outreach and sales support with an Indiana-based provider of public safety training and compliance management systems.
The first call never left Seidler, and as she wrote retrospective of her years in 911, "That was the first addition to the shell that I eventually built around my psyche to protect myself as I continued through the next 14 years of my 911 career.”1 She never discussed this display of “weakness”—tears—with co-workers, despite how normal the reaction was.2
In every respect, the emotional toil of EMS was—and is—no different for emergency dispatchers than it is for field responders. High job demands. Low job resources. Long shifts. Traumatic life-or-death events. Fatigue. Expectations to act flawlessly 100% of the time. Add wildfires, hurricanes, and COVID-19 to the mix and the cereal box turns upside down. Energy is depleted. The system empties.
The non-visual environment can amplify the emotional impact of what’s going on at scene and, similar to their field response counterparts, emergency dispatchers push their feelings into a shared zone of denial.
“Our culture does not express signs of weakness,” said Rhonda Kelly, National Director of Health, Wellness & Resilience (GMR Life) at Global Medical Response and ResponderStrong founder. “A sign of weakness is saying you can’t handle the job. We never admit to vulnerability.” 3
ResponderStrong is a collaboration between emergency responders and their advocates. Its mission is to improve mental health supports for emergency responders and their families through joint focuses on intervention and prevention.
In the long run, we’re only hurting ourselves, said Adam Timm, Change Management Director at RapidDeploy and former 911 emergency dispatcher for the Los Angeles Police Department (California, USA). "We have a strong ‘suck it up’ culture. We ignore the stress, until, at some point, diminishing returns deplete our ability to do the job we love to do.”4
Seidler refused to let her emotions show, at least on the surface. A lot of times, she said, emergency dispatchers fail to recognize the effects of trauma on themselves. They create a scene of a call in their head. The incident might not be so bad, or it could be worse.
“It all goes into a box, and we keep pushing more in,” she said. “It never goes away, and we never talk about it. There was nothing available, no resources, to help. I never felt there was anyone I could go to find support.”
Seidler reached out to Jim Marshall, 911 Training Institute Founder and Director, and Michelle Lilly, Northern Illinois University Associate Professor of Psychology. Both are pioneers shedding light on the experience of traumatic stress among emergency responders. Marshall asked Seidler to share her story to advance the mission of his newly organized 911 Wellness Foundation. Marshall said she wasn’t alone in her uncertainty despite a job she loved and knew made a difference in the lives of others.
“He said this is an issue we have to address before we lose good dispatchers to burnout,” she said. “He was determined to do something about it.”
Seidler connected with Lilly after she left 911 during coursework for a master’s degree in mental health studies that piqued her interest in post-traumatic stress disorder (PTSD) and its effects on military personnel and first responders. Lilly’s research interests focus on cognitive and emotional processes that predict PTSD in two populations: survivors of interpersonal trauma and 911 telecommunicators.
Promoting the wellness message
Marshall began working in 2005 to get the “wellness” message across in presentations, classrooms, and publications. His insights about 911 stress came first from his dispatcher sister, then his visits to communication centers and one-on-ones with struggling 911 professionals. His education and profession—a licensed mental health professional for over 30 years—provided a layer of expertise he could apply to the relatively uncharted realm of advocating in support of 911 resilience and well-being.
Marshall hit a nerve. Emergency dispatchers opened up to him about the stress they encountered and during breaks, they shared stories (though not the details) of traumatic calls and the belief—like Seidler—that they lacked support. Realizing an untapped critical need in the dispatch community, in 2010 Marshall volunteered to co-chair a National Emergency Number Association (NENA) workgroup that developed the Acute/Traumatic & Chronic Stress Management Standard (published in 2013). In 2011, Marshall joined 911 leader Jim Lanier (Alachua County, Florida, USA) in co-founding the nonprofit 911 Wellness Foundation.
They focused the foundation’s efforts on boosting industry-wide awareness of the NENA Stress Management Standard and engaging stakeholders to support the mission of strategic planning for 911 resilience. They poured their resources and energy into building a conduit, actively promoting standard goals to foster well-being and resiliency nationally and on an agency specific level.
Lilly is a pioneer in research on the mental and physical health of 911 telecommunicators. Her initial study linking 911 dispatch to PTSD was conducted with an undergraduate research assistant in her lab, Heather Pierce, who worked for seven years as an emergency dispatcher in Chicago’s western suburbs before returning to school.
The response to their study was overwhelming, Lilly said.
“At first, we thought it would be an interesting one-time project, but after seeing the reactions and interest from the 911 community, I felt drawn in and decided to do a follow-up study measuring PTSD symptomatology in a different way. In less than a year, my lab recruited over 800 participants for a second study,” she said.5
Lilly’s research added the muscle of evidence to the reality of stress disorders in dispatch. Others built on her work to create a repository of information to help 911 professionals understand how stress can affect them and provide skills fostering resiliency and positive coping.
The 911 Wellness Foundation ceased operations in 2017, having achieved its initial mission, so that its members could lend their expertise to NENA’s expansive wellness initiatives.
“Ultimately, we believed in the long run the resilience agenda could be sustained best by our 911 membership organizations. That’s happening now!” Marshall said. The foundation still maintains its website (www.911wellness.com) as a free resource in support of the wellness movement. Marshall remains devoted to the cause. He is a member of NENA’s Wellness Committee and, along with Tracy Eldridge, Public Safety Community Engagement Manager at RapidSOS, are co-chairs of the workgroup updating the Acute/Traumatic and Chronic Stress Management Standard. The standard defines specific stress-related health risks and how agencies and individuals can address the risks. NENA anticipates releasing the revised standard in early 2021.
In 2018, Marshall and Tracy Laorenza-Trask co-edited The Resilient 9-1-1 Professional: A Comprehensive Guide to Surviving and Thriving Together in the 9-1-1 Center.
Marshall is grateful for being “adopted into the 911 family as a mental health professional” and being part of the wellness drive.
“Together we have an obligation to equip our 911Pros with resources that meet or exceed the demands we place on them,” he said.
What is wellness?
Wellness is about health and well-being on several levels. The National Wellness Institute defines wellness as:6
- A conscious, self-directed and evolving process of achieving full potential
- A multidimensional and holistic approach, encompassing lifestyle, mental and spiritual well-being, and the environment
- Positive and affirming
Kelly defines “wellness” as a state of being. It’s feeling satisfied with our lives and the ability to recognize when we’re not in sync and readjust. Wellness demands a path, she said.
“What does that path look like?” she said. “That depends. A path is sensing the quality of life, a sense of life that is satisfying.”7
Wellness is a combination of factors, Seidler said.
“You need physical well-being and the ability to share,” she said. “You need a supportive structure to bounce things off other people. You need self-care. Finding something that recharges you.”
Considering the “suck it up” culture prevalent in EMS, including emergency dispatch, how do you convince people to take care of themselves? People directed into emergency services recognize challenges to personal lives are magnified. Depending on perspective, the “hard stuff” in crisis can break a person. A kick to the butt related to stress is bound to happen. The action taken after the kick can make all the difference.
Organizational psychologist John Becknell, a former paramedic, said it’s a matter of reframing the “dangerous stuff” as an expected part of the human adventure. Cultivate the skills, knowledge, and passion and a person is well on the way to getting “really good at simply rocking and rolling with adversity.”8
What you can do
Becknell’s tips to rocking and rolling with adversity include “self-talk” to cultivate a friendship with yourself, seeking and nurturing relationships outside of yourself, flipping the switch off after shift, and claiming the good and bad as part of your life story.
“You can weave calls into a sense of meaning,” Becknell said. “Each time you pull the memory, you claim the story as a unique part of your life.”9
Timm, founder of The Healthy Dispatcher, advocates a tool chest heavily weighted with establishing an attitude that emergency dispatchers have a choice. These tools are:10
- Physical activity (tap into the power of exercise)
- Healthy eating (“stressed” is “desserts” spelled backward)
- Social support (someone working alongside can help)
- “BE” (be in the moment, de-stress, practice meditation, breathe in/breathe out)
Beyond the individual lies the organizational commitment to building a strong culture and making resources available. Give people the permission to reach out without fear of judgment. Let individuals choose what works for them within a domain (e.g., nutrition, exercise).
“Leadership can’t walk in saying what you need,” Kelly said. “You tell leadership what you need. If what’s in place isn’t working, say so. Focus on the potential, not the pathology.”11
Seidler said a place to start is a concentrated effort to dispel the negative stigma surrounding seeking help for stress. Promoting wellness is a priority.
“Encourage self-care programs, peer support, and know when to seek the assistance of a licensed clinician,” Seidler said. “Train your staff to recognize danger signs and know where to seek assistance and to provide that peer support when it is sought.”
Finally, realize that tough times and living well are not incompatible. You can live a good life while having a long, successful career in EMS.
Seidler said the profession helped shape the person she is today.
“I loved the work,” she said. “I was talking to people on their worst day and helped make it not so bad. I knew I was making a difference in their lives.”
Sources
1 Seidler A. “Personal Stories of 911 Professionals: The Amy Seidler Story.” 911 Wellness Foundation. 2011. https://911wellnessdotdotcom.files.wordpress.com/2014/07/seidlerstory911wf.pdf (accessed Nov. 30, 2020).
2 See note 1.
3 “Agency Wellness Programs That Work.” Ems.gov webinar. 2020; Oct. 29. https://www.ems.gov/ems-focus.html (accessed Dec. 2, 2020).
4 Fraizer A. “Take Care of Yourself.” Journal of Emergency Dispatch. 2020; April 7. https://iaedjournal.org/take-care-of-yourself/ (accessed Dec. 3, 2020).
5 "Research Spotlight: Michelle Lilly and Kim Turner.” Annals of Emergency Dispatch & Response. 2019; April 9. https://aedrjournal.org/research-spotlight-michelle-lilly-and-kim-turner/ (accessed Dec. 3, 2020).
6 “The Six Dimensions of Wellness.” The National Wellness Institute. 2020. https://nationalwellness.org/resources/six-dimensions-of-wellness/ (accessed Dec. 3, 2020).
7 See note 3.
8 “Living Well and Leveraging Adversity and Stress in the Long Haul.” Ems.gov webinar. 2020; Aug. 20. https://www.ems.gov/ems-focus.html (accessed Dec. 2, 2020).
9 See note 8.
10 See note 4.
11 See note 3.
Wellness resources
911 Wellness Toolkit: https://911wellness.com/building-your-psap-csmp/
The NENA Standard on Acute/Traumatic and Chronic Stress Management (NENA STA-002) became effective in August 2013 and states that “Public Safety Answering Points (PSAPs) shall establish Comprehensive Stress Management Programs (CSMP). The resources offered collectively represent a “Toolkit” you can use to implement the standard.
The 911 Wellness Resource: https://911wellness.com/
The resource offers tools to launch a 911 center’s Comprehensive Stress Management Program (CSMP.)
