Emergency communication operators (ECOs) are routinely exposed to duty-related trauma and tasked with obtaining pertinent information to identify the nature of the emergency, allocate necessary resources and provide critical details to those responding to the crisis. The associated stress places ECOs at an increased risk for mental health problems. Research (e.g., Blalock, Black, Bourke, & Van Hasselt, 2023) indicate more than one-third reported they were experiencing clinically significant levels of anxiety, depression, and PTSD. Unfortunately, although ECOs appear to know their jobs were negatively affecting them, they are reluctant to seek help.
As Blalock and her colleagues point out, the almost 100,000 emergency communication operators (ECOs) (often referred to as “911 operators” or “dispatchers”) in the United States (US Department of Labor, 2021) are the “true first responders” during a crisis. They are tasked with receiving incoming calls, coordinating the appropriate response, and often providing lifesaving instructions over the phone. Amid high-pressure working conditions, ECOs must remain calm and in control of their emotional reactions to traumatic events.
As they simultaneously analyze and transmit critical information, ECOs are exposed to potentially traumatic events at rates that typically exceed other those experienced by other first responders (Trachik et al., 2015). Unfortunately, very few studies have examined the impact the job has on their mental and physical health.
Stress for ECOs can come from occupational stressors such as shift work, insufficient pay, perceived lower status, inadequate training, lack of organizational support, and decreased attention from supervisors (McCarty and Skogan 2012). The unpredictability of shift work has also been considered a key organizational stressor (Violanti et al., 2017) due to the negative impact rotating schedules can have on an individual’s personal life, family time, and sleep schedules (El Sayed et al., 2019).
Physical health challenges include a lack of regular exercise, poor nutrition, obesity, inadequate breaks, and fatigue, as well as loud noise and poor lighting associated with increased cortisol levels (Smith et al., 2019).
While ECOs do not physically respond to the scene of an emergency call, they still can be affected by a peritraumatic stress response (Friedman, 2013; Pierce & Lilly, 2012), a form of intense fear and helplessness that can lead to posttraumatic stress disorder (PTSD) (Aimé et al., 2014). Specifically, calls involving traumatic events, emotional or physical pain, and death can lead to difficulty sleeping (Gallagher & McGilloway, 2008), nightmares, flashbacks (Adams et al., 2015), and increased alcohol consumption (Shakespeare-Finch et al., 2015). Previous research has shown that during and immediately after a traumatic call, ECOs report higher levels of traumatic distress which are positively correlated with PTSD symptoms and burnout (Pierce & Lilly, 2012). Some investigations have estimated that prevalence rates for PTSD in ECOs range from 17.6% to 24.6% (Lilly & Allen, 2015), compared to 6.8% of US adults who meet criteria for PTSD (Terhakopian et al., 2008).
The National Wellness Survey for Public Safety Personnel
A collaborative effort between the Fairfax County (Virginia) Police Department (FCPD), the Behavioral Analysis Unit of the United States Marshals Service, and Nova Southeastern University, resulted in the development of the National Wellness Survey for Public Safety Personnel. The objective of the project was to determine (1) the prevalence and severity of anxiety, depression, PTSD, alcohol use, and suicidal ideation in a national sample of ECOs and (2) access to mental health resources as well as barriers to seeking treatment.
Professional Stressors
The 742 ECOs who completed the survey indicated they experienced the following professional stressors during the past year:
Concerns about exposure to COVID-19 (79.8%)
Low morale in the workforce (66.2%)
Coworkers do not pull their own weight (52.7%)
Government officials outside the organization do not understand what you deal with (52.7%)
Higher-level leadership does not understand the challenges you deal with (51.6%)
Negative media about your profession (50.8%)
Negative attitudes from the general public about your profession (45.8%)
Lack of closure regarding critical incidents in which I had a role (44.9%)
Overworked (43.7%)
Critical incidents involving a child or children (43%)
Micromanagement from your supervisor (42.3%)
Lack of control or inability to protect someone during a critical incident (41.6%)
Higher-level leadership does not run the organization effectively (40.7%)
Being directed involved in critical incidents (40%)
A coworker’s difficult circumstances have worsened the stress of others in the workplace (33.6%)
Responding to critical incidents (33.2%)
Lack of promotion potential (32.1%) lack of community support (31.9%)
Inadequate equipment/ resources (31.8%)
Personal Stressors
The 742 ECOs who completed the survey indicated they experienced the following personal stressors during the past year:
Concerns about exposure to COVID-19 (67%)
Lack of sleep/sleep issues (67%)
Lack of time for personal life tasks (53.6%)
Lack of time with friends (51.9%)
Financial worries (51.8%)
Lack of time for recreational activities (46.5%)
Lack of time with significant other (45.3%)
Health problems (family member) (43.7%)
Lack of time with family other than your significant other or children
(42.5%
Grief or loss (41.5%)
Health problems (self) (41.2%)
Someone close to you contracted COVID-19 (35.5%)
Lack of time with children (30.5%)
Female Stressors
Female ECOs were asked an additional series of questions related to stressors they may have experienced in the past year:
Feeling the need to prove themselves because they are female (20.8%)
Lack of respect from colleagues (17.9%)
Familial responsibilities interfering with job duties (17.9%)
Lack of respect from the public (16%)
Limited promotion potential (13.2%)
Pay differential (8.9%)
Having to tolerate unwanted sexist or sexual language (8.4%)
Career impacts due to pregnancy (2.4%)
Coping Strategies
To counteract the effects of stress, respondents endorsed the following activities:
Use of humor about society/human behavior (82.9%)
Use of humor about workplace interactions (80.2%)
Spend time with family (76.3%)
Use of humor about a victim (74.7%)
Use humor (64%)
Escape through television or streaming services (62.7%)
Spend time with pets (61.6%)
Self-deprecating humor (55.1%)
Spend time in-person with friends (51.6%)
Use of humor about an offender (49.7%)
Comfort/stress eating (48.5%)
Exercise to reduce stress (43.7%)
Escape in social media for entertainment purposes (41.5%)
Engage with nature (39.4%)
Drink socially (38.5%)
Use of humor containing sexual innuendos (37.6%)
Recreational hobbies (37.6%)
Find comfort through praying or meditation (29.8%)
Engage in healthy sexual behavior (25.9%)
Escape through video games (20.8%)
Mental Health Measures
On empirically validated mental health instruments:
35% of respondents who endorsed anxiety symptoms met or exceeded the diagnostic criteria for generalized anxiety disorder.
57% of respondents endorsed experiencing depressive symptoms beyond the minimal severity threshold and 35.6% endorsed depressive symptoms that met or exceeded the diagnostic criteria for major depressive disorder.
29.3% of respondents received scores indicating PTSD treatment may be beneficial in symptom reduction.
15.5% endorsed consuming alcohol to the extent that their scores represented a potential problem with alcohol abuse.
12.4% reported experiencing thoughts of passive suicidal ideation (e.g., thoughts of wishing they were dead or wishing they could go to sleep and not wake up), and 5.7% reported experiencing thoughts of active suicidal ideation.
Utilization of Behavioral Health Resources
Participants were asked to report their accessibility to, and interest in, engaging with behavioral health resources offered by either their department or elsewhere in the community. ECOs accessed various services:
Within their department | Outside resources | |
Doctoral level psychologist or non-doctoral level counselor | 16.4% | 16.7% |
Psychiatrist | 6.5% | 9.5% |
Peer support team member | 16.2% | N/A |
Chaplain, clergy, or other spiritual services | 6.7% | 7.3% |
Primary care physician or practitioner | N/A | 20.7% |
Barriers to Seeking Treatment
Of respondents who expressed an interest in seeking assistance but had not followed through, the following were the most endorsed reasons for not doing so:
“I wanted to handle it on my own” (39.2%)”
“It’s the way I am – I don’t ask for help” (30.6%)
“Concerns about confidentiality” (29.8%)
“Fear it would impact my career, future employment, or security clearance” (29.5%)
“I just keep putting it off” (27.9%)
“Stigma – concerns I’d appear unstable or “crazy” (26.4%)
“Stigma – concerns ‘d appear weak” (25.3%)
“Financial concerns about coverage” (20.2%)
“I didn’t think it was a big deal” (19.3%)
In response to being asked if they believed a co-worker seeking counseling or mental health treatment for stress-related problems may hurt their career, 10.9% responded “Yes,” 29.2% responded “Not sure,” and the remaining 60% responded “No.”
Discussion
ECOs serve as the initial contact in a variety of emergencies and must adapt quickly to dynamic situations. They are trained to independently and concisely make decisions under extremely trying conditions. Therefore, it is interesting that the two most endorsed barriers they identified to seeking treatment reflected their desire to handle stress on their own and their tendency to not ask for help. However, many of the professional stressors were associated with their work environment, including low morale and co-workers not pulling their own weight. Additionally, ECOs felt that government officials outside their organization or agency administrators do not understand the unique challenges they encounter on the job. This is consistent with research showing how negative management may exacerbate a hierarchical division among personnel and result in additional stress due to feeling undervalued by the organization (Adams et al., 2015). Personal stressors were consequences of shift work, including inadequate sleep and lack of time for personal tasks and friends. Further, more than half of ECOs endorsed financial worries as a personal stressor.
ECOs are the first line of contact between an individual in distress and an emergency response. Despite the emotional trauma endured on the job, attempts to protect them fall short compared to the on-the-scene responders. For ECOs, demanding call volume often denies them the opportunity to effectively process one call prior to answering the next. In effect, they experience the worst parts of a crisis but rarely benefit from the “closure” that comes from seeing the case through to its resolution. They may never know if the caller survived, if the child in question was found, or if their actions made a difference.
Agencies should recognize the psychological toll the job has on their dispatchers and allocate the same resources they offer other high-risk first responders. Validation of ECOs contribution has been previously identified as a significant moderator of their stress and well-being (Adams et al., 2015). For example, the invitation to attend critical incident debriefings was seen as a way for managers to validate and recognize the importance of ECOs role in a crisis (Adams et al., 2015). Team cohesion of all involved personnel may offer an avenue to process the trauma associated with the crisis. And, senior management should participate in call center “sit alongs” to gain an appreciation of the environment and the skills needed to perform this job effectively.
Findings from Blalock, et al. (2023) indicate ECOs were as likely to seek support from a mental health professional as they were from a peer. Supportive interaction with vocational peers may be particularly helpful for ECOs because of the potential increase in rapport due to shared historical experiences, capability to normalize, reduce stigma, and implicit understanding of the unique occupational situations (Forster & Haiz 2015). This supports research asserting that social support aids in the reduction of stress-related outcomes among numerous occupations Gustafsson et al., 2013; Mache et al., 2014; Patterson, 2003; Reivich & Seligman, 2011). However, gaps still exist in the current empirical literature regarding treatment comparisons and outcome measurements for peer support programs. Ideally, peer support should be a supplementary resource for use in conjunction with adequate mental health programs to enhance efficacy of services (Van Hasselt et al., 2019.
Blalock and colleagues (2023) concluded that strategies for supporting the mental health and wellbeing of ECOs should to be implemented early in their career to establish a precedent for, and reduce stigma about, seeking continual support. Training, preferably during the onboarding process, may inform new ECOs about the stressors they are likely to face, as well as provide education to build resilience and introduce effective coping strategies for addressing occupational hazards. Normalizing conversations about the effects of acute and repeated trauma exposure can be integral for increasing help-seeking behaviors, both during a first responder’s career and in retirement (Smith et al., 2019). Further, since ECOs often minimize their own difficulties and feel less inclined to ask for help, policy and training protocols should consider the benefit of implementing emotional regulation techniques and peer-based interventions. Specifically, providing ECOs with effective coping strategies may assist with stress reduction. Identified occupational stressors should be targeted and policies should be changed so ECOs are treated as a high-risk occupation. These policies should prioritize the physical and mental wellbeing of the men and women who are the first to answer the call to help their community in times of crisis.