Physical Health Challenges

The role of emergency service call-takers and dispatchers is critical to the outcome of patient’s health and well-being. Life and death hangs on the very actions taken at this first point of entry for all emergency responses. As such, call-takers and dispatchers are required to answer, analyze, and transmit complex information in making determinations about emergency status; location; level of patient acuity of illness, and appropriate level of response; and need for multi-agency emergency service personnel (for example, does the call require simultaneous response from police, fire, and EMS personnel?).^{Reference Burke, Sullivan and Simonetti39,Reference Burke, Sullivan and Simonetti40} As conduits between the distressed public and emergency service personnel, call-takers and dispatchers navigate a minefield of anguish, panic, and uncertainty with simultaneous demands for precise information. And all of this must be done nearly instantaneously, using manual or computer-aided dispatch.^{Reference Harrington41}

In a study of 9-1-1 emergency services dispatchers in the United States in 2001, dispatchers described routinely suppressing fear, anger, sadness, and reported a sense of helplessness. The research identified three types of physical problems that resulted, at least in part, from these challenges: sleep disorders, chronic pain, and migraines.^{Reference Shuler and Sypher7} The sedentary nature of the occupation also provides fewer opportunities for physical activity and release of stress, which can potentially exacerbate these problems. Compounding the sedentary aspect is the shift-work element of emergency service call-taking and dispatching, which has been linked to increased health risks across a range of professions, including increased rates of cancer, obesity, cardiovascular disease, blood pressure, poorer sleep quality, burnout, depression, and anxiety.^{Reference Harrington41–Reference Proper, Van de Langenberg and Rodenburg45}

In a study on biological correlates of stress in EMDs, cortisol measures in eight EMDs were compared to those of matched controls during leisure activities.^{Reference Weibel, Gabrion, Aussedat and Kreutz14} Cortisol is a hormone released by the body when it is under stress. The EMDs exhibited significantly increased cortisol levels throughout the day when measured every two hours over a ten-hour period, with an average elevation of almost 23% compared to controls. The subjective reports of distress by EMDs were strongly positively correlated with objective cortisol concentrations. High noise levels and poor lighting, in particular, were cited as the most problematic, and such evaluations were correlated with higher cortisol levels.

Obesity was reported to be incredibly high in one US-based study of 911 dispatchers, with 83% of telecommunicators in the study reported as being obese or overweight; 53% alone fell into the obese category.^{Reference Lilly, London and Mercer4} On average, there were 17 different health complaints with an occurrence at least once a month, all the way up to once a week. In addition to obesity, the most common complaints were headaches, backaches, insomnia, heartburn, and upset stomach. Cortisol dysregulation may be a major factor in some of these symptoms, as may the shift-work schedule, which can have a significant impact on physical health. Shift-work interferes with sleep, specifically impacting metabolism and the hormone ghrelin that is released when the body does not get enough sleep. Ghrelin prompts hunger signals. So stress, poor sleep patterns, dysregulated cortisol, and the sedentary nature of the job can all impact the health of the emergency service call-takers and dispatcher.

Mental Health Challenges

Studies dating back to the early 1980’s have documented the stress associated with the role of an emergency service call-taker or dispatcher. Focusing mostly on police dispatchers, the studies identified greater levels of stress among this group than the general population.^{Reference Doerner5,Reference Ksionzky and Mehrabian10,Reference McCammon, Durham, Allison and Williamson46} In 1997, a study examined stress among fire and police dispatchers, where operators were assessed for three days, two and one-half months following Hurricane Andrew (1992). The dispatchers reported rates of traumatic stress that were analogous to those of emergency personnel on the scene of a major air crash and relocated.^{Reference Jenkins23} However, like with 9/11, this occurred in the context of a major disaster as opposed to routine emergency dispatching, resulting in call-takers and dispatchers facing stress in both their occupational and personal lives; this made it difficult to disentangle the distress attributable to their roles as victims versus rescue workers.^{Reference Gurevich, Halpern and Brazeau20}

Thematic analysis for potential triggers associated with mental health challenges for emergency service call-takers and dispatchers identified traumatic and abusive calls in several studies.^{Reference Pierce and Lilly3,Reference Tracy and Tracy6,Reference James and Wright12,Reference Shakespeare-Finch, Rees and Armstrong17} Despite not being physically exposed to the emergency situation, call-takers and dispatchers experienced the trauma vicariously, experiencing fear, helplessness, or horror in reaction to calls about children, suicide, or domestic violence.^{Reference Pierce and Lilly3} Calls relating to vehicle accidents, incidents involving children or vulnerable adults, domestic violence, and suicides were commonly cited as the most distressing types of call.^{Reference Pierce and Lilly3,Reference Tracy and Tracy6,Reference Shuler and Sypher7,Reference James and Wright12,Reference Gallagher and McGilloway16,Reference Forslund, Kihlgren and Kihlgren24} Police dispatchers reported concern about handling fluid situations, such as robberies-in-progress or suicidal callers, in case they did not make the correct decisions.^{Reference Tracy and Tracy6}

Emergency service call-takers and dispatchers reported higher levels of traumatic distress compared to police officers, and this level of distress experienced during and immediately after a traumatic call positively correlated with PTSD symptoms and burnout.^{Reference Pierce and Lilly3} Veteran dispatchers had the highest rate of PTSD,^{Reference Lilly and Allen27} and exposure to traumatic calls resulted in difficulties sleeping, nightmares, flashbacks, and increases in alcohol consumption.^{Reference Gallagher and McGilloway16,Reference Adams, Shakespeare-Finch and Armstrong18}

Managing traumatic and abusive calls was also associated with a higher desire to leave the occupation and greater levels of emotional exhaustion.^{Reference Sprigg, Armitage and Hollis15} Call-takers and dispatchers dealt with abuse from callers,^{Reference Tracy and Tracy6,Reference James and Wright12,Reference Sprigg, Armitage and Hollis15} as well as from fellow professionals.^{Reference Sprigg, Armitage and Hollis15,Reference Gallagher and McGilloway16} While managing these calls, emergency call-takers and dispatchers are required to exhibit emotional neutrality,^{Reference Shuler and Sypher7} which serves to convey “dispassionate authority”^{Reference Morris and Feldman47} and control under pressure. They have to suppress their emotional reactions when dealing with these callers.^{Reference Tracy and Tracy6} Emergency Medical Service call-takers and dispatchers who received abusive calls were higher in emotional exhaustion, de-personalization, and anxiety and had a higher intention to quit their job.^{Reference Sprigg, Armitage and Hollis15}

A lack of high-quality training was identified by some emergency service call-takers and dispatchers as contributing to stress levels,^{Reference Doerner5,Reference Palmer11,Reference Gallagher and McGilloway16,Reference Adams, Shakespeare-Finch and Armstrong18,Reference Coxon, Cropley, Schofield, Start, Horsfield and Quinn19} and made prioritizing and managing emergency calls more challenging, which in itself appears to be stressful.^{Reference Forslund, Kihlgren and Kihlgren24} Call-takers and dispatchers made reference to a divide that exists between themselves and emergency services personnel in the field,^{Reference Adams, Shakespeare-Finch and Armstrong18,Reference Coxon, Cropley, Schofield, Start, Horsfield and Quinn19} and discussed the perceived invisible nature of their role.^{Reference Gallagher and McGilloway16} Bullying and a toxic working culture were reported in the literature, and study participants highlighted that inappropriate behavior by colleagues was not properly addressed by management, causing an additional strain and further mental health challenges for already stressed call-takers and dispatchers.^{Reference Gallagher and McGilloway16}

Informal and formal peer-support programs were commonly regarded as necessary to reduce the emotional burden of the work of emergency service call-takers and dispatchers.^{Reference Tracy and Tracy6,Reference Shuler and Sypher7,Reference Palmer11,Reference Shakespeare-Finch, Rees and Armstrong17–Reference Coxon, Cropley, Schofield, Start, Horsfield and Quinn19} Engaging in storytelling, sharing anecdotes, and the use of black humor allowed call-takers and dispatchers to open-up, vent, and debrief, and were important tools for preventing mental health challenges.^{Reference Tracy and Tracy6,Reference Shuler and Sypher7,Reference Adams, Shakespeare-Finch and Armstrong18} Work-life balance was considered a vital protective mental health measure, as was support from family and friends,^{Reference Palmer11,Reference Shakespeare-Finch, Rees and Armstrong17,Reference Adams, Shakespeare-Finch and Armstrong18} with call-takers and dispatchers who reported less-social support experiencing greater psychological distress following exposure to a hurricane.^{Reference Jenkins23}

Implications

Although emergency service call-takers and dispatchers may not experience emergencies first hand, they can experience vicarious trauma on a daily basis as a result of the job they do. Research exploring the effects of job-related trauma exposure in paramedics and emergency department personnel suggests that such exposure can have negative impacts on health and well-being and may contribute to burnout and compassion fatigue.^{Reference Fjeldheim, Nöthling and Pretorius48–Reference Van Mol, Kompanje, Benoit, Bakker and Nijkamp51} It seems reasonable to assume that emergency service call-takers and dispatchers are at-risk of similar outcomes.^{Reference Golding, Horsfield and Davies28} The findings from this literature review indicate that some call-takers and dispatchers do indeed experience both physical and mental health challenges and are therefore likely to be at-risk of emotional exhaustion and burnout, which may contribute to high absence rates seen amongst this group. Educational and peer-support programs may help to reduce compassion fatigue and burnout and assist in building resilience within emergency service call-takers and dispatchers.