Denise Georgian has been a 911 ambulance communications officer in Hamilton, Ontario, for 28 years, but she still remembers the first call in which she heard, she says, “someone’s love and torment through the phone.”

Georgian handled the episode with aplomb. Following protocol, she dispatched a response unit immediately, but it didn’t change the outcome of the call -- a life was lost and Georgian heard her caller’s reaction, a scream. She can not share details of the case for legal reasons, but she can describe its impact. “In this job,” Georgian says, “you’re supposed to be empathetic, but you can only take it so far. I really felt that woman’s heartbreak. And I felt useless.” Taking a break outside to collect her thoughts, she cried for about 10 minutes, then convinced herself that her reaction was silly and wouldn’t alter the facts of what had happened. So she returned to her station and “put away” what she had heard.

Perhaps inevitably, memories of that call have resurfaced over the past year during the veteran responder’s medical leave from her job. Georgian is certain that her mind and body have taken a heavy toll for the stress she has encountered in her career, and not just during the dramatic crises, but from the constant flow of adrenaline necessary to process 911 emergencies. Being a call-taker and dispatcher (EMS telecommunicators work in both roles) may require dealing with about 100 phone calls per day, usually juggling more than one at a time, each clocked by the system and held to strict standards.

Operators face several flashing computer screens on their desks and a wall of monitors displaying coded information. They routinely hear from frantic mothers of choking babies, suicidal teens, witnesses to car accidents, and women involved in domestic disputes. It's not unusual to hear someone's last breath, or to listen to someone committing suicide or murder—and some situations will present personal triggers.

Employees typically usually get 15-minute breaks every two hours and may be asked to work extra shifts if a center is understaffed. Georgian says she would never do anything else for a living— “What’s bigger than saving a life?” she asks —but wants people to know that even for someone as tough-minded as she is, being an emergency response communicator “takes a little piece out of you every day.”

The risk of developing symptoms of traumatic stress has nothing to do with being mentally strong or capable of the work. Says Georgian, “That idea is garbage.”

New research

A study published last month in the Journal of Traumatic Stress supports what 911 telecommunicators like Georgian have known for years -- the risk of post traumatic stress disorder (PTSD) in the profession is high, even higher than previously reported. Michelle Lilly, PhD, Assistant Professor of Psychology at Northern Illinois University first published a study on this topic in 2012. In that case, she found that 3.5% of 911 telecommunicators she interviewed about the worst calls of their career had developed symptoms characteristic of PTSD after the event. In the subsequent study, she used a much larger sample group and changed the metric for measuring PTSD. The methodology for the second study was much stronger, says Lilly, and the prevalence of PTSD was significantly higher: 18-24%.

Unfortunately, health policies in emergency call centers across North America have not kept up with what scientists have learned about distress and trauma, say many experts. Lisa Rouse is one of the RCMP dispatchers in Moncton, N.B., who sent police to the scene where Justin Bourque murdered three officers last year. In a recent interview with CBC television, she said she’s been dealing with the psychological aftereffects of that tragedy ever since. Rouse suffers from survivor’s guilt, has days when she’s stuck in negative feelings, and is afraid she’ll never feel normal again. 911 operators need more support to deal with PTSD, she says, and they need to know that it’s okay to ask for it—that their jobs will be safe.

Acknowledging and treating PTSD

The reasons 911 telecommunicators don’t always self-report psychological concerns are both cultural and structural. The attitude toward stress in this profession is coloured by “a John Wayne mentality that says ‘Suck it up, this is part of your job’,” says Vince Savoia, founder and executive director of Tema Contor Memorial Trust, an organization that provides services to emergency, corrections, and military personnel with stress injuries. Savoia says the belief that first responders should rise above horrific incidents mentally unscathed is slowly becoming outdated in Canada, at least in relation to paramedics, police, or firefighters, 22 of which have died by suicide since the beginning of 2015. Still, those answering emergency calls aren’t always perceived to be vulnerable to trauma, he says, because they still face an attitude that says, “Well, you weren’t there, so how could you need help?” It’s a double bind.

Story continues