She went home in tears, she said. This kid is dead, she told her boyfriend. And I don't know if I did everything right. I don’t know if I could have saved him.

Jamie Acosta still remembers the first call in which someone died. Over the phone, she learned that a 16-year-old had wrapped his car around a telephone pole. Afterward, she replayed it in her head, trying to figure out if she somehow could have gotten the ambulance to the scene faster.

Stories about the mental health struggles of people working new Silicon Valley jobs, like Facebook and YouTube moderators , have recently gained deserved attention. Largely forgotten are people like Acosta, who worked a job that has long existed with intrinsic problems and little effort to remedy them. As a 911 dispatcher in Illinois for 19 years, Acosta’s job was to sit and listen to the worst moments of people’s lives. The general public doesn’t always understand how difficult the job can be, but 911 telecommunicators have taken to calling themselves the “first first responders,” since they often serve as the very front line of life-saving communication.

For almost anyone, an experience like that would register as traumatizing—the kind of thing that keeps you awake and agonizing over what else you could have done to save the person's life. But for Acosta, it was something else, too: another day on the job.

At some agencies, there are two people involved with 911 calls: the call takers, who spend their long days listening to people pleading for help; and the dispatchers, who initiate life-saving care by sending the police, firefighters, and paramedics to the person in need. In other agencies, the two operator positions are blended, and one person does both.

Every day, 911 dispatchers sift through the most stressful of situations, obtaining vital information from people in distress, figuring out what kind of help they need, and mitigating the situation as much as possible, which sometimes includes giving potentially life-saving instructions to people who are panicked and scared. “We take a big pile of crap and we turn it into something workable,” one of them said.

“It’s their job to keep the caller calm, to get the information, give instructions for life-saving medical treatment. They’re just dealing with one after the other, one after the other,” said David Reiss, a psychiatrist and trauma expert who has treated dispatchers.

For many of them, the role takes its toll physically and mentally over time. “The calls where a mother or father is hysterical or their teenager has hung themselves or overdosed; the female you get on the line who's literally in the middle of being beaten or raped—all those screams and visualizations get trapped in our head” one of them said.

VICE spoke to seven 911 telecommunicators for this story, some of whom requested to change their names and locations because they are still employed as dispatchers. They described a working environment with long hours in which they are left disturbed in a lasting way by the things they hear—conversations they can’t help but replay in their heads. But internally, they are provided little in the way of support. The 911 telecommunicators VICE spoke to said they felt looked down upon by the police officers and firefighters who work alongside them. And in contrast to their higher-profile colleagues, they were given few internal resources to cope with their experiences on the job.

Much of the data collected about emergency service providers focuses on police and firefighters, but the mental-health statistics available about 911 telecommunicators are striking. In 2019, the state of Virginia surveyed its emergency services personnel and found that “Public Safety Communicators”—i.e. 911 call-takers and dispatchers—were more than twice as likely as the general population to experience suicidal thoughts, and also more likely to than police officers and firefighters. While around 8 percent of the general population grapples with PTSD, the number is far higher among emergency dispatcher personnel. Michelle Lilly, a psychologist who studies 911 telecommunicators, said her research suggests somewhere between 17 and 24 percent of them suffer from it.

“The calls where a mother or father is hysterical or their teenager has hung themselves or overdosed; the female you get on the line who's literally in the middle of being beaten or raped—all those screams and visualizations get trapped in our head.”

In the mid-2000s, Troy, a 41-year-old 911 dispatcher in Michigan, picked up a call that would stick with him. You’ll find my body in a red Honda parked outside, the man on the other end of the line said. The man had given his address, and Troy was hard at work trying to persuade him not to kill himself. After a few minutes, Troy heard the sound of a gunshot over the phone. Authorities would later determine the caller had shot himself in the head.