PTSD and the 911 Call Taker: A PowerPhone Webinar

Copyright © 2013, PowerPhone, Inc.
Stress and PTSD (Post
Traumatic Stress Disorder)
in the Call Handler
Welcome to this webinar on recognizing and
dealing with Critical Incident Stress and
PTSD (Post Traumatic Stress Disorder) in
the communications Center

•  Webinar is being recorded
•  Telephone of VoIP
•  Your phones are muted
•  Q&A via Webinar Chat
•  #PTSD911 ~ @PowerPhone
For Your Information
Type your questions here.
#PTSD911

About Your Speaker
George Deuchar, MAS; PowerPhone
Law Enforcement Training Consultant
!  Retired 26-year police veteran
!  19+ years with PowerPhone
!  Tens of thousands trained worldwide
!  Crisis Negotiator and certified
facilitator for CISD
#PTSD911

MODULE I:
Introduction
Welcome to Module I, an introduction to
the Emergency Medical Dispatch
Recertification Course.
MODULE 1: Critical Incident Stress
4

Copyright © 2013, PowerPhone, Inc.5
Critical Incident Stress
•  Stress is normal and comes
from the many demands and
pressures that we all experience,
at some level, each day.
•  We have demands on us that are
physical, mental, emotional, or
even chemical in nature.
•  The word "stress" includes both
the stressful situation, known as
the stressor, and the symptoms
you experience under stress,
your stress response.
http://thefullmoxie.com/2013/01/14/dont-over-think-things/stress/#PTSD911

Dealing With Critical Incidents
A Critical Incident is an event that may overwhelm an
individual’s capacity to cope, possibly resulting in a
subsequent state of emotional turmoil
They are sudden powerful events which are outside
the range of ordinary human experience
•  Sandy Hook Shootings in Newtown, CT (December
14, 2012)
•  Boston Marathon Bombing (April 15th, 2013
•  Texas Fertilizer Plant Explosion (April 17th, 2013)
•  Moore, OK Tornados (May 20, 2013)
#PTSD911

Critical Incidents You May Experience
•  Violent death or traumatic injury of public safety
personnel in the line of duty
•  Taking a call related to a tragedy involving a
family member or close friend
•  Infant or child mortality or life threatening injury
•  Suicide of a fellow worker
•  Multiple fatalities/Mass Casually Incident: fire,
accident, or other tragic event
•  A rescue operation where the victim expires
•  Suicide caller, barricaded suspect, hostage
taking
•  Violent homicide or suicide of a resident
7
#PTSD911

Critical Incident Stress
Critical Incident Stress is the stress that follows an
extraordinary life event. It is normal to feel, think, and
act different for a period of time.
•  Physical: Loss of appetite, insomnia, upset stomach,
headaches, sweats, muscle weakness, poor
coordination
•  Emotional: Anger, sadness, grief, mixed emotions, guilt
•  Behavioral: Withdrawal, isolation, increased
consumption of alcohol, recklessness, avoidance
•  Cognitive: Distractibility, forgetfulness, preoccupation
with detail, flashbacks, nightmares, intrusive thoughts
8

Critical Incident Stress Debriefing
•  Peer support process
•  Not Therapy
•  Confidential
•  No fee
•  Educational in nature
•  Not a critique of the
response
•  Facilitated Ventilation
and Validation
•  Referral to a Mental
Health professional,
when necessary
Managers should
be alert to
personnel in crisis
and direct them
when needed to
Employee
Assistance
Programs (EAP)
through their
agencies if
available or
arrange for a
CISD.

Critical Incident Stress Debriefing
Facts: What was the call?
What was your role in the call?
Thoughts: What was your first thought when the call
was reported?
Reactions: What was the worst part for you?
What is going through your mind right now?
Symptoms: Any symptoms during the incident?
Any symptoms after the incident?
10

CISD: The Teaching Phase
The Teaching Phase
•  Stress may or may not happen
•  Normal reactions to abnormal events
•  Watch diet and stimulant intake
•  Exercise
•  Rest
•  Give yourself time to recover
•  Maintain normal routine
•  Use your support system(s)
•  Talk to others
•  If reactions are intense or prolonged, seek help
11

Principles of Trauma-Related Stress
•  Trauma is in the eye of the beholder: What bothers
you, may not affect the person next to you
•  The traumatic response is a normal response to an
abnormal event
•  There is a wide range of responses to trauma
•  Traumatic stress is a psycho-biological event
•  Previous traumas that are unresolved have a
significant influence in amplifying current traumatic
events and hindering recovery
•  What you resist, will persist
12
#PTSD911

Contributing Factors to a Telecommunicator’s
Burnout and Depression
•  Working in a perceived low position
within the departmental hierarchy
•  Insufficient training
•  Lack of support and positive
reinforcement from officers,
supervisors, and administration
•  Not feeling like you are part of the
team
•  Shift work
•  Antiquated equipment and facility
•  Confinement and lack of interpersonal
communication

Contributing Factors to a Telecommunicator’s
Burnout and Depression (Cont.)
•  Lack of breaks
•  Negative citizen contacts
•  Lack of personal development
•  Chronic exposure to tragedy
and human misery
•  Inability to bring closure to
critical incidents you are
involved in
•  Government bureaucracy and
overbearing rules and
regulations
#PTSD911

MODULE I:
Introduction
SECTION 2: What is PTSD?
15

What is PTSD?
•  PTSD is a syndrome of
psychological and often
physical symptoms that
develop in a person (or
persons) following a
traumatic event that may
effect you directly or
indirectly.
•  Normally associated with
soldiers in military
combat, we now know
that any overwhelming
life experience can result
in PTSD.
#PTSD911

What is PTSD?
•  PTSD develops in
different ways for each
person. The symptoms
of PTSD usually
develop in the hours or
days following the
traumatic event, but can
sometimes take
weeks, months, or even
years before they
appear.
#PTSD911

What is PTSD?
•  Any traumatic event that
threatens our safety or
makes us feel helpless can
trigger stressful responses
that may include anger, guilt,
depression, suicidal
thoughts, physical aches and
pains, substance abuse,
feeling alienated and alone,
sleeplessness, increased
anxiety, and more.
#PTSD911

Who is Affected by PTSD?
•  Post-traumatic stress disorder
(PTSD) may happen to those
who directly experience the
traumatic event, but may also
appear in those who witness
it, and those who respond to
it, including emergency
workers and law enforcement
officers, and call-handlers.
•  It can even occur in the
friends or family members of
those who went through the
actual trauma.

PTSD vs. the Normal Response to Trauma
•  It’s common after a
traumatic event to have
some recurring bad
dreams, feel afraid, and
rethink the trauma
frequently.
•  But normally these have a
short life and fade away.
When this normal
response becomes stuck
and won’t go away, and
may even become worse,
then you probably are
experiencing PTSD.
#PTSD911

Signs and Symptoms of PTSD?
There are three main types or
clusters of symptoms
associated with PTSD:
1.  Re-experiencing the
traumatic event
2.  Avoiding reminders of the
trauma
3.  Increased anxiety and
emotional arousal

Re-experiencing the Traumatic Event
Re-experiencing a traumatic
event can take the form of
upsetting memories,
flashbacks that make you feel
like the trauma is happening
again, nightmares, intense
physical reactions like
sweating and a pounding
heart, and rapid breathing.
#PTSD911

Avoiding Reminders of the Trauma
Some persons will avoid
activities, places , or even
feelings that remind them of
the trauma.
They lose interest in life
and feel emotionally
detached from others and
their jobs.
They become emotionally
numb and feel their future is
limited.
#PTSD911

Increased Anxiety and Emotional Arousal
Some persons will
experience increased
anxiety and emotional
arousal including difficulty
falling or staying asleep,
inability to concentrate,
being in a state of hyper-
vigilance, or feeling jumpy or
nervous.
#PTSD911

MODULE I:
Introduction
SECTION 3: PTSD in
the Call-Handler and
Contributing Factors
25
Heather Pierce is a former 911
telecommunicator with ten years of
experience. Currently she is a Research
Associate at Northern Illinois University.
Heather Pierce
Heather and Dr. Lilly
conducted the research that is
the basis of this section.

PTSD and the Call-Handler
Research Questions:
•  What types of calls are being handled and what is the
frequency of exposure to potentially traumatic events?
–  Reported handling on average 15 of the 21 different
call types
–  Many reported exposure occurring daily
•  Did the call handlers experience intense and distressing
emotional reactions, such as fear, helplessness, or
horror in response to these events?
–  Indicated experiencing a reaction to 32% of the calls
identified
•  Call handlers that experienced 15 calls, may have
experienced distress in reaction to 5 of those calls

Research Questions: (Continued)
•  Was the exposure to potentially traumatic calls and
emotional distress associated with PTSD symptomology?
–  A significant relationship was found between exposure,
distress, and PTSD symptomology, such that, as
exposure and distress increased so did the scores of
PTSD symptom severity.

•  About 16% of the
calls dispatchers
identified as their
worst, involved the
unexpected injury or
death of a child.
About 13% were
suicidal callers,
10% were police-
officer shootings
and another 10%
involved the
unexpected death of
an adult.
0"
2"
4"
6"
8"
10"
12"
14"
16"
Child"
death"or"
injury"
Suicidal"
caller"
Police"
shoo:ng"
Death"of"
adult"
16%
13%
10% 10%
Percent
#PTSD911

The participants
reported having
experienced a high
level of distress
while handling and in
the time period shortly
after the call.
Comparatively, call
handlers rated their
distress twice that of
a sample of police
officers and civilians.
#PTSD911

•  3.5% of the participants
reported PTSD symptoms
severe enough to qualify for a
diagnosis
•  PTSD symptoms that may be
present in telecommunicators
can impair decision-making
abilities and functioning, which
could pose signiﬁcant risk to
the general population
that relies on them to quickly
and effectively coordinate an
emergency response.
“……. this is the first study on
emergency dispatchers, who
experience the trauma
indirectly.”

Prevention and Intervention
“The results of the PTSD study show the need to provide
these workers with prevention and intervention support as
is currently provided for their front-line colleagues. This
includes briefings and training in ways to handle emotional
distress.”
http://www.koreysufka.com/prevention_comes_first.htm#PTSD911

MODULE I:
Introduction
SECTION 4: Newly Discovered
Treatments for PTSD
32

The Problem with Unresolved Stress
•  The problem with stress
is that it turns on your
sympathetic nervous
system and stimulates
the release of stress
hormones throughout
your body.
•  These hormones give
you super energy and
cause other changes in
the body such as the
"fight or flight"
response.
Speeds up body
Sympathetic
•  Dilates pupil of eye
•  Inhibits flow of
saliva
•  Speeds heartbeat
•  Inhibits stomach
secretions
•  Secretion of
adrenaline
•  Inhibits bladder
contraction
#PTSD911

•  Therefore, stress over a
long time can be very
harmful. When stress
hormones remain elevated,
there is a gradual but steady
stream of harmful changes
to the body.
•  Long-term stress can
suppress the immune
system, which may lead to
the development of
diseases, and can lead to
physical and
psychological problems.
#PTSD911

Some studies show that
the hormones
associated with chronic
stress are linked to
increased fat in the
abdomen. That, in turn,
increases the risk of
chronic and serious
illness such as
diabetes.
#PTSD911

Symptoms of Stress
•  Being overwhelmed or pressured is among
the most common signs of stress. Other
symptoms include:
•  Physical complaints such as stomach
aches, diarrhea, headaches, nausea, and a
sensation of numbness or tingling in your
hands, arms, and face.
•  There maybe unexplained anger, crying for
no reason, or having a short temper.
•  There may be issues with family members,
friends, and even teachers.
•  Some people no longer act their age, and
regress.

Symptoms of Stress
•  There may difficulty falling asleep, or even
oversleeping.
•  There may be personality changes where you
withdraw or requiring more attention than usual.
•  Impatience may be elevated.
•  If you are recognize some of these symptoms in
you or a colleague, chances are that the level of
stress is high.
•  Treatment is needed, because stress can lead to
permanent feelings of helplessness and
ineffectiveness.

Stress Reduction
•  You can reduce normal stress
symptoms using many of the
following techniques:
•  Identify the sources of stress
•  Talk it out. Talk to a friend,
family member, or therapist if
your stress level is too high.
•  Take time out. Before you reach
your breaking point, take time
out for solitude.
•  Set limits. Never hesitate to say
"no" before you take on too
many commitments
#PTSD911

Stress Reduction
•  Try exhaling. Breathing can measure and alter your
psychological state, making a stressful moment
increase or diminish in intensity..
•  Exercise daily. Exercise is thought to increase the
secretion of endorphins, naturally produced
substances in the brain that induce feelings of
peacefulness.
•  Proper Nutrition to provide your stressed mind and
body with essential nutrients.
#PTSD911

Treating PTSD
•  Unfortunately, PTSD
doesn’t normally respond
to these methods of
reducing stress. You are
psychologically stuck and
the symptoms persist with
all of the possible damages
to the body, to relationships
such as family and friends,
and to job performance.
•  It is important to recognize
that yourself or a co-worker
has PTSD and involve
professional intervention.
#PTSD911

Treating PTSD
•  Treatment for PTSD relieves
symptoms by helping you
deal with the trauma you’ve
experienced.
•  You will be expected to
recall and process the
emotions and sensations
you experienced during the
original event.
•  Treatment for PTSD will also
help restore your sense of
control and reduce the
strength of the traumatic
memory.
#PTSD911

Treating PTSD
In treatment for PTSD, you’ll:
•  Learn how to deal with
and control bad
memories
•  Examine your thoughts
and feelings about the
trauma.
•  Cope with feelings of
guilt, self-blame, and
mistrus.t
•  Address problems PTSD
is causing in your life and
relationships.
#PTSD911

Types of Treatment for PTSD
•  Cognitive-behavioral therapy for PTSD and trauma
involves carefully and gradually “exposing” yourself to
thoughts, feelings, and situations that remind you of the
trauma.
•  Since PTSD affects both you and those close to you,
family therapy can be especially productive.
•  Medication is sometimes prescribed to people with
PTSD to relieve secondary symptoms of depression or
anxiety.
•  EMDR (Eye Movement Desensitization and
Reprocessing) incorporates elements of cognitive-
behavioral therapy with eye movements or other forms
of rhythmic, left-right stimulation, such as hand taps or
sounds. #PTSD911

EMDR (Eye Movement Desensitization and
Reprocessing)
•  EMDR (Eye Movement
Desensitization and Reprocessing)
is a fairly new and nontraditional form
of therapy developed by Francine
Shapiro Ph.D., in 1987.
•  During EMDR sessions, the therapist
asks the client to think about a
traumatic event and at the same
time, move their eyes rapidly -
following the movement of a pencil
or a finger by the therapist.
•  What is happening during this
process and why this seems to work
is still largely unknown
#PTSD911

Treating PTSD
•  The theory is that the rapid eye
movement in EMDR creates similar
brain activity to REM (rapid eye
movement) that we experience
during sleep.
•  This REM helps us to process and
rearrange ideas and to resolve
conflicts.
•  We are able to work through
things. We still retain the memory
but without the emotional pain and
the feelings of smell, taste, terror of
the event.
#PTSD911

Treating PTSD
•  The credibility of EMDR has been
elevated by recently posted guidelines
that define who may benefit from the
treatment. For example:
•  The American Psychiatric Association
(APA) declares that EMDR is effective for
treating symptoms of acute and chronic
PTSD.
•  The Department of Veterans Affairs and
the Department of Defense have issued
joint clinical practice that "strongly
recommend" EDMR for the treatment of
PTSD in both military and non-military
populations.
#PTSD911

Treating PTSD
•  An EMDR session can last up to
90 minutes during which the
EMDR therapist will have you
recall a disturbing event as they
have you follow finger
movement with your eyes quickly
switching back and forth. Some
therapists use alternatives to
finger movements, such as hand
or toe tapping or musical tones.
•  Gradually, the therapist will help to
shift your thoughts to more
pleasant ones.
#PTSD911

Treating PTSD
Although most research into EMDR
has examined its use in people with
PTSD, EMDR is being used to treat a
number of other psychological
problems. They include:
•  Panic attacks
•  Eating disorders
•  Addictions
•  Anxiety, such as discomfort with
public speaking or dental
procedures

Stress Management Training by PowerPhone
•  Host or contract PowerPhone
to provide this training at your
location.
•  8 hour class; conducted by
subject matter experts.
•  $229 per person. Quantity
discounts available.
•  PowerPhone.com or
800.53.POWER for more info.
#PTSD911

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PTSD Resource Page
including slide deck and
PTSD White Paper soon.
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