“You Can’t Triage It Until You Answer It” Anticipatory Anxiety in 911 Dispatchers

Many of you know that I am writing a non-fiction book about 911 Dispatchers, slated to be published next year. A good part of that book is devoted to dispatcher stress. Numerous causes of job stress have been consistently identified by 911 Dispatchers (and, before 911, emergency service dispatchers) over many decades. Workload, lack of recognition/respect, low pay, work setting, shift work/sleep disturbance, shift and weekend work/social isolation, and insufficient training have appeared repeatedly in journal articles (see bibliography). It appears to me that increased emphasis on certification has brought an improvement in the previously identified area of training deficits. But many of the other areas remain problematic.

One cause of job stress frequently mention by 911 Dispatchers is anticipatory anxiety. They often don’t name it that, but that is what they are talking about. Here are some examples I’ve collected over the years and some of my thoughts about them:

“I never know what’s coming up in that next call. There’s always the possibility of a surprise. And not necessarily a good one.”

Competent focused training will help you frame this as a normal expectation for your job, a job which you have been trained to handle.

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“I just pick up the phone and all hell breaks loose. Somebody’s trapped. I have to be accurate. I have to be fast. I have to be calm. I send the job and another phone is ringing. God help me, I don’t want to pick up that phone. My performance can be reviewed by people who work straight days, weekends off, probably never did my job and have a “pause” button they can use in reviewing the call. I didn’t have a “pause” button when I was taking it!”

and

“I’ve seen other dispatchers in this department get interviewed for hours about a call they took.”?

Explanation of a department’s after-action analysis demystifies that process. Having another dispatcher in the room for that analysis provides peer support and a friendly face, normalizing what can be thought of as a scary process.

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“I got a call from my uncle, who was having a heart attack.”

If you work in a small town or city, the odds are you may hear from somebody you know. Understand that this gives you the chance to help them when they need help. Understand also that negative outcomes are part of Public Safety and a caller being your friend or relative does not immunize them from this possibility. Know also that if a negative outcome occurs, it would have occurred no matter who took that call.

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“You can’t triage it until you answer it. I’ve got six phone buttons blinking in front of me. We have a car fire in a busy intersection and that’s probably what they are all calling about. But I don’t know that until I answer each call. I try to be professional with the people calling to report the car fire that we already know about and are responding to. But I have to rush them along to make sure that next button isn’t somebody having a baby or a heart attack or a choking child. As far as I’m concerned, every blinking button is major disaster until I answer it and determine that it isn’t.”

This is a situation that occurs more often in one- or two-seat PSAPs. And this dispatcher’s assessment is correct: They’re all very serious calls until you determine that they are less than that. Each blinking light on this dispatcher’s console contributed a little stress on its own. But this dispatcher has learned to do her job well. She assigns that waiting calls stressor a relatively low value in her work world while trying her best to be professional and fast.

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“All I did was hit the button and talk with some guy threatening to blow up some banks. We got the area around the banks cleared and the guy was telling the truth! There were bombs that went off. Suppose I had taken a food on the stove call or a dumpster fire or both while the bomb guy was waiting? Maybe he would’ve hung up and people would’ve been hurt or killed. We just don’t know what the next call will bring until we answer it.”

For many dispatchers, the idea that the next call is a mystery until it is answered is exciting. This in itself is good news, because it clearly shows that unpredictability is not by definition a bad thing. Doing the “What if” exercise can be okay for training purposes. Or it can drive you crazy in a PSAP on a night shift. Or any other shift, for that matter, if you have the time to think about it.

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As you see from the above dispatcher reports, anticipatory anxiety can present in different ways for different people with different histories and experiences. Or not at all in others. There is a not a “better or worse” scale at work here. There is a “people are different from one another” factor that influences individual responses to stressors.?

I’m sure that if you are a 911 Dispatcher you can add your own examples to those offered above. Some associated with performance, some with performance review, some with the potential for being involved with a call with personal loss. Essentially, all are related to the unknown and loss of control.

Some of the recommendations offered by people examining 911 Dispatcher stress I find inadequate. “Involve dispatchers in department decision-making.” Well, sure, thanks. The idea here is to give dispatchers more control over their situation. However, the other people in that decision-making meeting aren’t going to be on that one-to-one call when I’m talking to somebody who has been assaulted and dumped on the side of the road. That doesn’t mean the people in that meeting aren’t good people. It just means that getting involved in policy decision-making (which is important) does not necessarily have a direct effect on my handling 911 calls. Unless the decisions are to budget for more help and more training, of course. Which still wouldn’t help with anticipatory anxiety right now.

“Create a work environment that allows the dispatcher some control of their actions” is another solution I’ve heard. That’s a bit abstract for the situation. Your expected actions as a 911 Dispatcher are pretty rigorously prescribed for you.? But what you can control are your reactions.

You can be prepared for the “unthinkable” things by thinking about them. By being in a group with other professional 911 Dispatchers who approach the “horrible thinking” assignment as a training and preparation exercise. Build emotional muscle by mentally “working out.” Work out how you react to a call from a relative. From somebody who is reporting a possible drowning of a child the same age as your child. Don’t feel bad about anticipatory anxiety. EMT’s, Emergency Department Nurses and Physicians have their share of it.

Remember that “Who you are” is different from “What you do.” If you experience anticipatory anxiety, it is not a sign of intrinsic personal weakness (“Who you are”). It is because of “What you do.” Which is routinely having conversations with people in significant need of immediate assistance of all kinds. Conversations in which you are expected to be both fast and accurate (these two things usually have an inverse relationship, one going up while the other goes down. Yours is an unusual job.).

Acknowledge and accept that this “unknown next call” is exactly why you are where you are. Your job is the first step in bringing order to chaos. You can’t do that without being exposed to chaos. Physical chaos, emotional chaos, logistical chaos. All these things are your turf. Talk about this with other 911 Dispatchers.

Be certain to take care of yourself with sufficient sleep and exercise and a reasonable diet. These three things equip you with a stronger physical base from which to do your sedentary job. A sedentary job where your heart rate can spike in a second. You will remember that spike and not want to experience it again. That’s part of anticipatory anxiety.

There are some “fixes” for some of the long-time causes of dispatcher stress. Having a schedule with permanent, rather than rotating, shifts might help with sleep-related complaints, for example. But for anticipatory anxiety, a frequently identified cause of 911 Dispatcher stress over a period that spans many dispatcher careers, you need specific training focused on this phenomenon to help you to expect the unexpected and deal with it when it comes. This training is not designed to make you unfeeling. Quite the opposite, it acknowledges your feelings, helps you to understand where they come from and how to integrate your job with the balance of your life.

Discussion of anticipatory anxiety should be part of the hiring and orientation processes. Tell candidates that they will eventually be expected to perform at a high level in new situations that are often out of control, not conducive to accurate communication on the part of the caller and can result in negative outcomes. Tell them that, even though we all know about all the factors working against clear communications in some calls, negative outcomes will always be subject to after-action analysis for learning purposes.

I have found that people come into the emergency dispatcher job with positive anticipation. It takes a little time to develop anticipatory anxiety. You need to know more about the workings of the system before you can get really anxious about it. It takes a little time to passively develop anticipatory anxiety, so it follows that it takes a little time to actively put it in its place. The learning process that will help you put anticipatory anxiety in its place is not a solo experience. You need trained guides to master this challenge. Public Safety departments should acknowledge the existence of anticipatory anxiety (911 Dispatchers have been doing so for at least the last four decades, as evidenced by the professional literature) and equip their employees to deal with it.

Anticipatory anxiety is a normal reaction to an abnormal situation. Your job requires you to do things most people would not like to do. You can learn to handle anticipatory anxiety and move on to enjoying the many satisfying aspects of your work.

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Bibliography:

Burke, Tod, (February and March 1993) “The Correlation Between Dispatcher Stress, Burnout and Occupational Dissatisfaction.” APCO Bulletin.

Burke, Tod, (April 1993) “The Correlation Between Dispatcher Stress and Control.” APCO Bulletin.

Guthery, Tom and Jean (1984, December) “Dispatchers: The Vital Link” Police Product News, pp. 32,32, 50, 51.

Holt, Francis X. (November 1989) “Dispatchers’ Hidden Critical Incidents.” Fire Engineering Magazine.

Sewell, James D, Crew L., (1984) “The Forgotten Victim: Stress and the Police Dispatcher.” FBI Law Enforcement Bulletin 53(3), 7-11.

Sparrow, Cindy, Chamberlain, Andrew, (August 2020) “Solitude, Suffering and Stress.” British APCO White Paper.

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