9-1-1; What Is Your Emergency?

Monday, May 11, 2009

Dispatchers = Compassion: How to Recognize & Prevent Compassion Fatigue

Taken from Public Safety Communications Magazine, May 2009
Written by Debra Peterson, communications supervisor with Salt Lake City (UT) Fire Dept. serving as training coordinator. She has worked in public safety since 1977 and in communications since 1980.

Ask any dispatcher what traits they deem necessary to be an effective public safety telecommunicator and somewhere in that long list of attributes you'll inevitably find the word compassion. No one can disagree with that. If you ask yourself or a co-worker why they wanted to become a dispatcher in the first place, you'll most likely hear such comments as "I wanted to help people" or "I wanted to make a difference."

Hopefully, they (and you) still have that same optimism and enthusiasm today. But what if you don't? What if you hear yourself saying: "I can't do this anymore." "What's the use?" or even "Why do we keep going there?" If you've said or thought something along these lines recently, you may be suffering from compassion fatigue.


First used by the U.S. Army Nurses Corps in the early 1950s, the term compassion fatigue is now a psychological condition recognized in numerous professions, such as animal shelter workers, clergy and psychologists. During the past 20 years, the public safety communications profession has focused on Critical Incident Stress (i.e., what it is and how to identify and manage it). Although not formally recognized until recently, compassion fatigue has probably always occurred in the dispatch profession, but it's just now being considered a professional hazard. Also known as burnout, it's at the far end of the stress spectrum.

Stress is experienced through all five senses - taste, sound, sight, touch and smell. Memories are also formed using all five senses and stored in different parts of the brain. Example: Imagine for a moment a loaf of freshly baked bread. See it all nice and browned on top. Smell the aroma as it fills the house. Hear your knife cutting through the crust. Feel the warmth as you pick up that first slice. Taste the different textures of crust, inner bread and warm melted butter. Your mind has just pulled stored memories from different areas of your brain to make one complete picture - a memory - of an incident.

Now, let's switch to the dispatch world. You answer a phone and hear a mother screaming that her baby is choking. You calmly go through the steps you've been trained to perform, get proper incident information; send help; and give pre-arrival instructions. When help arrives, you hang up the phone, but then what?

If the phone isn't obsessively ringing and demanding our immediate attention, most telecommunicators replay the event again and again and again in their minds. First, you hear the phone ringing. Then you hear the mother screaming. You see the address on the ANI/ALI screen. You feel your fingers on the keyboard making the log and hear your co-worker dispatch the call while you turn your attention back to the caller and give pre-arrival instructions. You have used three out of the five senses to make one memory.

Two days later, you answer another call that turns out to be very similar, a screaming mother with a choking baby. You go through the same steps to process that call but something else happens. In a split second, you remember the previous call, that you were eating (taste) a healthy green salad just as you are now during this call and that your co-worker is again wearing the same ghastly perfume (smell) she was wearing two days ago. Your subconscious recorded everything from the call two days ago and is now involuntarily bringing it back to you. The current call will be added to your memory storage banks as a new incident and can be recalled when you least expect it. Imagine this cycle happening over and over. It can cause compassion overload.

Although the event hasn't happened to you, all of its emotion has been shared and transferred to you. You experience it through someone else's eyes, making it the "secondary circle of trauma." Because telecommunicators don't get the satisfaction of delivering hands-on treatment and because conforming to new HIPAA laws means it's virtually impossible to call a hospital and find out patient disposition, telecommunicators are left imagining outcomes or scouring obituaries for several days after an incident.

Unlike Critical Incident Stress, which is incident driven, compassion fatigue is cumulative and forms over time. Many would expect the 20-year veteran telecommunicator to be more susceptible than a three-year veteran. Not so. Just as everyone handles and manages stress differently, everyone's capacity for compassion is also different. The key is prevention, and the first step is recognition.

Recognize the Condition

Symptoms of compassion fatigue closely resemble those of post-traumatic stress disorder (PTSD). Just like burnout, compassion fatigue is an exhaustion that not only refers to emotional fatigue, but also physical and spiritual fatigue. You may have a diminished ability to experience joy or care for others, or you may begin to doubt your lifelong belief system. You're irritable at home and work, you experience sleep disorders, feel helpless and inadequate, and try to avoid tasks that typically would cause you more discomfort. You feel that you don't do anything right, and you've alienated yourself from friends and family. No matter what you say to yourself to talk your way out of the dumps, you still compare yourself to the mouse in a cage, running circles on a very, very small exercise wheel with no escape from the human suffering you're exposed to daily.

Take Care of You

Firefighters are taught to first care for their own safety, then their partner's and then the public they serve. Although that order goes against their human and moral instincts of wanting to help, the reality is they cannot help anyone else if they're incapacitated. There are numerous safety rules in place they must follow. Example: No one goes into a burning building without their personal protective equipment (Hollywood got it wrong in Backdraft), nor would they climb the stairs to fight a high-rise fire without their high-rise pack. Police officers also have safety rules to follow. Rather than jump into the middle of a group of five people fighting with knives slashing, officers wait for backup. Again, you can't help someone else if you're incapacitated.

Telecommunicators' jobs differ from those of our first responder counterparts because we handle all calls while they handle one at a time to completion. We are in information overload. So where's our safety net?

To avoid or conquer compassion fatigue, your life has to be balanced. Forty hours each week you're giving compassion, expending energy and helping people solve their problems, which range from the everyday mundane to life-threatening situations. Then you go home and care for family members or take care of household problems. And just like a battery that needs to be recharged, you run dry to compassion and energy. You need to replenish and receive, or take in, as much as you give out.

During the initial training for Critical Incident Stress Management, potential team members are told, "Stress is our body's normal reaction to abnormal events." So compassion fatigue can be defined as a natural consequence of stress that results from helping traumatized or suffering people. But it's also a preventable consequence, and no one is immune to this condition. It comes back to personal management and your life balance.

Preventetive Steps

The first step in preventing compassion fatigue comes from within. Focus on the positive rather than the negative. You can't control what calls you're going to answer that may put you in touch with a screaming mother and choking baby or other trauma, but you can change your thoughts. Rather than be angry because this mother has unwisely chosen to give a whole hotdog to a nine-month-old child, be positive and focus on the fact that you're doing everything you can to help the baby.

Whenever I hear someone in our office say, "It's been a bad day. I killed three people," I remind them that they did not kill three people and that we, as a team, used every tool available to us to turn the situation around and make it better. Sometimes life just goes wrong. Try remembering the oft-cited homily, "Look at the glass as half full instead of half empty." This may be difficult at first, just like the safety rules for firefighters and police officers on the street, but it will get easier over time.

Second, keep a healthy skepticism. There's nothing wrong with being angry at the father for abusing his child or the drunk driver who just killed an entire family, but put it in perspective and let it go. Allow yourself to feel sorrow, anger and empathy, and then move on.

The third step, and the most difficult for some, is exercise. If you've ever been in a CISM debriefing, you know that exercise is very important and a main coping and stress relief technique. It's easy to sit on the couch and click through all the TV channels while eating a chocolate bar or bag of potato chips, but exercise gets rid of the harmful hormones released in your body during stressful times. The good thing is that exercise can come in all forms. If you don't like the regimen of a gym workout, look around your house for things to do. As I write this, I know there's a driveway with about six inches of snow that needs to be shoveled, which translates to roughly 30 minutes of exercise for me. When was the last time you cleaned out your kitchen cabinets and put down new shelf liner? Does your shower door have hard water deposits and scum accumulation? As you can tell, I like to exercise and accomplish a task at the same time. It makes my mind more peaceful and allows me to rest easier. The key is to find what works for you and stick to it.

The fourth and final step in a healthy stress-reduction plan is to rest and relax. Find time for yourself, and do things you enjoy. Whether you prefer reading, gardening, playing the piano or soaking in a hot bubble bath complete with candles (yes, guys, you can soak too), it's important to take a vacation from responsibility for at least a few minutes every day.

At Work

Your employer can also help create a healthier work environment. Found at www.compassionfatigue.org, the Compassion Fatigue Awareness Project suggests that employers provide a respite for staff following any traumatic event. I know of one dispatch center that has a special room with a big comfy lounge chair, low lighting, a candle and access to soft music where their dispatchers can seek refuge after a difficult situation or call. This center provides a safe haven that encompasses four of the five senses, and dispatchers often provide their own nourishment to complete the circle.

Education is also important. Just knowing what to be aware of is usually all it takes to break the compassion fatigue cycle and keep a healthy perspective on life and the trauma we deal with. Two hours of stress management education is required in the initial Utah State EMD Certification class, as well as two hours for every recertification after that. (One example of how to fill that requirement is reading this article.)

Our biggest asset in creating a healthy work environment is each other. We sometimes spend more time interacting with co-workers than we do with family. This enables us to know each other well enough to recognize possible warning signs of compassion fatigue, such as prolonged grouchiness or a defeatist attitude. If these co-workers are open to dialogue, you can talk to them. If not, refer the situation to your supervisor. You'll be doing them a favor.

Well deserved (not phony) praise goes a long way toward creating a positive, caring environment. Tell the person sitting next to you they did a good job on a call, or tell the radio person they handled "that shooting" well. Allow yourself to feel good about a job well done, even if the ultimate outcome wasn't desirable. James Matthew Barrie (the creator of Peter Pan) said, "Those who bring sunshine to the lives of others cannot keep it from themselves."

If you're curious to see how you rate on the compassion scale, log onto www.isu.edu/bhstamm/tests/satfat.htm. This free online test created by B. Hudnall Stamm and Charles R. Figley is not meant to diagnose or confirm one's compassion or lack thereof; it's just a guide to see how you're faring and if there may be cause for concern. I took the test and confirmed what I had already surmised: I'm in the safe and healthy zone for now. I was glad to know that my occasional outbursts against society are normal and healthy. Remember, compassion fatigue is just a term, not a disease. The goal is to turn compassion fatigue into "compassion satisfaction," in which you feel the same rush of adrenaline and eagerness to help people you did during the first week of your career, regardless of how many years ago that was.

1 comment:

  1. This is an excellent post. For more resources, I would invite you to visit my website www.compassionfatigue.ca which has free articles on Compassion Fatigue and strategies, a 90 minute video (also free) about CF and Vicarious Trauma as well as a link to a blog where I post strategies weekly. The more we can share information with one another, the better off we will all be. I will be coming back to read your posts. Françoise Mathieu, M.Ed, CCC. Compassion Fatigue Specialist. www.compassionfatiguesolutions.com