Body, Mind, and Soul – A Look at 911 Well-Being in the United States

Where we’ve been and where we can go to safeguard ECCs

“Check-up From the Neck-up” for Leaders: Your Mindset about Devotion, Sacrifice, and Safeguarding Well-being

If you’re reading this right now, you’re likely a leader who feels a sense of responsibility for the well-being of your personnel. You already know from your daily life in the comm center how psychologically and physically demanding this work is. Yet you chose this work. You decide to do it amidst all the negatives, and likely still believe deeply in its importance. And our citizens and communities across North America need you to do it. But what a bind this is! The very work that we all need you to do, and in which you take great pride, is a major risk to your wellbeing and your teams’, and as a result, to your families – the people who matter most in your lives. Now what?

A Key Moment for a Few Tough Questions About Your Leadership Mindset

Let’s revisit our key questions: Why should you, and the smart people you lead, choose to enter and stay in this profession so fraught with risks to a person’s well-being? And how can you, in good conscience, recruit new people to join you in this work?

Your answer may be: “Because I’m doing a lot as a leader to ensure I and our team can combat those risks and stay healthy on the job: we work hard to build a healthy organization, we’ve got a peer support team, resilience training, access to good therapists, and more.” If that’s you, excellent. You’ll want to absorb key information in this article to support your efforts and build upon them strategically. So, stay with us. But if you don’t resonate with that statement, let me offer a few words of support.

Your answer to, ‘Why do this job and recruit others to it,’ might be: “Well, it’s what I do. It’s my job. And somebody’s got to help protect our communities, just like our war fighters who defend our country. The personal damage I incur in the line of duty is a cost I’m willing to pay.”

As a long-term trauma therapist, I certainly have had to incur some damage as part and parcel of being in the trenches with suffering people for decades. But let’s check something: there can also be an unspoken resignation embedded in our acceptance of such costs – a sense that significant damage to our quality of life is just part of the sacrifice we and our team must accept in these crisis-focused careers. There may be a sense that there’s little you or I can do about it. Can you relate? Such resignation for tough-minded people like 911 professionals can only happen if we believe there are no real solutions to help us overcome this battle with the risk factors. In this article, I will show you that these solutions exist and are within your reach. But another factor may be at play, which can boost the risks of adverse impacts for you and your people if not addressed . . .

Mindset and Denial

Whether you’re an emerging or veteran leader, you may cope by depending on a degree of denial about the very real danger you and your people as 911 professionals are fording daily: ‘We’re fine, we’ll be fine. And after all, if some folks can’t handle it, they don’t belong here.’ It’s true, some folks are not cut out for this work. But it’s also partly false and not a great slogan for recruitment these days. I’ll attest that denial can temporarily be a healthy, beautiful thing: it helps us stay desensitized just enough to continue forging through extraordinary hardships in our worst days without quitting. And heaven knows you, as a 911 leader, need to forge forward! So, denial is a beautiful thing to an extent – until the cumulative effect of excessive chronic disregard for the dangers we face takes its toll on our well-being. Been there? Many of us have. But we can’t live there.

So, which of these mindsets sounds most like yours? You may not be firmly planted in one or the other. But if denial is your primary coping tool, consider this: If war fighters and their leaders deny the existence of their enemy as they cross into their territory, they may be signing their own death certificates. Yes, they might need to make great and unavoidable sacrifices. But a sacrifice to our lives or quality of life made because we denied and failed to prepare for the preventable is a waste of precious life. We need not resign ourselves to battles we can win.

It comes down to this: you have good cause to be confident investing – and encouraging others to invest with you in the 911 profession, if you’re taking the necessary strategic steps to uphold the well-being of your team. You can win the battle against 911 health risks. You and your team can thrive in your mental and physical health, thereby also safeguarding your families, if you adopt three concrete, actionable steps and strategies:

1. Know and fully accept the real impacts of the specific risks to your team's well-being. If you don’t know your enemy, you can’t defeat them.
2. Commit to assuring you and your people have access to the necessary resources. Make this your top leadership priority upon which all the technical success of your ECC depends.
3. Don’t waste your valuable time reinventing strategies and resources that already exist. Know and embrace specific resources already created, and new ones coming soon, to help you manage these risks.

Know the Health Risks Your Team Faces: Psychological and Physical

Psychological Risks

Researcher Osorio and colleagues (2025) found that emergency telecommunicators in nine countries, including the U.S. and Canada, struggled with mental health challenges at the following rates:

• PTSD, 17.8%
• Depression, 28.2%
• Anxiety, 17.2% (May be driven by hyperarousal and performance pressure.)
• Hazardous drinking (A frequent pattern, but no rate stated. May reflect self-medicating attempts and responder cultural influence.)

911 professionals in the United States have the highest rates of PTSD and a rate of depression comparable to their peers in other countries. Lilly and Allen’s study findings (2015) were cited in an article subsequently published by the Centers for Disease Control (CDC) and the National Institute for Occupational Safety and Health (NIOSH) (2021). They can be considered the most authoritative to date. Lilly and Allen found that 24.6% of 808 U.S. telecommunicators acknowledged symptoms consistent with a diagnosis of PTSD. And 24% of this sample reported symptoms consistent with Major Depression. Both these rates are multiple times higher than those of the general public.

Physical Risks

Lilly, London and Mercer (2016) also found that approximately 53.4% of personnel fell within the obese Body Mass Index (BMI) range – a rate significantly higher than that of the general U.S. population average (39.8%). Further, they identified a high co-occurrence with other health complaints, such as poor sleep or hypertension, associated with both sedentary work nature and occupational stressors.

I have polled over 10,000 911 professionals since 2005, asking “How many hours of sleep do you average in 24 hours?” They have consistently reported averaging between four and six hours of sleep for years, often during an entire 911 career. This rate is significantly below the seven to nine hours urged by board-certified sleep physicians in accordance with the increased associated risks for multiple serious health problems. These sleep patterns represent a true epidemic in our 911 workforce that requires our immediate and top-priority attention. Sleep loss can significantly undermine our emotional regulation and resilience, but it also places our core health at risk. Long-term sleep disruption is associated with increased vulnerability to metabolic syndrome, cardiovascular disease, insulin resistance, and other chronic illnesses.

Jehan, et al (2017) showed that morbid obesity combined with chronic poor sleep or sleep deprivation significantly heightens the risk of metabolic syndrome and its associated diseases.

Here’s the bottom line: the mental and physical health risks for our 911 professionals are epidemic and must be strategically addressed as a top priority of ECC leadership and the greater 911 profession. The good news is that we now know what to do to reverse these trends and safeguard your workforce. Let’s explore these solutions now.

The Solutions for a Better 911 Future

In 2022, the National Emergency Number Association (NENA) established the NENA Standard to Protect the Wellbeing of 9-1-1 Professionals. Combined with seminal resources from APCO International's website, it can greatly empower you as an ECC leader. This standard clearly articulates the problems discussed here in full detail. But it goes far beyond reciting problems. This standard defines a set of solutions prioritized to significantly resolve the problems we’ve identified in this article. Specifically, the Standard states that all emergency communications centers shall have Comprehensive Stress Resilience Plans (CSRPs), which assure the following elements of care are provided for all personnel:

• Optimizing 911 workplace conditions
• Stress resilience training
• Effective use of Critical Incident Stress Management (CISM)
• Provision of peer support and peer support program development
• Employee Assistance Programs (EAP)
• Evidence-Based Treatments (EBT)
• Sleep optimization for 911 professionals
• Support for preventing and overcoming 911 obesity
• Comprehensive and ongoing training for call mastery
• Management of exposure to incident-related imagery
• Long-term support to the 911 workforce after high-impact events

While it can seem daunting to ensure all such supports and initiatives are established in your center, the NENA Standard to Protect the Wellbeing of 9-1-1 Professionals provides you with much guidance to implement these solutions. And you likely already have some of them in place. You also do not have to implement them all at once. Assess your progress to date and prioritize which solutions you will pursue one at a time from here. 

The Historical Challenge with Finding Qualified Therapists: New Progress!

The resource most challenging for our 911 leaders and their personnel to put in place is ready access to clinicians who truly understand 911 work stressors and their culture. Clinicians need such a knowledge base as an essential foundation upon which they can effectively relate to and treat 911 professionals. Fortunately, 2024-2025 APCO International President, Stephen Martini, and 2024-2025 NENA President, Melanie Jones, recently joined together in an initiative with one of our country’s organizations most dedicated to the treatment of PTSD – the EMDR International Association (EMDRIA™), whose purpose is “to promote, foster, and preserve the highest standard of excellence and integrity in Eye Movement Desensitization and Reprocessing (EMDR) practice for the membership, for the mental health professions, and for the community which shall be served by the mental health professions.”

This initiative aims to greatly improve our 911 professionals’ access to culturally competent clinicians. I’ve had the privilege of serving as the subject matter expert, developing a comprehensive course for EMDRIA-member clinicians and equipping them with cultural competence within 911. Soon, this four-hour educational documentary-style course, Achieving Cultural Competence Serving 911 Professionals, will become available to all their member clinicians in the U.S. EMDRIA will feature therapists who have completed the course on their website, where our ECC leaders and telecommunicators can find them. ECC leaders can now access a free 20-minute video introduction to the course which they can share with their local clinicians to inform them about the course and to encourage them to serve their 911 personnel. Download the introduction available here. Such local partnerships can make a lifetime of difference for our 911 professionals by safeguarding their health across their entire lifespan. 

Emerging Partnerships Between Private Sector Companies and Mental Health Professionals

ECC leaders have another cause for optimism: private sector companies are beginning to sit up, take notice, and support mental health initiatives through product innovation. These leaders are rising to the challenge to support the health and well-being of the 911 workforce. Eventide Communications, a long-time leader in software audio recording, has invested in responsibly developed AI analytics to help ECC leaders better understand the intense demands telecommunicators face, including the ability to identify stressful call content. The company collaborates with mental health professionals who specialize in the study and support of the 911 community. Eventide is also partnering with the grassroots organization, Positive911, to use technology to address the heavy weight of daily call handling and recognize and celebrate moments of excellence. Eventide’s innovations include ongoing training for call mastery, tools to manage exposure to incident-related imagery, and long-term support for the workforce following high-impact events.

Conclusion: Cause for Big Hope and a Great Future

As an ECC leader, you can now become fully equipped to safeguard the future well-being of our 911 professionals as you embrace three steps: 

1. Fully accept the reality of the mental and physical risks that you and your people face.
2. Prioritize systematic support of their well-being by implementing your ECC’s Comprehensive Stress Resilience Plans using the guidance provided in the NENA Standard to Protect the Wellbeing of 9-1-1 Professionals.
3. Pursue ongoing relationships with local mental health professionals who are qualified and culturally competent to serve 911 professionals using the upcoming 911 therapist-finder resources coming soon from EMDRIA (watch for more news from APCO International and NENA in the coming months).
4. Engage private sector partners like Eventide, who offer technological solutions complementing all your efforts above.

Our 911 leaders have always carried a heavy burden of responsibility for the mental and physical health of their people. Now, you have more help than ever to ease that burden and succeed at securing their wellbeing, retention, and a better quality of life for the entire ECC team at work and at home. 

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Article Bibliography

Allen, C. A., Mercer, M.C., & Lilly, M.M. (2016). Duty-related posttraumatic stress symptoms in 9-1-1 telecommunicators: The roles of childhood trauma exposure and emotion-focused coping, Advanced online publication, Journal of Aggression, Maltreatment & Trauma. DOI:10.1080/10926771.2016.1175534

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing

Baseman, J., Revere, D., Painter, I. et al. Impact of new technologies on stress, attrition and well-being in emergency call centers: the NextGeneration 9–1-1 study protocol. BMC Public Health 18, 597 (2018). https://doi.org/10.1186/s12889-018-5510-x

Carleton, R. N., Afifi, T. O., Taillieu, T., Turner, S., et al. (2019). Mental disorder symptoms among public safety personnel in Canada. Canadian Journal of Psychiatry, 64(1), 54–64. https://pubmed.ncbi.nlm.nih.gov/28845686/

Dwight, C., & Palmer, K. (2021). “I can’t switch off”: Insights into chronic poor sleep and fatigue among police communications workers. Policing: A Journal of Policy and Practice, 15(1), 210–225.

Jehan, S., Zizi, F., Pandi-Perumal, S. R., Wall, S., Auguste, E., Myers, A. K., Jean-Louis, G., & McFarlane, S. I. (2017). Obstructive Sleep Apnea and Obesity: Implications for Public Health. Sleep medicine and disorders: international journal, 1(4), 00019.

Johnson, Angela. "The Lived Experiences of 911 Dispatchers With Compassion Fatigue: An Interpretive Phenomenology" (2023). Doctor of Philosophy (PhD), Dissertation, Counseling & Human Services, Old Dominion University, DOI: 10.25777/5m83-pm64
https://digitalcommons.odu.edu/chs_etds/146

Lilly, M.M., London, M.J., & Mercer, M.C.* (2015). Predictors of obesity and physical health complaints among 9-1-1 telecommunicators. Safety and Health at Work, 7, 55-62. doi: 10.1016/j.shaw.2015.09.003 https://pubmed.ncbi.nlm.nih.gov/27014492/

Lilly, M.M., & Allen, C.E. (2015). Psychological inflexibility and psychopathology in 9-1-1 telecommunicators. Journal of Traumatic Stress, Advanced online publication. doi: 10.1002/jts.22004. https://pubmed.ncbi.nlm.nih.gov/25964163/

Lilly, M. M., & Allen, C. E. (2021). Impact of new technologies on stress, attrition, and well‑being in emergency dispatch personnel: A prospective evaluation of text‑to‑911 implementation. Journal of Emergency Dispatch Studies, 8(2), 45–59.

Kindermann, D., Sanzenbacher, M., Nagy, E., A., Cranz, A., Nikendei, A., Friederich, H. C., & Nikendei, C. (2020). Prevalence and risk factors of secondary traumatic stress in emergency call-takers and dispatchers - a cross-sectional study. European journal of psychotraumatology, 11(1), 1799478. https://doi.org/10.1080/20008198.2020.1799478

Marshall, J. and Laorenza, T. (Editors). The Resilient 9-1-1 Professional: A Comprehensive Guide to Surviving and Thriving Together in the 9-1-1 Center. 2018. South of Heaven Publishing. (Amazon)

National Emergency Number Association. (2022, March 14). NENA Standard to Protect the Wellbeing of 9‑1‑1 Professionals (NENA‑STA‑002.2‑2022). Arlington, VA: NENA.

Osório, C., Talwar, S., Stevelink, S. A. M., Sihre, H. K., Lamb, D., & Billings, J. (2024, November 4). Systematic review and meta-analysis on the mental health of emergency and urgent call‑handlers and dispatchers. Occupational Medicine, kqae104. https://doi.org/10.1093/occmed/kqae104

Osório, C., Talwar, S., Stevelink, S. A. M., Sihre, H. K., Lamb, D., & Billings, J. (2025). Correction to: Systematic review and meta-analysis on the mental health of emergency and urgent call-handlers and dispatchers. Occupational Medicine, XX, 1–2. https://doi.org/10.1093/occmed/kqaf058

Stanley, D. P., & Manning, L. P. (2023). Exploring the lived experiences of 911 dispatchers: A phenomenological study / Découvrir le vécu des répartiteurs et répartitrices au 911 : une étude phénoménologique. Canadian Journal of Counselling and Psychotherapy, 56(3–4), 324–346. https://cjc-rcc.ucalgary.ca/article/view/71678

Tiesman, H. M., Elkins, K., Brown, M., Marsh, S., & Carson, L. M. (2021, April 6). Suicides among first responders: A call to action. CDC NIOSH Science Blog. https://blogs.cdc.gov/niosh-science-blog/2021/04/06/suicides-first-responders/