Who Cares for the Caregivers?
By Dru Clarke, Customer Training Manager
Compassion Fatigue (CF) was a term first coined in the healthcare field to describe the cost of caring for individuals who are charged to care for those in crisis or undergoing trauma. As 9-1-1 professionals we are the caregivers of the entire public safety ecosystem: from caller, to responder, stakeholders, to the community, and back to us internally, our service is a cobweb touching all facets of the industry. We are the first of the first responder; the first care providers delivering emergency medical instructions, pre-arrival instructions, and sometimes just actively listening to create caring space. That caring space over the phone is crucial for talking to callers on their worst day, and speaking to some on their very last day. Callers like Debra Stevens of Arkansas who spent her last 22 minutes in fear of drowning in her car during swift water rain. The dispatcher repeatedly scolds her saying it’s her fault, shut up, stop freaking out you’re not going to die. Debbie died in that incident August 24th 2019 as a casualty of compassion fatigue. But compassion fatigue is a symptom, not the root cause of systemic service degradation.
As 9-1-1 professionals, we can go from taking a parking complaint – to a shooting – a lost dog call – to a child CPR. The range of emotions that we experience on a typical shift can be endless albeit exhausting, and the adrenaline from one call certainly carries over into the next when we don’t process appropriately and unplug. Not only are we charged with caring for callers but our responders as well. We are the voice they rely on to be their eyes and ears in the field, and we kick into high gear when they’re in a pursuit, or come across the radio screaming, or worse, when they don’t respond to a status check while on a traffic stop. The anxiety of silence as dispatchers eats us alive, and then we go right back to handling the mundane property damage accident. How do we refresh, recharge, and reset our service, or do we just power through day after day with no release?
As an industry, we don’t do a great job of teaching coping skills and resilience. Instead, we train our dispatchers that the caller’s emergency is not our emergency. With well intention, we teach and train our new hires to disconnect from the caller’s trauma in order to process, control, and dispatch the call. The problem with this is we build emotional walls that overtime causes us to be numb. The phenomenon of numbness is that it doesn’t mean the pain is not there, we are just not able to process it, so it builds up and bleeds out in unexpected ways. We’ve gravely underestimated the weight and impact of vicarious trauma. Our minds do not know the difference between physical and mental imagery. To be there mentally is the same in our minds as being there physically and the symptoms of vicarious trauma and primary trauma are the same. Overtime, the walls that we built, meant to be a boundary becomes a barrier to service. To feel is to be human. Our feelings are our connection to our humanity, and we can not lead or serve from a place deprived of feeling, because the cost of care is lives: the callers, our responders, and our own.
Warning Signs of Compassion Fatigue (CF)
While repeated vicarious trauma can lead to compassion fatigue, if you don’t have methods to refill your emotional tank, they are not one in the same. Vicarious trauma changes the way you perceive and move through the world. It alters your behavior and creates filters of threat that may not actually exist in real time (believing is seeing). Most of us characterize this as triggers. Since taking a call involving the sound of gunshots, I’m now triggered whenever I hear gunshots. That’s vicarious trauma, but that may not lead to CF. I can be triggered and still remain compassionate. CF is a state of exhaustion and dysfunction biologically, psychologically, and socially as a result of prolonged exposure to compassion stress.
Biological / Physical Manifestations
Compassion fatigue can manifest in biological ways to include: headaches, fatigue, lack of sleep or disturbances during sleep, muscle tension, digestive issues, and cardiovascular issues. The mind houses your feelings but the body manifests those feelings or lack of in various ways. Early warning signs of compassion fatigue are signaled throughout the body. In the same way that hunger can affect your body causing you to feel weak or get a hunger headache, is the same regulation path that your body uses to signal you’re running low on empathy. Paying attention to how our bodies physically change after prolonged caring is a sure way to spot compassion fatigue before it builds to an uncontrollable level.
Psychological (Emotional) Manifestations
Awareness of our bodies is essential for us to regulate emotions, and when we miss the bodily signs, the emotional warning signs are another layer of signaling. Emotional warning signs of compassion fatigue may look like, irritability, lack of focus, feelings of hopelessness or doom, numbness, withdrawal, loss of interests in hobbies, and addiction. Sometimes it’s easy to overlook the emotional warning signs when we’ve developed a culture of living in “the red.” I equate it to knowing your car needs gas but thinking, well I can make it to my destination on less than a quarter tank, so I’ll fill up later. This becomes our habit and lifestyle in the Emergency Call Center. When speaking to my fellow 9-1-1 professionals, they often tell me those emotional warning signs above are just how people in the Communications Center are. That’s the most dangerous mindset to adopt. That’s just _____ [insert name of the irritable doomsday person in the center who often does not serve from a place of care and compassion]. To adopt a culture where fatigue is the norm degrades service, encourages complacency, and harms our front-line whether they know it or not. It’s important for people to know, you are not your trauma. You are not the things that happened to you. You are not the emotions you feel right now. You are so much more than what is being expressed and I want you to help you express yourself in ways that are healthier for you in the long run.
Social (Organizational) Manifestations
Another layer of compassion fatigue warning signs live on the organizational level. Symptomatic manifestations of social compassion fatigue may look like increased absenteeism, lack of joy, pride, or confidence in performing job related tasks, avoidance of certain types of calls or people (those problematic employees). The social manifestations, if not dealt with, become organizational deficiencies and liabilities. You’ll start to hear things like management just doesn’t care. Why should I try harder if I’m the only one. This decreases organizational efficiency. Call processing times increase, use of sick leave increases, apathy sets in.
Compassion Resilience (CR)
It is interesting to me that the term was coined compassion “fatigue” because my mind automatically goes to weightlifting. Many years ago, I took weightlifting as an extra curricular activity in high school. I was 6’0 feet tall 150lbs i.e. scrawny. In order to gain the muscle necessary I had to change my diet, increase my resistance, decrease my reps, and lift harder with a spotter. When my muscles became weak or fatigued the spotter ensured I maintained good form and helped me place the weight down safely. We have to think of compassion this way. Compassion is a muscle. It can grow or deteriorate based on how we train and take care of that muscle. Sometimes we’ll need to rest between our reps. Learn how to take a break. A quick break to stretch, change your physiology, breathe deeply, and then get back to the work, or a longer break like a mental health day off. Sometimes you’ll have to change your diet. Make sure that what you’re eating fuels your physical needs. Your mood is deeply affected by the foods you eat. If you’ve been exposed to Maslow’s hierarchy of needs, you know that you can not create safety, joy, belonging, or compassion until your basic physiological needs are met. Then, find your spotters. Who within your agency will spot you. Peer to peer, are you welcoming feedback and sharing in your feelings? Are you allowing people to take things off of your plate or are you piling project on top of project because you lack trust in others to get it done? Organizationally, do you have a quality assurance department that will “spot” check individuals for compassion; not in a punitive way, but in a motivational way to promote organizational and individual growth. Perhaps your spotters are a team of peer support individuals that will check on your people after tough calls. Whatever you do, know that you can’t do this alone. Compassion requires company; all hands. As the frontline is compassionate towards callers, the middle managers need to be compassionate towards the front line, and upper management needs to be compassionate towards all. Compassion resilience is the process of maintaining physical, emotional, and social well being while still supporting and caring for those in crisis. Let’s discuss some ways we can build compassion resilience in the areas compassion fatigue hits hardest.
Physical Compassion Resilience
Remember the body manifests our emotions physically. Sometimes the ability for us to care for others depends on releasing the tension stored in our body from fatigue. Physical resilience requires rest. Sometimes as dispatchers we start competing with each other: who received the least amount of sleep. This is unhealthy. Find rest. Utilize quiet rooms during your break to nap and reset. Other ways to maintain physical compassion resilience includes standing up if you have a standing desk. Changing your posture sometimes allows stress to leave the storage of your body. Keeping tactile stimuli at your console can also help relieve stress. Things like stress balls or a fidget cube can be a good bodily reset. Breathing exercises also help to coregulate emotional responses. Breathing exercises like box breathing, 4-7-8 breathing where you inhale for 4 seconds, hold for 7, slowly exhale for 8 seconds is very useful for anxiety. My favorite breathing exercise is Lion’s breath breathing. Deeply inhale and deeply exhale pushing your chin down through your jaw to your neck and let your tongue hang out like a lion. Yes, it’s quirky, but it helps improve cardiovascular functioning. Sometimes while caring for others or working high pressure events we forget to breathe. Remember your breath.
Emotional Compassion Resilience
Resilience will look different for all of us, especially emotional resilience. Boosting our emotions requires us to tap into our happy place. What stimulates joy for you internally? For some of us this may look like journaling. According to Teaching self-care to caregivers by Shapiro. S. Brown, keeping a gratitude or mindfulness journal to re-center yourself towards the good occurring in the your life instead of hyperfocusing on the negative can increase compassion. Music is a major way I boost or regulate my emotions. Having music readily available at your console may begin to feed yourself mentally. I’ve seen people use “happy” lights at their consoles. Sometimes our dispatch centers are dark dungeons or closets in the back of a building where the sun won’t shine. Having light therapy available, especially if you suffer from seasonal affective disorder can be useful. Always consult your physician before investing in light therapy, but it could be a great way to feed your emotional health. Our emotional health is also heavily tied to hope. Find outlets of hope in your life that live beyond the console and your organization. Stay tethered to your hobbies, and to your family if that feeds you. Also a hope building exercise is scheduling vacation time in the future so you have something to look forward to,
Organizational (Social) Compassion Resilience
You can not manage what you do not measure. Our organizations have to invest in measuring compassion fatigue and job satisfaction. Our service to the community relies on a healthy front line, so we have to move towards awareness. Our ECCs must adopt a trauma informed mindset where we are aware of the signs, symptoms, and remedies for compassion fatigue. Do we have safe spaces in place where people feel they can share their emotions confidentially? Do we have human resources available to our people like (Employee Assistance Programs) and are they educated on what EAP provides? If you are in a management role, are you reaching out or are you solely relying on people to utilize that open door policy you’ve always had? If you want different results, you have to do things differently. Meet your people where they are and develop a process out of it. Let people know it’s okay not to be okay and model what caring communication should look like in the communications center. Let compassion be the norm.
Compassion fatigue is emotional exhaustion that robs our people of their service and clouds their “why.” It has negative service outcomes for any organization, but especially for our Emergency Communications Centers where we need our people to serve from a place of care. Compassion is currency. Yes, you can care on credit but eventually you’ll have to pay it back (with interest). We have to keep our compassion tank full and stop running on empty, because our citizens, our responders, and our staff need our care. Who will care for the caregivers? We will. Through empathy and safe spaces, thanking our communicators for showing up fully, nurturing their well being, and listening to them; actively listening to them. By normalizing feelings, we will tear down the walls of numbness, and foster vulnerability, because it is the human experience of hurt and pain that humbles and connects us.
“We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our clients. We experience their fears. We dream their dreams. Eventually, we lose a certain spark of optimism, humor and hope. We tire. We aren’t sick, but we aren’t ourselves.”
– C. Figley, 1995