A 911 dispatcher in Kane County for 18 years, Tammy Kleveno is never far from the calls that shook her.
A child run over by a truck. A husband committing suicide in front of his wife. A teen sobbing as her dad holds a gun to her mother's head.
"Sometimes you don't ever find out if they survived," said Kleveno, who took up running to deal with the stress.
It's no surprise to Kleveno, but a new study suggests 911 dispatchers are at risk of developing post-traumatic stress disorder.
The findings come from Northern Illinois University researchers Michelle Lilly and Heather Pierce, who wanted to know how indirect exposure to trauma affects emergency call takers.
Their study is believed to be the first of its kind, surveying 171 dispatchers in 24 states. Respondents weighed in on everything from the types of calls they handled to how they reacted. They also recounted their most disturbing on-the-job experiences.
"The descriptions were just shocking. They're behind a desk, they're on the telephone, they're not publicly visible -- and yet they're going through these phone calls that are just horrifying," said Lilly, who teaches psychology at the DeKalb university and lives in Glen Ellyn.
More commonly associated with combat veterans, PTSD is an anxiety disorder that can lead to flashbacks, nightmares, confusion and depression, among other symptoms. It's usually set off by a traumatic event, such as a natural disaster or assault, experts say.
The NIU study, published March 29 in the Journal of Traumatic Stress, should broaden the debate on how trauma is defined, Lilly said, because it "suggests that one does not need to be physically present during a traumatic event, or to even know the victim of a trauma, in order for the event to cause significant mental health challenges."
The study found dispatchers are most often troubled by calls involving the unexpected injury or death of a child, followed by suicidal callers, police-involved shootings and unexpected adult deaths.
Respondents reported feeling fearful, helpless or horrified in nearly a third of calls considered potentially traumatic, with 3.5 percent of them reporting symptoms severe enough to be diagnosed with PTSD.
"We've always known the profession is stressful, but now we have empirically shown it can be potentially traumatic," Pierce said.
Pierce herself was a 911 dispatcher in Kane and Kendall counties for 10 years before she went back to school to study psychology and later teamed up with Lilly, her professor.
She said dispatchers face "enormous pressure" to remain composed while extracting key information under some of the most intense circumstances. Sometimes their efficiency is crucial to life-or-death situations. And it all happens fast.
"You can go from dead silence to chaos within seconds. It's a very short period of time to collect yourself," said Pierce, of Yorkville.
The majority of dispatchers surveyed were white women with an average age of 38 and an average 11 years experience.
Lilly said the sample is "pretty skewed" because it consists of only dispatchers who were willing to talk. She suspects a broader study would find an even stronger link between 911 calls and anxiety.
"At this point, we probably don't have a true estimate," she said.
Whether the research has any impact on professional standards or liability for employers remains to be seen.
Nationwide, there are an estimated 100,000 to 120,000 dispatchers working at an estimated 6,000 emergency call centers, according to the National Emergency Number Association, a nonprofit focused on issues related to the profession.
Rick Jones, the organization's operations issues director, said it recently undertook a committee project devoted to issues of stress and PTSD. He said the committee of dispatchers, mental health professionals and 911 administrators is likely to suggest call centers put in place stress management programs across the board.
Jones said some 911 entities already have programs to help employees deal with job stress while "others have nothing."
"It's very important that as we go forward, we are expanding," he said.
Jones said the need for stress management likely will increase as technology paves the way for 911 calls by video. The deaf and hard of hearing have had access to video 911 services for years, he said, but the prevalence of smart phones and other handheld video devices could eventually push them into the mainstream.
Also increasing is the real-time demand on dispatchers, with some learning to talk callers through baby deliveries and first-aid techniques.
"In more recent years, there's been recognition from the local and particularly the national level that call takers and dispatchers are the first responder," he said. "We've got call centers using medical protocols, and some of the bigger ones deliver a baby a week. If somebody gets shot, they're doing first aid by phone before anybody gets there. This isn't clerical work."
John Ferraro, who oversees about 60 dispatchers as deputy director of DuPage Public Safety Communications, or DU-COMM, was among those eager to review the NIU study. He said the call center has come a long way over the years to beef up assistance for dispatchers who may be overstressed.
"I like to think we're proactive," he said.
Ferraro said managers are trained to identify situations that might be particularly upsetting, and dispatchers are encouraged to leave their desks and talk with a supervisor after a "tough call."
In the past five to seven years, he said, dispatchers also have become regular invitees to stress-debriefing meetings with police, firefighters and other front-line responders.
"It's just about everyone kind of talking about it and feeling better about it," Ferraro said. "It helps not only with the stress of the situation, but it helps them to hear what the responders were dealing with. Kind of the group hug feels good."
Ferraro said call takers also can receive counseling through an employee assistance program, and several were sent to a training seminar last year on dealing with stress.
For Kleveno, it eventually became too much.
In late 2007, the Sugar Grove woman left her job with Tri-Com Central Dispatch in Kane County after realizing she'd become somewhat "indifferent," a disposition she attributed to years of burying her own emotions.
Kleveno still speaks fondly of her days as a dispatcher, but says she feels healthier at her desk job with the Geneva Fire Department, where she's an administrative assistant.
"You really don't realize how it impacts so many areas of your life until you don't do it," she said. "It kind of becomes your nature."
Stress: Technology paving way for 911 by video