When the calls began coming into the City-County Communications Center early on May 24 that a man had shot at Billings police while fleeing a downtown convenience store, reports about what happened were initially scattered in the chaos of the ensuing moments.

Dispatchers at the center, which takes 911 and emergency calls and helps coordinate emergency responses, tried to sort through it. Was anybody — officers or civilians — shot or hurt? Where was the shooter?

Officers eventually found the man at a nearby hotel and shot and killed him when he charged them with a gun. No one else suffered serious injuries, but as the incident unfolded, dispatch had no way of knowing what happened.

According to a national study published earlier this year, moments like that take an emotional and mental toll on dispatchers.

"We do hear it all and we rarely get to hear the end of the story, so our imaginations might fill in the blanks and that could be worse than what actually happened," said Melissa Pfeffer, a dispatcher and the center's critical incident stress management (CISM) peer debriefer. "We might not be there to see it, but the other senses are there."

The study, published in the Journal of Traumatic Stress in March and authored by Northern Illinois University psychology professor Michelle Lilly and researcher Heather Pierce, shows that about one in 30 of the 171 emergency dispatchers from 24 states interviewed reported symptoms severe enough to warrant a diagnosis of post traumatic stress disorder.

PTSD is an anxiety disorder that can develop after a person goes through a traumatic experience, especially one involving injury or death. It's most frequently associated with active-duty military, emergency responders and law enforcement, but the study shows it also hits emergency dispatchers.

Pfeffer said she's seen it happen in Billings. Dispatchers take plenty of routine calls, but they also have to calmly work through big crises.

They often hear the worst of what's happening: the victim of a bad crash calling for help, the cries of a crime victim or the last words of somebody about to commit suicide.

"It's those kinds of things that don't make sense, that you can't wrap your head around, that are the hardest to deal with," Pfeffer said.

As the center's CSIM peer debriefer, it's Pfeffer's job to help the two dozen dispatchers at the center start working through those incidents.

She's been doing the job for about a year — the center didn't have debriefer until then, she said — and meets regularly with CSIM specialists from other agencies in the area, chaplains and mental health professionals.

Pfeffer keeps an eye out for co-workers who might be struggling. She's ready to talk through the issues and, if necessary, refer them to a mental health professional for more help.

"It's easier to talk to somebody who knows what you're going through," said Diane Guy, a supervisor at the center. "It's key to getting other dispatchers to talk. We end up talking to each other a lot because we're safe within these walls."

Pfeffer said the toughest issues in Billings mirror the two that national survey respondents said reported: officer-involved shootings, such as the May incident in downtown Billings, and the death of children.

Often not knowing what's happening after police, ambulance or fire crews arrive adds to the stress.

"A lot of times, we don't know how it ended," Guy said. "So we try to let them know after."

In addition to Pfeffer's services, dispatchers go through training from the day they're hired on what to expect and how to deal with all of the calls that come in, with a focus on asking the same questions for each one and approaching them in a professional manner without getting emotionally attached. They also undergo training on how to speak with suicidal people.

They're also given four free counseling sessions each year at St. Vincent Healthcare, but the employees must seek them out.

The national study was the first of its kind and indicates that dispatchers had a high level of stress during 32 percent of traumatic calls.

However, the day-to-day challenge of juggling multiple calls also can take a toll, Guy said, and is one of the biggest stressors in the workplace.

There's an expectation that everything runs smoothly all of the time in dispatchers' interactions with the public. The daily grind can eventually get to even the most well-trained employee.

"We have a group of people that are very capable of handling anything that's thrown at them on a day-to-day basis," Guy said. "But we are aware of (the stress) at the center and we make sure individuals are tended to."

While the CSIM program is still fairly new at the dispatch center, Pfeffer said she's seen it become better-utilized over the last year and hopes that it helps to encourage co-workers to ask for a hand if they're struggling.

"A lot of us are the type of person who thinks, 'We're the caregivers,'" she said. "We don't usually see that, sometimes, we need help too."

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