Liz Frings

Vicarious Trauma in 999 Call Handlers and Control Room Staff

Before a police car, ambulance or fire engine arrives, someone in a control room has usually already been on the phone: talking a parent through CPR, or staying on the line with someone in crisis. When the call ends, the next one comes in, and most of the time they never find out what happened.

Control room staff are often left out of conversations about the mental toll of emergency work. Being affected by trauma you hear about, rather than see or go through yourself, has a name: vicarious trauma, sometimes called vicarious traumatisation or secondary trauma. This article looks at what it is, why people working in 999 and other emergency control rooms are especially at risk, what the figures show, the signs to look out for, and what can help. I specialise in EMDR for emergency services personnel, and I have written it for call handlers, dispatchers and control room staff in the police, ambulance and fire services, and for the people who manage and support them.

What vicarious trauma means

The idea of being traumatised through other people's experiences was first described by the psychologists Lisa McCann and Laurie Anne Pearlman in 1990, in their work with therapists who heard about trauma every day. They called it vicarious traumatisation, and noticed that over time, repeated exposure to other people's traumatic experiences could change how a helper saw the world: whether it felt safe, whether people could be trusted, and what they could control.

Three things set it apart:

  • It is cumulative. It usually builds over many calls, rather than coming from one.
  • It changes how you see the world. People often describe becoming more fearful, more suspicious, or more aware of every way things can go wrong.
  • It is a normal response to abnormal work. It is not a sign of weakness, or of being unsuited to the job. It happens because you engage with the people you are helping.

Vicarious trauma can also lead to post-traumatic stress disorder. The diagnostic criteria for PTSD include repeated exposure to the distressing details of traumatic events as part of your work, not only being there in person. A large study of UK police officers in 2020 found strong support for that, and that this kind of repeated exposure was linked to PTSD and complex PTSD (Brewin and colleagues, 2020).

Why control room staff are at risk

Hearing it without seeing it

Call handlers hear the worst moments of people's lives, but only through sound, which is why they are so exposed to vicarious trauma. The mind fills in what the eyes can't see, and the images people create can be more vivid and more frightening than the reality. Many control room staff describe carrying scenes in their heads from calls where they never saw a thing.

Rarely finding out how it ends

A paramedic or officer usually sees an incident through to some kind of end. A call handler often doesn't. The line goes dead, the crew arrives, and the call handler moves on without knowing whether the baby started breathing or the person on the bridge was found. That lack of closure leaves calls unfinished in the mind.

Feeling responsible but powerless

Control room staff give instructions that can save a life, such as CPR guidance or advice to get out of a burning building, but they can't act physically. When an ambulance is delayed or help can't get there in time, they are the ones on the line, listening, unable to do any more. Many describe that sense of powerlessness as the hardest part of the job.

No time to recover

In a busy control room, the next call is often waiting before the last one has sunk in. There is rarely space to take a breath, let alone process what has just happened.

What the figures show

Research and recent figures from across the UK show how much pressure control room staff are under.

Ambulance call handlers. In June 2025, Unison published figures obtained through Freedom of Information requests to UK NHS ambulance trusts (Unison, 2025). They showed that:

  • more than a quarter (27%) of ambulance control room staff had left their jobs over the previous three years
  • at least 510,254 days were lost to sickness in 999 control rooms between April 2021 and March 2024
  • in 2023/24 alone, 166,940 days were lost, more than a month of sick leave for every call handler, compared with an average of four days for UK workers
  • turnover in 2023/24 reached 80% at South East Coast Ambulance Service, 33% in the North East, 31% in Yorkshire and 28% in South Central
  • South East Coast lost 19,319 days to sickness in 2023/24, more than 54 days per call handler

Call handlers interviewed for the report described 12-hour stretches with limited breaks, and said support after a distressing call was inconsistent. A further Unison survey of 213 staff in NHS 111 call centres, published in March 2026, found that the volume of calls (82%), staff shortages (75%) and aggressive or abusive callers (66%) were the hardest parts of the job (Unison, 2026). A University of Bradford study of 999 ambulance control room staff describes them as a hidden and under-researched part of the workforce (University of Bradford).

Police control rooms. The largest survey of UK police wellbeing, carried out by the University of Cambridge in 2018, included operational staff such as emergency call operators as well as officers. Of the 16,857 people who took part, 90% had been exposed to trauma, close to one in five had symptoms consistent with PTSD or complex PTSD, and over two-thirds of those with symptoms were unaware of it (University of Cambridge, 2019). The College of Policing has since funded research specifically into the experiences of police emergency call handlers (College of Policing).

The wider research. A 2017 review of 16 studies of emergency call handlers in the fire, police and ambulance services, led by the University of Surrey, found that the stress of the work appeared to be linked to poorer psychological health. The main stressors were exposure to traumatic calls, lack of control over a high workload, under-resourced and pressured environments, and lack of support from management. The researchers noted that although call handlers are not physically present, they experience trauma vicariously (Golding and colleagues, 2017).

Signs of vicarious trauma to look out for

The signs of vicarious trauma often creep up slowly, and people tend to put them down to tiredness or a hard week.

  • Intrusive images or sounds from calls, including scenes you imagined rather than saw
  • Feeling constantly on edge, or startling easily, especially at sounds such as phones ringing
  • Fear for the people you love, checking on children, avoiding certain roads, or imagining the worst whenever someone is late
  • Dreading particular types of call, such as calls about children, suicides or cardiac arrests
  • Numbness or detachment, feeling flat, or being unable to feel much about calls that should be upsetting
  • Irritability and a short fuse, at work or at home
  • Poor sleep and nightmares
  • A darker view of the world, feeling that people are dangerous or that nowhere is safe
  • Pulling away from friends, family or colleagues

If several of these have lasted more than a few weeks, or they are affecting your work, your relationships or your sleep, it is worth taking seriously. PTSD in emergency services workers explains the signs of PTSD in more detail.

How it differs from burnout and compassion fatigue

These three often overlap, and many control room staff experience all of them.

  • Burnout comes from workload and working conditions: too many calls, too few staff, too little control. Burnout in the NHS looks at it in more detail.
  • Compassion fatigue is emotional exhaustion from caring for people in distress, often showing up as numbness. What happens when caring wears you down explains it.
  • Vicarious trauma is about the trauma itself getting under your skin, changing how you see the world and leaving you with symptoms that look like PTSD.

The distinction matters, because the help is different. Burnout needs changes to the work. Trauma symptoms often need trauma-focused therapy.

What helps

At work

Good support at work makes a real difference to vicarious trauma. Many services now use Trauma Risk Management (TRiM), peer support and defusing after difficult calls. In March 2026, East of England Ambulance Service became the first UK ambulance service to introduce trauma training designed specifically for its control room teams (EEAST, 2026). Unison has called for better training, regular breaks during shifts and improved emotional support for call handlers.

If you manage a control room team, some of the most useful things are simple: checking in after a difficult call, protecting breaks, and making it normal to step away for a few minutes.

For yourself

  • Take a moment between calls when you can. A few slow breaths, a stretch, or looking away from the screen helps your nervous system reset.
  • Mark the end of your shift. A walk, a change of clothes, or the drive home with music on can help separate work from home.
  • Talk to colleagues. People who do the job understand it in a way others can't.
  • Notice the signs early. It is much easier to deal with this early than once it has built up over years.

Independent support

Police Care UK, The Ambulance Staff Charity and The Fire Fighters Charity offer support independent of your employer, including to control room staff. If you work for an NHS ambulance trust, counselling for NHS staff explains other routes.

How EMDR and counselling can help

When calls keep coming back as images, sounds or feelings, EMDR can help with vicarious trauma as well as direct trauma. It works on the way distressing memories are stored, and it can be used with memories of calls, including images you only ever imagined. You don't have to describe every call in detail. EMDR without talking about the trauma explains how that works, and EMDR for emergency services staff covers how it is used with these roles.

Counselling gives you a space to talk about the job and how it is affecting you, at your own pace, with someone who won't be shocked by what you have heard. It can also help with what sits around the trauma, such as exhaustion, relationships and decisions about your career.

Many control room staff worry about what might get back to work. In my practice, I don't share anything with your employer or occupational health without your agreement, unless there is a serious risk to you or someone else. Is counselling confidential? explains how that works across different routes to support.

Frequently asked questions

Can you get PTSD from a phone call?

Yes. PTSD can develop from repeated exposure to the distressing details of traumatic events at work, not only from being there in person. Research with UK police has supported this.

Is vicarious trauma the same as PTSD?

Not always. Vicarious trauma describes the wider effect of hearing about trauma over time, including changes in how you see the world. Some people go on to develop PTSD, and some don't.

I've done this job for years. Why is it affecting me now?

Vicarious trauma is often cumulative. Many people cope for years, and then one call, or a change at home, tips the balance. That doesn't mean you have stopped being good at the job.

Do I need a diagnosis to get help?

No. You can have counselling or EMDR without a diagnosis, whether what you are feeling is vicarious, direct or a mix of both.

Talking to someone

I'm a BACP registered counsellor and EMDR practitioner, offering EMDR therapy and person centred counselling in Nottingham and online. If you would like to ask whether I might be the right fit, you can get in touch before committing to anything.

Sources

More about EMDR therapy