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International Center for 9/11 Justice

The Journal of 9/11 Studies

The  Journal of 9/11 Studies  is the flagship publication of the International Center for 9/11 Justice. Since 2006, the journal has published more than 160 peer-reviewed papers, many of which have become foundational works in the 9/11 literature.

Today, its mission is to offer new evidence-based findings and perspectives regarding the events of September 11, 2001; to examine the wider societal consequences of 9/11; and to develop knowledge regarding similar or related “deep events” and State Crimes Against Democracy. (For guidance on the scope of the journal, please read IC911’s Research Agenda .)

The journal recognizes the importance of both multidisciplinarity and interdisciplinarity when researching the 9/11 crimes and is committed to advancing empirically and theoretically rigorous work. All submissions are subject to double-blind peer review.

The journal’s papers can also be found on the journal’s original website, Journalof911Studies.com .

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Journal of 9/11 Studies

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These images are licensed under the Wikimedia Commons / Public Domain / CC-BY-2.0 / CC-BY-2.5 / CC-BY-SA-3.0 / CC-BY-SA-4.0 by: Anthony Quintano, TSGT Cedric H. Rudisill, USAF, Kim Carpenter, Travis Wise

The response to September 11: a disaster case study

Affiliations.

• 1 Mount Sinai School of Medicine, World Trade Center Health Program, New York, NY. Electronic address: [email protected].
• 2 New York University School of Medicine, Department of Psychiatry, New York, NY.
• 3 Mount Sinai School of Medicine, World Trade Center Health Program, New York, NY.
• PMID: 25459334
• DOI: 10.1016/j.aogh.2014.08.215

Background: The response to 9/11 continues into its 14th year. The World Trade Center Health Program (WTCHP), a long-term monitoring and treatment program now funded by the Zadroga Act of 2010, includes >60,000 World Trade Center (WTC) disaster responders and community members ("survivors"). The aim of this review is to identify several elements that have had a critical impact on the evolution of the WTC response and, directly or indirectly, the health of the WTC-exposed population. It further explores post-disaster monitoring efforts, recent scientific findings from the WTCHP, and some implications of this experience for ongoing and future environmental disaster response.

Findings: Transparency and responsiveness, site safety and worker training, assessment of acute and chronic exposure, and development of clinical expertise are interconnected elements determining efficacy of disaster response.

Conclusion: Even in a relatively well-resourced environment, challenges regarding allocation of appropriate attention to vulnerable populations and integration of treatment response to significant medical and mental health comorbidities remain areas of ongoing programmatic development.

Keywords: 9/11; World Trade Center; disaster response; environmental disaster; post-disaster health surveillance.

Copyright © 2014 Icahn School of Medicine at Mount Sinai. All rights reserved.

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• Research Support, U.S. Gov't, P.H.S.
• Firefighters / psychology
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• Health Impact Assessment
• Inhalation Exposure / adverse effects*
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• Mental Disorders / epidemiology*
• Mental Disorders / etiology
• Occupational Exposure / adverse effects*
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• Respiratory Tract Diseases / epidemiology*
• Respiratory Tract Diseases / etiology
• September 11 Terrorist Attacks* / psychology
• Survivors / psychology

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• 200-2011-39356/PHS HHS/United States

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Hard lessons from 9/11

Christina Pazzanese

Harvard Staff Writer

Professors detail how it reshaped homeland security, foreign policy, study and treatment of PTSD, and crisis planning and management

Beyond their vast and terrible human toll, the 9/11 terrorist attacks changed and continue to influence life in America in myriad ways. Harvard professors detail how the tragedy reshaped U.S. homeland security and foreign policy, changed the study and treatment of post-traumatic stress disorder (PTSD), led to a nationwide overhaul of crisis planning and management, and prompted substantial new regulatory changes in rules for building and fire safety.

Homeland Security and Foreign Policy

Is America safer from attack by Islamic terrorists than it was 20 years ago or was the war on terror a failure?

Many people are asking those questions now, after the recent messy withdrawal of American forces from Afghanistan and the return to power there of the Taliban. The decision to leave the country ended a costly 20-year war — increasingly unpopular in the U.S. — that was launched in retaliation for the 9/11 attacks by al-Qaida, which had found safe harbor in the south Asian nation.

“The Taliban flag will be waving in Afghanistan on Sept. 11. That is your split screen. There’s just no question about it,” said Juliette Kayyem ’91, J.D. ’95, Belfer senior lecturer in international security at Harvard Kennedy School (HKS).

“But I think it’s much more complicated and unfair to our efforts” to conclude that because the Taliban was not defeated, the U.S. wasted $2.2 trillion and thousands of lives in Afghanistan. “It’s not nothing, and it’s not luck that there was no similar size 9/11 attack in the U.S. for 20 years,” she said.

Without a military presence in Afghanistan, there will be a “detrimental impact” on future U.S. counterterrorism efforts, but “we’re not back to Sept. 10,” said Kayyem.

The counterterrorism capacity and capabilities of the U.S. and our Western allies have improved over the past two decades, especially in surveillance, droning, and information sharing, and U.S. homeland security is far more robust, said Kayyem, a former assistant secretary in the Department of Homeland Security in the Obama administration.

But concerns remain. The withdrawal will be viewed in parts of the Arab world as a Taliban victory over the U.S. and undoubtedly help terrorist recruitment. It will also provide political fodder for critics of U.S. hegemony and interventionism. In addition, some Afghan refugees who have difficulty transitioning in their new countries could prove susceptible to radicalization, Kayyem said.

Though the Taliban controls more territory today than it did on 9/11, the early U.S. counterterrorism efforts were “broadly successful” in weakening al-Qaida and the Taliban and preventing terrorist attacks, said Fredrik Logevall , Laurence D. Belfer Professor of International Affairs at HKS and a professor of history on Harvard’s Faculty of Arts and Sciences.

However, the Bush administration’s pivot to Iraq in 2003 set the mission adrift, and the failed effort to establish a democratic Afghan government after Osama bin Laden’s death [in 2011] deeply undermined that early success, said Logevall.

“The historian in me wants to say that it’s too soon to know if the war on terror was a failure,” he said. “But given the expenditures involved, [which were] massive, given the costs — in all respects of the term ‘cost’— of the interventions in Afghanistan and Iraq, both with respect to conditions in those countries, but also in the region, I think the picture is a pretty grim one.”

Other costs are lost time and opportunity.

“Waging that counterterrorism has diverted attention from the complex challenges posed, for example, by a rising China, by Russia, by a nuclear North Korea,” said Logevall.

A U.S. foreign policy retrenchment could be on the horizon, given the strong public support for the decision to end the war, he said, along with the fierce criticism of the Biden administration’s execution of the withdrawal.

“It’s clear that Joe Biden has, for a long time, been skeptical about using American military power to turn this or that country into a democracy, and he’s a skeptic about nation-building. So, I think we probably won’t see a lot of effort in that direction,” he said.

But the blowback could also provoke Biden to become more assertive in projecting American military power, said Logevall.

“There’s a nontrivial chance that the administration will want to show, ‘Hey, we’re still in the game, and we’re still the force to be reckoned with.’”

Post-Traumatic Stress Disorder (PTSD)

Unlike many disasters, 9/11 was a uniquely communal event: It occurred on live television, targeted symbols of American business and government everyone recognized, and claimed victims engaged in everyday activities, like going to work or taking an airline flight.

“I think 9/11 was a collective trauma for the nation,” said Richard F. Mollica , professor of psychiatry and founding director of the Harvard Program in Refugee Trauma (HPRT), which conducts training and scientific research and provides mental health services to people in conflict areas and who have experienced natural disasters. “We all realized, as a nation, our vulnerability to these terroristic life events.

Before 9/11, public understanding of post-traumatic stress disorder (PTSD) was limited, and trauma was still an emerging field of study.

“In those early days, people only thought of trauma around war veterans” said Karestan Koenen , a professor of psychiatric epidemiology at Harvard T.H. Chan School of Public Health who studies PTSD. “I think the 9/11 terrorist attacks really brought home that trauma could happen to anyone, that it can happen and not be your fault.”

The attacks sparked “a revolution” in the field’s thinking about self-care for trauma victims as well as for those who treat them. “In 2001, no one was talking about burnout; no one was talking about self-care; no one was talking about resiliency,” said Mollica.

Sept. 11 showed that some treatments for trauma victims did more harm than good. One treatment that was untested but thought to be therapeutic was “critical incident stress debriefing,” in which people were asked to talk about their experiences, often in minute detail.

“They were activating in people high emotional arousal, and all the research that was done following that showed it actually generated post-traumatic stress disorder and depression and made people sick,” said Mollica. The Harvard Program on Refugee Trauma first developed the Harvard Trauma Questionnaire , a well-known mental health assessment tool, back in the 1980s. “And so, one of the big outcomes of 9/11 was that debriefing was thrown out as part of the psychological first aid.”

“It really brought home the importance of studying [which] treatments are effective and why research on treatment is really important,” said Koenen.

In fact, New Yorkers were far more resilient than many experts had predicted. Traumatologists were surprised to see that what appeared to be elevated rates of PTSD dropped dramatically not long after 9/11, suggesting that they “mistook ordinary stress reactions (e.g., insomnia, anger, intrusive images) as the psychiatric illness of PTSD,” said Richard McNally , a psychology professor who studies anxiety and panic-related disorders.

That misreading underscored the need for the field to focus more on early intervention and prevention in order to be able to answer such key questions as whether we can predict who is most likely to get PTSD, identify those individuals early on, and prevent its onset.

After 9/11, many more were drawn to the field, and the scientific community began to pay closer attention to the disorder. As part of the genomic revolution, the study of the genetics of PTSD and the role that genetic factors play in shaping the response to trauma grew dramatically, said Koenen, who works in this area.

“Before 9/11, a lot of people still dismissed PTSD as a real thing. And 9/11 made it into something more legitimate to study,” said Koenen, who said she had been discouraged from working on trauma as a postdoc in 2001. Sept. 11 spurred more biologically-based research, and there was a huge growth in imaging, brain-related research, and biomarkers, in part because of significant new government investment in 9/11-related scientific research.

Koenen said the work done in the aftermath of 9/11 demonstrated to the public the links between disasters and mental health, paving the way to quicker response to mental health concerns during the pandemic, with increased research and public health outreach, broader public awareness, and acceptance of treatment options as a critical need.

“It’s clear that mental health was top of mind very early, and I’m not sure without 9/11 whether that would have been true,” she said.

Preparation for Crisis Response

  On 9/11 Joseph Pfeifer was a 20-year veteran of the New York City Fire Department, a battalion chief in charge of four firehouses in lower Manhattan, including one across from the World Trade Center. He was out on a call just blocks away when he saw the first plane hit the north tower. As the first chief on the scene, he radioed for a second, then a third alarm, and ordered the first wave of firefighters to begin evacuating the building.

“I knew I was responding to the largest and the most dangerous fire of my life,” he said.

First responders had years of training and experience. Pfeifer , now a senior fellow with the Program on Crisis Leadership at HKS , said that in hindsight there were critical gaps in their preparation as well as in the communication and collaboration between agencies. Police and fire units set up operations blocks apart, adding to the technical difficulties of radio communications. There was limited video and data and uneven information sharing, all of which complicated decision-making.

“I would have loved to have seen 10 seconds of [news] video of the south tower collapsing. I had no idea that building fell down. And yet, I ordered our firefighters to evacuate the north tower,” said Pfeifer, who details in a new memoir how his brother, also a firefighter, perished while rescuing people trapped inside the north tower. “I would have done it more urgently if I knew the whole building [had] collapsed.”

After-action analyses confirmed that closer coordination between responding agencies, between federal, state, and local governments, and more comprehensive preparation and training were needed.

Arnold Howitt , founding faculty co-director of the Program on Crisis Leadership, said Sept. 11 (and later, Hurricane Katrina) demonstrated that extreme emergencies could unfold much more quickly and at far greater scale than previously understood.

The federal government began investing heavily in research and training around crisis planning and management in order to do a better job preparing for and responding to more routine emergencies, like major snowstorms, and novel crises, like a terrorist attack. In 2004, FEMA introduced the National Incident Management System , a framework to assist governments, nongovernmental organizations, and the private sector to deal with emergencies.

Looked at broadly, public safety and public health agencies are better prepared, have more thorough training, and greater ability to quickly adapt to changing circumstances and improvise where necessary than they did in 2001, said Howitt.

Communication with the public, now seen as critical to any effective emergency response, has advanced. And the principles and value of collaboration up and down all levels of government, between political leaders and their agency professionals, and across disciplines are far better appreciated nationally than 20 years ago, he said.

“Very, very rarely do these large events fit into the skill sets and the responsibilities of a single agency,” Howitt said. “Building those kinds of cooperative relationships has definitely improved significantly in the years since, but it’s also still unevenly implemented.”

Federal agencies, however, are limited in what they can do on their own. States and local municipalities retain significant authority and control over what actions can be taken and by whom. Even private businesses sometimes have a say, for example, when hospitals or medical professionals are involved.

That makes it harder for the federal government to act quickly in a unified and cohesive way and leads to highly varied crisis responses around the country, limitations that became evident throughout the COVID response, said Howitt.

Structural Engineering and Fire Safety

More like this.

Where were you when it happened?

Choosing a concentration

New York minute

The sudden destruction of the twin towers, whose design had been hailed as innovative in the late 1960s, raised serious questions about the soundness of the World Trade Center’s construction and fire safety.

“Structural engineers like myself were shocked,” that such iconic structures had been attacked and then had to watch as they burned and collapsed, said Hanif Kara , professor in practice of architectural technology at Harvard Graduate School of Design .

“There’s a consensus among structural engineers that the inherent strength and robustness of each tower’s structure prevented an immediate collapse,” said Kara. Since then, much work has been done to understand what caused the collapse, and among the complex findings, “there is little doubt that fire-protection was a major failing.”

Though 9/11 did very little to dampen enthusiasm for super-tall skyscrapers — at least 40 buildings around the world now surpass the 1,368-foot height of the doomed World Trade Center — it did prompt important changes to the way they are built.

In 2005, the U.S. National Institute of Standards and Technology (NIST) issued 30 recommendations for revisions to building fire codes, standards, and practices. More active approaches to fire-safety during construction are now common. Building frames must now include fire protection and engineers can use computational analysis to model what could happen structurally in a fire rather than relying on defensive fire protections.

How people exit high-rise buildings in an emergency has also changed since 9/11.

“As a consequence of the twin towers’ occupants being trapped within the stairways, which were only [44 or 56 inches] wide, today’s stairs in the replacement WTC towers are 50 percent wider. Additional stairs, purely for urgently exiting, are now considered essential. And, most importantly, [elevators] that operate on backup power are also now a core component of evacuation strategy,” said Kara.

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Long-term memory for the terrorist attack of September 11: Flashbulb memories, event memories, and the factors that influence their retention

More than 3,000 individuals from seven US cities reported on their memories of learning of the terrorist attacks of September 11, as well as details about the attack, one week, 11 months, and/or 35 months after the assault. Some studies of flashbulb memories examining long-term retention show slowing in the rate of forgetting after a year, whereas others demonstrate accelerated forgetting. The present paper indicates that (1) the rate of forgetting for flashbulb memories and event memory (memory for details about the event itself) slows after a year, (2) the strong emotional reactions elicited by flashbulb events are remembered poorly, worse than non-emotional features such as where and from whom one learned of the attack, and (3) the content of flashbulb and event memories stabilizes after a year. The results are discussed in terms of community memory practices.

Brown and Kulik (1977) suggested the term flashbulb memory for the “circumstances in which one first learned of a very surprising and consequential (or emotionally arousing) event,” for example, hearing the news that President John Kennedy had been shot. Since Brown and Kulik's description of their findings, the range of topics addressed in studies of flashbulb memories has grown substantially, from initial questions about special mechanisms ( McCloskey, Wible, & Cohen, 1988 ; Neisser & Harsh, 1992 ) to more recent questions about the impact of aging and dementia ( Budson, Simons, Sullivan, Beier, Solomon, Scinto, et al., 2004 ; Budson, Simons, Waring, Sullivan, Hussoin, & Schacter, 2007 ; Davidson, Cook, & Glisky, 2005), the history of post-traumatic stress disorder ( Qin, Mitchell, Johnson, Krystal, Southwick et all, 2003 ), as well as the role of social identity [e.g., as seen in the presence or absence, respectively, of flashbulb memories of French citizens and French-speaking Belgians of the death of French President Mitterraand ( Curci, Luminet, Finkenauer, & Gisle, 2001 ; see also Berntsen, 2008 ; Hirst & Meksin, 2008 )]. Researchers have also begun to investigate memories for the flashbulb event itself ( Curci & Luminet, 2006 ; Luminet, Curci, Marsh, Wessel, Constantin, Genocoz, et al., 2004 ; Pezdak, 2003 ; Shapiro, 2006 ; Tekcan, Berium, Gülgöz, & Er, 2003 ). In this literature, the term flashbulb memory refers to memory for circumstances in which one learned of the event and would include memories of where, when, and from whom one learned of, for instance, the terrorist attack of September 11, 2001. The term event memory refers to memory for facts about the flashbulb event and would include, for instance, that four planes were involved in the 9/11 terrorist attack and that both the Pentagon and the World Trade Center were targets. 1

Flashbulb memories and their associated event memories are often considered special because they involve events that are not ordinary or everyday, and usually are not personally experienced, but rather, they are public and emotionally charged ( Neisser, 1982 ). It is the public nature of flashbulb memories and their associated event memories that ensures the memories strongly influence both individual and collective identity ( Berntsen, 2008 ; Hirst & Meksin, 2008 ; Neisser, 1982 ). Their role in shaping identity depends, of course, on their being retained ( Bruner, 1990 ; Conway & Pleydell-Pearce, 2000 ). Surprisingly, whereas much is known about how well flashbulb and event memories are retained over a period of approximately a year, much less is known about their long-term retention. This relative neglect applies not just to the issue of the amount retained, but also to differences in the kind of information that is retained over the long-term and the factors that might affect the level and content of long-term retention. For instance, whereas many researchers have emphasized that flashbulb events inevitably elicit strong emotions from individuals, few researchers have contrasted the long-term retention of memories of these emotional reactions with the long-term retention of memories of other features of flashbulb memories, for example, who you were with when learning of the event, where you were, or how you were informed (see, however, Levine, Safer, & Lench, 2006 ). Moreover, although a number of psychological studies have related the level of retention to individual cognitive factors (e.g., rehearsal), none have discussed the contribution of memory practices, that is, the way a society goes about ensuring that a public event will never be forgotten by the public ( Hirst & Manier, 2008 ; Olick & Robbins, 1998 ; but see Hoskins, 2007 ). Memory practices may play a role in the retention of flashbulb and event memories given the public nature of the reference event.

The present paper, then, focuses on four issues: (1) the long-term retention of flashbulb and event memories, (2) the comparative retention of emotional reactions with the retention of other features of a flashbulb event, (3) possible difference in the underlying processing associated with the formation and retention of flashbulb and event memories, and (4) the factors that shape long-term retention, including the role of memory practices. It explores these issues in the context of the terrorist attack of September 11, 2001.

Consider the issue of long-term retention. From the extant research, it is not clear whether forgetting for flashbulb and event memories slows or accelerates after the first year. Three studies suggest that the rate of forgetting of flashbulb memories slows dramatically after the first year. Two of these studies based their conclusions on the vividness or accuracy of flashbulb memories. Kvavilashvili, Mirani, Schlagman, and Kornbrot (2003) found that British citizens reported vivid, confidently held memories of the circumstances under which they learned of the death of Princess Diana, even after a delay of 51 months. Berntsen and Thomsen (2005) discovered that elderly Danes accurately remembered the weather on the day of the German W.W. II invasion of and withdrawal from Denmark.

Neither of these studies, however, employed a test-retest methodology, in which memories are assessed shortly after the flashbulb event and then after a significant retention interval. This methodology supplies a putatively reliable memory with which to compare the consistency of later recollections and is consequently the preferred means of studying flashbulb memories (see, however, Winningham, Hyman, & Dinnel, 2000 ). Kvavilashvili et al. did not have an initial assessment for a test-retest. Berntsen and Thomsen had verifiable information about the original event, but their documentary methodology does not permit as wide a ranging examination of mnemonic attributes as the test-retest method does. Relying on public records such as weather reports largely precludes exploring those attributes Brown and Kulik (1977) identified as the canonical features of flashbulb memories, for example, who the respondent was with, how the respondent reacted emotionally, or who the informant was. Bohannon and Symons (1992 ; see also Bohannon, 1988 ) conducted the third study, finding a slowing in forgetting, and did employ a test-retest methodology in their investigation of the Challenger explosion, but, in the end, based their conclusions about the rate of forgetting on cross-sectional data.

Two studies did ground their conclusions about long-term retention on the results of test-retests. Unfortunately, Neisser and Harsh (1992) employed only one retest in their study of the Challenger explosion, making any analysis of the rate of forgetting difficult. On the other hand, Schmolck, Buffalo, and Squire (2000) used two retests in their study of the announcement of the verdict in the O.J. Simpson criminal trial. They found that at 15 months, a little less than 40% of the flashbulb memories they examined contained no distortions, and only about 10% contained major distortions. At 32 months, the pattern was reversed: Only about 20% contained no distortions and over 40% of the memories contained major distortions. These results strongly support the claim that the rate of forgetting increases, rather than slows, over time.

Because of the controversy over the rate of forgetting of flashbulb memories, it is difficult to evaluate Talarico and Rubin's (2003) claim that, despite a flashbulb event's public and emotionally charged nature, the rate of forgetting of flashbulb memories is the same as the rate of forgetting of ordinary autobiographical memories. Talarico and Rubin suggested that flashbulb memories and ordinary autobiographical memories differ not in their rate of forgetting, but in the confidence with which they are held, with confidence in flashbulb memories remaining high, even as the memories are forgotten. Confidence in ordinary autobiographical memories declines as the memories are forgotten (see also Weaver, 1993 ). Talarico and Rubin, however, only tested retention intervals of eight months or less. Schmolck et al. (2002)'s findings indicated that flashbulb memories may be an exception to the pattern of forgetting observed for ordinary, autobiographical memories when long-term retention intervals are considered.

Talarico and Rubin (2003) compared their participants' memory for their reception event for 9/11 with a self-selected autobiographical memory – a memory of an “everyday” event from the three days before September 11. A perhaps more general point of comparison would be the forgetting curves obtained in diary studies ( Rubin, 2005 ). These studies involve the assessment of a wide-range of types of memories over a substantial period. The forgetting curves collected across studies are remarkably similar, showing rapid forgetting in the first year and then slowing. As a result, they indicate that autobiographical memories may follow the well-established pattern of forgetting documented since Ebbinghaus (1913/1964) . Linton (1986) , for instance, showed dramatic forgetting over the first year and then a much slower rate of forgetting of 6% for the next five years. Similarly, Wagenaar (1986) found a substantial decline of 20% in the first year for critical details and then a slower decline of approximately 10% for the next four years. If Talarico and Rubin's findings of equivalent forgetting of flashbulb and ordinary memories up to eight months extends to longer retention intervals, then the diary studies would suggest that the results of Schmolck et al. (2000) are an anomaly, and those of Bohannon and Symons (1992) , Kvavilashvili et al. (2003) , and Berntsen and Thomsen (2005) may be more typical.

In the present study, we asked whether the accelerated forgetting Schmolck et al. (2000) observed for the Simpson verdict between the first and third years applies as well to flashbulb memories for the terrorist attack of 9/11. Consequently, we assessed our participant's memory for 9/11 one week, 11 months and 35 months after the terrorist attack. We choose the 11 months and 35 months retention intervals because they were in the same time frame used by Schmolck et al., but minimized potential effects of anniversary commemorations.

In addition, we also examined the retention of associated event memories at one week, 11 months, and 35 months after the terrorist attack. The scant relevant literature on event memory is as inconclusive about long-term retention as the literature on flashbulb memories. Bahrick and his colleagues ( Bahrick, 1983 , 1984 ; Bahrick, Bahrick, & Wittlinger, 1975 ) have shown that neutral facts, such as the names of fellow college students, college streets, or college-learned Spanish vocabulary, are steadily forgotten for six years, and then, if still retained, preserved for decades to come. Along the same lines, Belli, Schuman, and Jackson (1997) found good retention after decades for newsworthy events such as the Tet Offensive, at least for participants for whom the event “defined” their generation. Neither of these studies examined whether respondents remembered the circumstances in which they learned of the event, making their relevance to the topic of flashbulb memories at best speculative. The flashbulb memory studies that also explored event memory indicate that for retention intervals of a year or less, event memories are subject to a steady decline (Finkenhauer, Luminet, Gisle, & Filipopot, 1998; Smith, Bibi, & Sheard, 2003 ; Tekcan et al., 2003 ). In the only study that examined event memory at longer retention intervals, Bohannon and Symons (1992) found that event memories declined a substantial 20% between the 15-month and 36-month intervals, suggesting that, while the rate of forgetting may not accelerate, it clearly does not slow after a year.

Finally, as noted earlier, we also investigated whether long-term retention for emotional reactions to 9/11 differs from memory for other features of flashbulb memories, as well as what factors shape long-term retention of different features. There is almost no research comparing memory for emotional reactions with memory for other features of flashbulb memory (but see Qin et al., 2003 ). Levine and colleagues explored memory for emotional reactions to flashbulb events, but used relatively short retention intervals and did not make comparisons with other features, as we do here ( Levine, Prohaska, Burgess, Rice, & Laulhere, 2001 ; Levine, Whalen, Henker, & Jamner, 2005 ).

As for the factors that might affect retention, we explore whether any similarity in the patterns of forgetting of flashbulb memories and event memories implies that the processes that underlie the retention (and forgetting) of these two types of memories are the same. Some research on flashbulb memories and event memories would suggest that the underlying processes are similar. For instance, through their modeling of the formation and maintenance of flashbulb memories, Luminet, Curci, and their colleagues have argued that some factors involved in the formation of event memories overlap with those involved in the formation of flashbulb memories (e.g., rehearsal, see Luminet, 2008 , for a review). Their model also documented differences in factors uniquely involved in the formation of flashbulb memories, specifically, surprise and novelty. Testing the complex models developed by this group goes beyond a chief aim of the present paper – to explore long-term retention of flashbulb memories and event memories. Nevertheless, we investigated some factors that could putatively predict levels of forgetting. We also examined the way the content of the memories changes over time, on the assumption that if the predictors or content changes differ for flashbulb and event memories, then different processes may be involved.

We are not only interested in intrapsychic factors. We also present analyses in the General Discussion that suggest provide evidence that different retention curves reported in the literature can be attributed to different social memory practices.

Participants, recruitment, and procedure

Participants were recruited in Boston and Cambridge, MA; New Haven, CT; New York, NY; Washington, DC; St. Louis, MO; Palo Alto, CA; and Santa Cruz, CA. For Survey 1 (one week after the attack), tables were set up either on the campuses of the collaborators or in surrounding neighborhoods. Lab members also asked friends and acquaintances if they would be interested. In the survey, we asked if participants were willing to be contacted in a year for a second survey. All respondents indicated their willingness. Surveys and stamped return envelopes were given to all participants.

For Survey 2, we contacted respondents to the first survey through e-mail, the postal system, or both, and asked them if they wished to participate in the second survey. We also recruited additional participants, in the same ways, for both the second survey and a third survey, to examine possible effect of prior participation. For Survey 3, we recruited all participants who responded to Survey 1 and/or Survey 2 and added another group of new participants.

For all three surveys, participants were told that they had one week to fill out the survey and return it to the experimenters. There was both a paper version and a web-based version for Surveys 2 and 3. Participants recruited through the postal system received a survey, but were told they could use the web-based version if they wished. Those who were recruited through e-mail were told that they could fill out the web-based version or receive a paper version either through e-mail (as a pdf file) or in the post. We recruited participants between September 17, 2001 and September 21, 2001 for Survey 1; August 5 and August 26, 2002 for Survey 2; and August 9 and August 20, 2004 for Survey 3. We closed the website two weeks after the last day of recruitment and stopped accepting returned postal surveys five days later.

Table 1 shows the number of participants from each of the six recruitment locations. 38% of the respondents to Survey 1 completed Survey 2, while 18% of the respondents on Survey 1 completed both Surveys 2 and 3. For Surveys 2 and 3, 27% responded through e-mail. These return rates are comparable to other surveys without a monetary incentive or a follow-up query ( Baruch, 1999 ). We compared the responses to each question on the survey, one question at a time, and found no significant differences in the responses of the web-based and postal responses (in all cases, p > .4), thus we merged the data from the two formats. To make the exposition in this paper straightforward, we will confine most of our analysis to the 391 participants who filled out all three surveys.

Distribution of samples in which a participant responded on one or more than one survey

Notes. Boston (Bos), New Haven (NH), New York City (NYC), Washington, DC (DC), St. Louis (STL), Palo Alto (Palo), Santa Cruz (SC).

Separate surveys were designed for each testing period, with Survey 1 serving as the model for the other two. The surveys were approximately 17 pages and took about 45 minutes to complete. Copies of the surveys can be found at http://911memory.nyu.edu .

All surveys began with a general statement of the aims of the project, a consent form, and a request for an identification code that would allow the experimenters to track questionnaires across the three survey periods. Table 2 summarizes the probes on the questionnaire in Survey 1 that figured in our present analyses. Questions 1 – 6 were relevant to establishing the consistency of flashbulb memories; Questions 7 – 11, the accuracy of event memories, and Questions 12 – 23 dealt with predictors, specifically, consequentiality (as assessed by personal loss or inconvenience), the intensity of the emotional response, and rehearsal (as assessed by attention to media and conversations). We did not attempt to cover the entire range of predictors found in the literature. In some cases, such as surprise and novelty, we expected uniformly high scores, making such data insensitive as a potential predictor. In other cases, such as prior knowledge, we were uncertain what to ask as we prepared the survey a few days after the attack (e.g., while we were constructing the survey, there were still questions about who carried out the attacks). Survey 2 followed a similar format to Survey 1, except that two versions were constructed and distributed such that participants were asked, in equal numbers, for the flashbulb memory questions either: (a) How confident are you that your recollection is accurate (different questions assessed time, source, place, etc.), or (b) How accurately do you think that you will remember two years from now? Participants responded on a 1 – 5 scale, with 5 being the highest rating. Survey 3 was similar to Survey 2, although the time frame for the forecasting questions was changed from two years to seven years. Eight demographic questions concluded the surveys, probing, among other things, for residency.

Relevant questions in Survey 1

A coding manual for Survey 1 was developed after reading through 50 surveys to determine the range and nature of the responses. It was written to be a stand-alone document that would provide complete and independent guidance to a coder. Table 3 contains examples of the coding scheme. If 50 similar responses were coded as “other,” then the coding scheme was revised and this “new” option was added. The coding was then redone for this question. Such recoding was done for 14% of the questions. The coding manuals can also be found on http://911memory.nyu.edu .

Examples of coding schemes

To assess interrater reliability of the coding, at the end of the coding process for each survey, we randomly selected 10% of the surveys to be dual-coded. We then calculated for each question either kappas or Cronbach alphas (whichever was appropriate) for each question. Reliability ratings were good for both the short-answer questions and open-ended questions, in that they all exceeded .80.

General Considerations

As Luminet, Curci, Marsh, Wessel, Constantin, Gencoz, et al. (2004) noted, a large sample and numerous comparisons can produce misleading significant differences. Following their guidelines, we set a significance level of .01. Moreover, we report Cohen's d ( Cohen, 1992 ), for which .20 is indicative of a small effect size, .50 a medium effect size, and .80 a large effect size.

We began by comparing the rate of forgetting a year after the September 11 attack with the rate of forgetting after three years.

Coding considerations

We devised separate coding schemes for flashbulb memories and event memories. Our coding scheme for measuring the consistency of flashbulb memories differed from the one employed in Neisser and Harsch (1992) . We developed this new procedure because we wanted not simply to determine whether responses were consistent over time, but also how they varied in content from one survey to the next. In our measure of consistency of flashbulb memories, we matched the coding for Survey 1 with the coding of the other two surveys, producing consistency measures that contrasted Survey 2 with Survey 1 (S12) or Survey 3 with Survey 1 (S13). Two responses were consistent if they were coded in the same manner, with a “1” assigned if the items were consistent and a “0” if they were inconsistent. As Table 2 indicates, we focused on six of the canonical features of Brown and Kulik (1977) . The six consistency scores were averaged to form an overall measure of consistency, ranging from 0 to 1.

The Neisser-Harsch coding scheme allowed for graded scoring, whereas our scheme did not. That is, in Neisser and Harsch (1992) , a “correct response” could have received a score of “2” or “1,” with “0” reserved for clearly incorrect responses. Our measure was dichotomous. If a participant had originally wrote “I was listening to the TV as I got dressed” and later remembered “I was watching TV,” Neisser and Harsch would have scored it a “1” out of a possible two. We would have scored it a “1” out of a possible one (see Table 2 ). Consequently, when the various scores are summed over canonical features, the relative ranking of two participants might differ according to the Neisser-Harcsh and our coding schemes. In order to explore the relation between these two scoring procedures, we asked two coders to follow the Neisser-Harsch scheme for 50 participants' responses to the three surveys. The coders evidenced a high degree of interrater reliability, kappa = .81. The correlations between our overall consistency scores and the consistency score based on the Neisser and Harsch scheme were significant (S12: r = .29, p < .05; S13: r = .38, p < .01). Although these significant correlations are not large, they suggest that the pattern of results we observed would also have been found if we had followed the procedure specified by Neisser and Harsch. In order to assess this claim, we redid the analyses presented below in the section on “forgetting and flashbulb memories” using the scores derived from the Neisser-Harsch coding scheme. We found the same pattern of results as the one reported in this section for the Neisser-Harsch coding (in all cases, p < .05).

As for our coding scheme for event memory, we compared the answers to our probes about the event itself with the correct answers, as determined by news accounts. As Table 2 indicates, we probed for five different sets of facts: (1) number of planes, (2) name of airlines, (3) location of attacks, (4) location of President Bush, and (5) order of major events. With respect to the questions about the number of planes and about where President Bush was at the time, if respondents were correct, they received a score of 1. Otherwise, they received a 0. For the question about the identity of the airlines, each correctly identified of the two involved airline carriers received a score of .5. Furthermore, for each incorrectly mentioned airline carrier, we subtracted .25 from the total score, with a maximum penalty of .5. To keep the range of scoring between 0 and 1, we changed any negative score to a zero. We scored (9) in a similar manner, but since there were three crash sites, each correct response received a score of .33 and incorrect answers were penalized at a rate of .16. For (11), we had listed six possible events for the respondent to order (see Table 2 ). We calculated the Spearman Rank correlation between the respondent's order and the actual order. A negative correlation was recorded as 0. The total accuracy score was the average score across the five probes. Here and elsewhere, we use the term accuracy when discussing event memory; consistency when considering flashbulb memories.

Forgetting and flashbulb memories

We were chiefly interested in determining whether the rate of forgetting increased or slowed over the long term, specifically, between Survey 1 and Survey 3. As Table 4 reveals, 11 months after the attack (when Survey 2 was administered), participants offered consistent answers about their flashbulb memories only 63% of the time, on average. The decay over the next two years (when Survey 3 was administered) was much smaller, with a proportional decline of 9%, or an average of 4.5% a year. Although the difference between the consistency between Surveys 1 and 2 and the consistency between Surveys 1 and 3 was significant, t (390) = 5.21, p < .01, the effect size is small ( d = .28), providing further support that the rate of forgetting had slowed after the first year.

Consistency and Confidence Ratings

In order to contrast memory for emotional reactions on hearing the news about 9/11 with other features of flashbulb memories, we separately tabulated the consistency of responses across the three surveys to an open-ended question about the emotional reaction of the respondent upon hearing the news ( Table 2 , Question 4). For both Surveys 2 and 3, the overall measure of consistency was significantly greater than the measure of consistency associated with the open-ended probe of emotion: for S12, t (375) = 8.72, d = .56, p < .01, for S13, t (364) = 9.17, d = .53, p < .01 (see Table 4 ).

Participants' relatively poor recollections of their emotional state can also be detected in their responses to the six questions that specifically asked them to rate the intensity with which they felt sadness, anger, fear, confusion, frustration, and shock ( Table 2 , Questions 14 –20). We were not interested in participants' recollection of the specific rating score they gave: This would require them to remember both the level of their intensity and the scale they used to express this intensity across surveys. Rather we were interested in their memory of the relation among different emotions, for example, whether, after 9/11, they felt more sadness than shock. To explore these relations, we translated the emotional ratings an individual participant gave into z-scores, calculated separately for each survey and each participant. We calculated Pearson Product-Moment correlations between a participant's z-scores on Survey 1 and Survey 2 and between a participant's scores on Survey 1 and Survey 3. Table 4 contains the average correlation for these two calculations. The correlation between Survey 1 and Survey 3 was significantly less than between Survey 1 and Survey 2, t (390) = 2.90, p < .05, but the effect size was small, d = .15, indicating that most of participants' forgetting of their emotional responses happened between Survey 1 and Survey 2. For an individual respondent, the correlation would need to be greater than .73 to be significant at the .05 level. Only 31.3% of the respondents had a correlation greater than .73 between Surveys 1 and 2 and only 25.3% between Surveys 1 and 3.

Finally, although the flashbulb memories were not consistent across surveys, confidence ratings were high (see Table 4 ). As noted, this pattern of inconsistent memories accompanied by high confidence rating suggests that a trademark of flashbulb memories extends across long-term retention periods ( Talarico & Rubin, 2003 ). The decline in confidence between Survey 2 and Survey 3 was not significant ( p > .30).

The pattern of results we found did not arise because we repeatedly tested our participants. In order to determine whether the small decline in overall consistency we observed between Survey 2 and Survey 3 could be attributed to an effect of filling out Survey 2, we compared the overall consistency scores for the sample that filled out only Surveys 1 and 2 ( M = .63; SD = .20) with overall consistency scores for the sample that filled out only Surveys 1 and 3 ( M = .55; SD = .23). The difference between these two consistency scores represented a significant decline, t (458) = 3.44, p < .01, again with only a medium effect size, d = .32. In order to explore further the effect of multiple surveys, we also compared the overall consistency scores on Survey 3 of the three-surveys sample with (1) the overall consistency scores for participants who only filled out Surveys 1 and 3 and (2) the overall consistency scores for participants who only filled out Surveys 2 and 3 (with Survey 2 now serving as the baseline). These two comparisons were not significant ( p s > .40). In addition, there were no significant differences between the various samples in terms of age, religion, residency, political viewpoint, gender, or race/ethnicity ( p s > .30). In other words, the large decline we observed between Surveys 1 and 2 and the smaller decline that occurred between Surveys 2 and 3 is probably not a result of our retesting procedure.

Forgetting and event memory

Similar to the consistency measure for flashbulb memories, the overall measure of event memory accuracy showed a pattern of slowing in the rate of forgetting for facts about 9/11 between the first and third year (see Table 5 ). Examining the overall measure of accuracy, an ANOVA revealed a main effect for survey, F (1, 390) = 88.5, p < .001, η p 2 = .19. The drop in accuracy from Survey 1 to Survey 2 was significant, with a decline of 13% and a medium effect size, t (390) = 11.81, p < .001, d = .61. We did not find a significant decline in accuracy from Survey 2 to Survey 3, t (390) = .77, p = .45.

Facts accurately remembered: Means of the Accuracy Scores and Standard Deviations (in parentheses)

Notes. Data was either nominal or interval. Nominal data is reported as frequencies, interval data as proportions. The proportions are reported with standard deviations.

A closer examination of the responses to each probe revealed a more complicated story than suggested by overall accuracy scores. As Table 5 indicates, the pattern of forgetting depended on the information being sought. There was no significant difference between the accuracy on Surveys 1 and 2 for two probes: the crash sites and the order of the events ( p s > .50). For the number of the planes, there was only a significant decline from Survey 1 to Survey 2, using a McNemar test, χ 2 (1) = 14.75, p < .001.

The names of the airline carriers showed a continuous decline across surveys and large effect sizes: Survey 1 vs. Survey 2, t (390) = 7.72, p < .001, d = .50; Survey 2 vs. Survey 3, t (390) = 6.21, p < .001, d = .30. We account for this result in the General Discussion section. As for the probes about the location of President Bush at the time of the attack, again, using a McNemar test, there was a significant decline from Survey 1 to Survey 2, χ 2 (1) = 95.43, p < .001, as well as a significant improvement from Survey 2 to Survey 3, χ 2 (1) = 68.81, p < .001. We attribute the increase in accuracy about the location of President Bush from Survey 2 to Survey 3 to what we call the Michael Moore Effect (also see Greenberg, 2004 ). Michael Moore's film Fahrenheit 911 brought dramatic attention to President Bush's location by featuring his reading of The Pet Goat in a Florida elementary school. Table 5 contrasts the frequency of correct responses for the question about President Bush's location for those who reported that they did or did not see the Moore film. There was no significant difference between those who did or did not watch the Moore film on Surveys 1 and 2, but a significant difference emerged on Survey 3, χ 2 (1) = 24.41, p < .001. In other words, there was a marked overall improvement between Surveys 2 and 3, with those who saw the movie showing a greater improvement for Survey 3 (52%) than those who had not (32%). The improvement of those who did not see the Moore film may reflect the extensive discussion in the media the Moore film generated about the six-minute segment of President Bush's Pet Goat reading. The even more dramatic improvement of the Moore movie watchers may have been because of the film itself.

The only significant correlation between overall consistency and overall accuracy was between the overall consistency measure between Surveys 1 and 3 and the overall accuracy measure on Survey 3, r = .10, p < .05.

In sum, the present results suggest that the rate of forgetting slows between the first and third years for both flashbulb memories and event memories. This result suggests that the Schmolck et al. (2000) results may be an anomaly rather than a characteristic portrait of the pattern of forgetting of flashbulb memories over the long-term. Moreover, the lower emotion consistency than overall consistency scores suggest that people may forget their emotional reactions to hearing the news of the attack more quickly than other aspects of flashbulb memories, such as, where they were, who told them, and how they were told.

Are there different processes underlying the similar patterns of forgetting for flashbulb memories and event memories?

Even though we found similar patterns of forgetting for both flashbulb memories and event memories, this does not mean that the same factors are affecting remembering and forgetting in the two cases. We address this issue by examining whether the same factors predict consistency and accuracy and whether the pattern of types of changes in content over the long-term are the same for flashbulb memories and event memories. If differences in predictors and content changes can be found between flashbulb memories and event memories, then different processes probably underlie the retention (and forgetting) of these two memory types.

Predictors of consistency and accuracy

We focused on five putative predictors: two probes of consequentiality—residency and the combination of personal loss and inconvenience – as well as emotionality, media attention, and ensuing conversation. We also examined the location in which a participant learned of the attack as a predictor, but it had no affect on our measures of consistency, confidence, or accuracy, and is not discussed further. As to residency, we divided our sample into New Yorkers and non-New Yorkers. Respondents who resided outside the city borders were classified as non-New Yorkers. We explored whether participants who lived in downtown Manhattan (near Ground Zero) differed from other participants, inasmuch as other researchers have found differences between the downtown population and the larger population (Galea & Vlahov, 2004; Sharot, Martorella, Delgado, & Phelps, 2007 ). We failed to find any differences on our measures of consistency, accuracy, or confidence using this distinction ( p s > .20).

In assessing the effect of personal loss and/or inconvenience ( Table 2 , Questions 12 and 13), we counted concrete answers such as damage of home, loss of business, personal injury to self, friend, or relative, cancellation of school, and/or lack of food. 2 We did not include psychological distress as a form of loss or inconvenience (e.g., felt anxious, lost appetite), although good arguments could be made to do so. This classification scheme should not adversely skew our results. If anything, it should decrease the likelihood of finding differences that might arise because of “personal loss or inconvenience,” inasmuch as it excludes from the “loss” sample participants who reported suffering psychological distress. An individual was said to “experience personal loss or inconvenience” if they stated one “concrete” example. According to this criterion, 40.4% of the respondents who completed all three surveys experienced personal loss or inconvenience.

In assessing emotional intensity, the surveys asked participants to rate the intensity of their emotions on a 1 – 5 scale, with 5 being most intense (see Table 2 , Questions 14–20). Inasmuch as we were mainly interested in the effects of participants' initial emotional reaction, we focused our attention on the responses recorded on Survey 1, deriving two measures of overall intensity from Survey 1's six emotional probes: (1) the average of the six emotions we probed for and (2) the highest rating given to the six emotions. These two measures were significantly correlated ( r = .70, p < .001). Both scores yielded enough variability to permit further analysis.

Questions (21) and (22) in Table 2 probed for what might be treated as effects of rehearsal, in particular, the level of media attention and the degree of ensuing conversation. In addition, on Survey 1, we asked respondents to indicate how they spent their days following the attack, assigning a percentage to a list of activities (see Table 2 , Question 23). We summed the percentages assigned to activities (a), (c), (d), and (e) to obtain a measure of attention to the media. The percentage associated with (b) reflected the level of ensuing conversation. The correlations between these percentage scores and the 1–5 rating of media attention and ensuing conversation were significant, respectively, r = .29, p < .005, and r = .33, p < .005. We use the Likert-scale ratings of media attention and ensuing conversation in our analyses.

We found a clear difference in the extent to which our five putative predictors correlated with the level of consistency of flashbulb memories and with the degree of accuracy of event memories. None of the five putative predictors appeared to be related to the consistency of flashbulb memories, in either Survey 2 or Survey 3 (see Tables 6 and ​ and7). 7 ). We did find a suggestion that the consistency ratings of non-New Yorkers were actually greater than those of New Yorkers, t (298) = 2.00, p < .05, d = .24, a difference also found in Pezdek (2003) . Inasmuch as our difference did not achieve the .01 level of significance, we remain cautious in interpreting this counterintuitive trend. As far as emotionality is concerned, we failed to find any correlations between consistency and emotionality when separately calculating correlations for each of the six emotions probed for in the surveys.

Mean consistency, confidence ratings, and accuracy as a function of residence and personal loss or inconvenience

Correlations between measures of emotion, media attention, ensuing conversation, and measures of consistency, confidence, and accuracy.

On the other hand, four of the five factors were related to the accuracy of event memory: residency, personal loss/inconvenience, ensuing conversation, and media attention. A three-way ANOVA on the three dichotomous factors – with survey, residency, and personal loss/inconvenience as the dependent variables and overall accuracy as the independent variable—revealed main effects for residency, F (1, 296) = 4.39, p < .05, η p 2 = .15, and survey, F (1, 296) = 38.54, p < .001, η p 2 = .12, , as well as a two-way interaction between personal loss/inconvenience and residency, F (1, 296) = 7.22, p < .01, η p 2 = .15, and a three-way interaction between survey, residence, and personal loss/inconvenience, F (1, 296) = 4.89, p < .05, η p 2 = .02 (see Table 6 ). As in Pezdek (2003) , the main effect for residency indicates that New Yorkers' event memory was more accurate than that of non-New Yorkers. The three-way interaction could be attributed to the failure to find any significant differences for Survey 1 ( p > .20). The two-way interaction between personal loss/inconvenience and residency can be traced to the significant differences between those with or without personal loss/inconvenience that emerged for the non-New Yorker sample on Survey 2, t (193) = 3.51, p < .001, d = .66, and on Survey 3, t (193) = 2.65, p < .01, d = .44, a difference that did not appear in the New Yorker sample on either survey ( ps > .20).

The relation between media attention and ensuing conversation, on the one hand, and accuracy, on the other, is revealed through correlational analyses (see Table 7 ). Accuracy on Survey 1 was significantly correlated with media attention and ensuing conversation in the first two weeks, but not with media attention and ensuing conversation over the 11 months or three years that followed. Accuracy on Survey 2 was correlated with initial attention to the media and initial conversations, but also the media attention and ensuing conversation over the next 11 months. Accuracy on Survey 3 was correlated with media attention and ensuing conversation in the first few days and over the 35-month period, as well as with ensuing conversation over the first 11-months.

We explored whether media attention and ensuing conversation served as mediators of our observed relation between memory accuracy and residency on the one hand, and personal loss/inconvenience on the other. We devised a measure of the cumulative level of media attention and ensuing conversation for the period of time covered by a particular survey by calculating the average of the ratings given on that survey and any previous surveys. For instance, to calculate the level of media attention relevant to Survey 3, we averaged over the rating of media attention provided in Surveys 1, 2, and 3. (For clarity's sake, media attention will refer to the rating participants gave to the question about how much they attended to the media on a particular survey. Level of media attention will refer to the averaged measure.)

Table 8 contains the levels of media attention and ensuing conversation after two weeks, 11 months, and 35 months. New-Yorkers and non-New Yorkers and those with or without a personal loss or inconvenience attended to the media equally; that is, we found no significant main effects or interactions for level of media attention ( p s > .30). This result suggests that media attention may not be a mediating factor for residency and personal loss/inconvenience. We did, however, find differences for the level of ensuing conversation. In a three-way ANOVA between survey, residency and personal loss/inconvenience, there was a main effect for survey, F (1, 285) = 265.34, p < .01, η p 2 = .48, and a significant interaction between residency and personal loss/inconvenience, F (2, 285) = 3.77, p < .05, η p 2 = .04. Non-New Yorkers with a personal loss or inconvenience talked significantly more about the attack than non-New Yorkers without a personal loss or inconvenience, for all three time periods (2 weeks: t (192) = 1.97, p < .05, d = .28; 11 months: t (183) = 2.71, p < .01, d = .40; 35 months: t (183) = 2.92, p < .03, d = .43). On the other hand, there was no significant difference in the conversations of those New Yorkers with or without a personal loss or inconvenience ( p > .50). These results nicely reflect the pattern of results we found for the effects of personal loss/inconvenience and residency on accuracy.

Average level of media attention and ensuing conversations for New Yorkers and non-New Yorkers with or without personal loss or inconvenience (PL/IN)

To determine whether the level of ensuing conversation does indeed mediate the effects of residency and personal loss/inconvenience on accuracy, we conducted three mediational analyses on the non-New Yorkers' data ( Baron &Kenny, 1986 ). The independent variable was personal loss or inconvenience (for non-New Yorkers), the dependent variable was accuracy, and the mediational variable was the level of ensuing conversation. We focused on the non New-Yorkers because that is where the level of ensuing conversation differed as a function of personal loss/inconvenience (see Figure 1 ). For the initial two-week period, the level of ensuing conversation failed to predict accuracy. Personal loss/inconvenience of non-New Yorkers also did not predict accuracy. Thus, basic assumptions underlying the mediational analysis were violated. According to Baron and Kenny, partial mediation is suggested if the regression coefficient associated with the path from personal loss to event memory decreases when the mediating variable is included in the regression. By this standard, we found evidence for partial mediation for the 11-months and 35-months periods. As indicated by the Sobel (1982) test, at 11 months and 35 months, the mediator of level of ensuing conversation carried the influence of personal loss to event memory (11 months: test statistic = 2.01. p < .05; 35 months: test statistic = 2.04, p < .05). These analyses suggest that what mattered was not particularly where participants lived at the time of the attack or what personal loss/inconvenience they experienced, but how much they talked about the event.

A four step process with (1) regression coefficient from analysis with level of ensuing conversation as the dependent variable and personal loss as predictor, (2) regression coefficient from analysis with event memory as the dependent variable and level of ensuing conversation as the predictor, (3) regression coefficient from analysis with event memory as the dependent variable and personal loss as the predictor, and (4) regression coefficients from analysis with event memory as the dependent variable and both level of ensuing conversation and personal loss/inconvenience as predictors. These latter coefficients are in parentheses. Analysis for the 11-month period is in regular type. Analysis for 35-month period is in bold type. Partial mediation occurs if the regression coefficient for personal loss associated calculated in Step 4 is less than the related coefficient calculated in Step 3.

In addition to consistency and accuracy, another important variable in studies of flashbulb memories is confidence. Although our five putative predictors did not have an effect on consistency, both media attention and ensuing conversation affected the level of confidence with which participants held their flashbulb memories (see Table 6 and especially Table 7 ). For Survey 2, how much respondents attended to the media and talked about the attack in the first 11 months was significantly correlated with level of confidence. As for their confidence after 3 years, what mattered was how much respondents attended to the media and talked about the attack over the three years, not just in the first few days or the first year.

Changes in the content of memories over time

The analyses of putative predictors suggest that the similar patterns in the rate of forgetting we found for flashbulb and event memories involve different underlying processes. We can further buttress this claim by examining the changes in the content of memories over time: Different pattern of changes for flashbulb and event memories would suggest that different underlying processes are involved in their retention (and forgetting). First, consider those flashbulb memories that were consistent and those event memories that were accurate. Did, for instance, the consistent flashbulb memories on Survey 2 remain consistent on Survey 3? Did the accurate event memories on Survey 1 remain accurate on Survey 2? And did the accurate event memories on Survey 2 remain accurate on Survey 3? The result in Figure 2 suggests that answers to these questions are mostly positive. In examining flashbulb memories, we separated responses concerning “objective” canonical features -- place, informant, ongoing activity at the time of the reception, and the activity immediately following the reception – from the one feature involving emotional reaction. For objective features, a consistent response on Survey 2 led 82% of the time to a consistent response on Survey 3. The results for event memory are similar, with accurate response on Survey 1 remaining accurate on Survey 2 and accurate responses on Survey 2 remaining accurate on Survey 3. The one exception to this pattern is the memories participants reported for their initial emotional reaction. A consistent response on Survey 2 remained consistent on Survey 3 only 44% of the time. This result is in line with our finding that the relative rated strength of different emotions changed across surveys (correlation of emotion z-scores, Table 4 ).

For flashbulb memories, the proportion of consistent responses on Survey 2 that remained consistent on Survey 3 (as indicated by consistency/accuracy ), as well as the proportion of inconsistent responses on Survey 2 corrected , repeated , or given an other response on Survey 3. For event memory, the proportion of accurate responses on Survey 1 accurate on Survey 2 (S2: consistency/accuracy ), the proportion of accurate responses on Survey 2 that were also accurate on Survey 3 (S3: consistency/accuracy ), the proportion of inaccurate responses on Survey 1 corrected , repeated or given an other response on Survey 2, and the proportion of inaccurate responses on Survey 2 corrected , repeated or given an other response on Survey 3. Standard deviations are expressed in error bars.

What about changes to inconsistent/inaccurate responses from one survey to the next? Inconsistent/inaccurate responses in one survey could be followed up in the next survey in at least three ways: through correction, repetition, or alteration. For instance, an inconsistent response on Survey 2 (based on the responses on Survey 1) could be:

• (1) Corrected in Survey 3. This is the proportion of inconsistent responses in Survey 2 revised in Survey 3 to be consistent with what appeared in Survey 1 (the corrected response proportion ),
• (2) Repeated in Survey 3. This is the proportion of inconsistent responses in Survey 2 (when compared to Survey 1) that were repeated in Survey 3 ( the repeated response proportion ),
• (3) Altered in Survey 3 to something other than the response on Survey 1. This is the proportion of inconsistent responses in Survey 2 remembered differently in both Surveys 1 and 3 (the other response proportion ).

In exploring these three options for flashbulb memories and their analogs for event memories, we did not include in our analyses those instances in which participants failed to answer a probe.

Is the frequency of one of these types of change larger than the frequencies associated with the other types? Does the pattern of frequency distribution differ for flashbulb and event memories? For objective features of flashbulb memories, participants tended to repeat their inconsistencies. For these features, there were significant differences between the proportion of repeated responses and the proportion of other responses , as well as between the proportion of repeated responses and corrected responses (both t -tests, p < .001). Such repetitions are concordant with a slowing rate of forgetting between Survey 2 and Survey 3. Moreover, the presence of repetitions suggests that a stable memory is forming after a year delay, with stories about the circumstances in which one learned of the terrorist attack remaining the same over the long-term, even if they are full of inconsistencies with the initial report. In contrast, participants were inclined to report remembering an emotion not reported in their original survey or in Survey 2 over either correcting or repeating a previous response (all t -tests, p < .01). This finding, again, is in line with our report of poor emotional memory.

The changes observed for event memories differed from what we observed for flashbulb memories, with event memories corrected rather than repeated from one survey to the next. We can determine the change in the content of event memories from Surveys 1 to 2 (indicated as S2 on Figure 2 ) and from Surveys 2 to 3 (indicated as S3 in Figure 2 ). We did not include the probe that asked participants to order the events because of the complexities arising when comparing both the degree of change and the nature of this change. For questions involving multiple answers (such as the name of crash sites), we examined each answer separately. As illustrated in Figure 2 , corrected responses were more common than either repeated or other responses, for both Surveys 2 and 3. Moreover, the proportions of corrected responses for event memories were greater on Surveys 2 and 3 than comparable figures for flashbulb memories. (All t-tests were significant at levels less than .005.) As for the uncorrected, inaccurate responses, on Survey 2, participants were as likely to say something else than repeat the errors they made on Survey 1. Survey 3 differed from Survey 2, in that for Survey 3, repeated responses were significantly greater than other responses, t (390) = 3.74, p < .001, d = .38. This latter finding suggests that, like flashbulb memories, a stable event memory may be emerging somewhere between the first and third year. Importantly, though, the content of this stable memory differs from the content of flashbulb memories: Event memories are converging on an accurate rendering of the past, whereas flashbulb memories are converging on personally accepted and confidently held, even if inconsistent, renderings. This difference strengthens the interpretation we advanced when considering the predictor data: That the retention (and forgetting) of flashbulb and event memories over the long-term involves different processes.

In this paper, we explored the long-term retention of flashbulb memories and the associated event memories. We investigated both the rate of forgetting and how different aspects of the memories might be forgotten at different rates, as well as the factors associated with the retention of both flashbulb memories and event memories.

Forgetting over the long-term

In the present study, the rate of forgetting of flashbulb memories in the first year was similar to that observed in other flashbulb memory studies, but, importantly, this rate of forgetting slowed substantially between the first and third year. This converges with other studies demonstrating a slowing rate of forgetting between the first and third years ( Berntsen & Thomsen, 2005 ; Bohannon & Symons, 1992 ). The current study, however, has the advantage of using a test-retest paradigm. The present study brings into question the generality of the results of Schmolck et al (2002), who found an increased rate of forgetting between the first and third years using a similar test-retest paradigm. Horn (2001) has also questioned the generality of Schmock et al., arguing that the steep forgetting Schmolck et al. observed between the fifteen-month and the thirty-second month tests may have been due to interference created by the announcement of the verdict of Simpson's civil trial in the sixteenth month. A similar confound probably does not arise for flashbulb memories of the terrorist attack of 9/11, the Challenger explosion, or the German invasion and withdrawal inasmuch as nothing so similar occurred during the retention periods of the respective studies for their respective samples.

When considered in conjunction with the other studies on long-term retention of flashbulb memories, then, the present study suggests that a slowing in the rate of forgetting after the first year is typical of flashbulb memories. In doing so, it supports and extends the findings of Talarico and Rubin (2003) , that is, that the rate of forgetting follows a similar pattern as found for ordinary autobiographical memories. The rate of forgetting found in the present study was similar to that found in most diary studies: 20% or more the first year and between 5% to 10% thereafter.

Our results also suggest that different aspects of the flashbulb memories may be forgotten at different rates. Memory for emotions can be quite unreliable ( Levine et al., 2006 ). Here we show that, despite the salience of the emotional reaction to flashbulb events such as 9/11, the memories of these emotional reactions tend to be forgotten more quickly than other aspects of the flashbulb memory, even over the long-term. The reason for this rapid forgetting needs to be further explored.

Our event memory results differ from those reported by Bohannon and Symons (1992) for the Challenger explosion, the only flashbulb memory study that examined event memory after three years. Bohannon and Symons found that forgetting continued to occur between the first and third year at approximately the same rate as it did in the first year, basing their conclusion on cross-sectional data, whereas we found a decline in the rate of forgetting when we examined longitudinal data, a finding consistent with work on memory for facts ( Bahrick, 1983 , 1984 ; Bahrick, Bahrick, & Wittlinger, 1975 ). We explain this difference across studies below.

Do different factors influence flashbulb and event memories?

Although the pattern in the rate of forgetting was the same for flashbulb memories and event memories over a three-year period, subsequent analyses of our data suggested that different processes may underlie these similar patterns. In particular, we failed to find any relation between five predictors (residency, personal loss or inconvenience, emotionality, media attention, and ensuing conversation) and flashbulb memories, but found significant relations for four of the five (all but emotionality) predictors for event memories. Moreover, we found that inconsistent flashbulb memories reported on one survey were repeated on the next survey, whereas inaccurate event memories tended to be corrected on the next survey. These data were not at ceiling, limited in variability, nor specific to the coding scheme we employed.

Other studies of flashbulb memories of 9/11 using a test-retest procedure reported similar failures to find predictors for consistency ( Curci & Luminet, 2006 ; Talarico & Rubin, 2003 ). It may be that various factors interact differently for different people. For example, some people may react emotionally and rehearse a flashbulb memory, whereas others may react emotionally and avoid rehearsing the memory. There could be enough variability in the population in the way various factors combine that comparing the effect of one of them on consistency across a population would be difficult. As a result, researchers might find low correlations for each factor in their flashbulb memory studies, even if in more controlled settings in which each factor is isolated they might find the predicted correlation. Luminet, Curci, and their colleagues have attempted to circumvent this problem by using structural equation modeling. Even this methodological advance has failed to produce uniform results (see Luminet, 2008 , for a review).

Memory practices

Our finding that the levels of media attention and ensuing conversation are correlated with accuracy of event memories suggests these two variables should figure critically in any account of retention of event memories. Both of these activities increase the degree to which the event memory is rehearsed ( Neisser, Winograd, Bergman, Schreiber, Palmer, & Weldon, 1996 ). In keeping with recent calls for a study of cultural products ( Morling & Lamoreaux, 2008 ) and for viewing the mind as extended ( Clark & Chalmers, 1998 ; Wilson, 2004 ), we also want to focus on the activity itself – the media attention or the ensuing conversation. Both media attention and ensuing conversation could be considered memory practices of a community , which refers to the way in which a community intentionally or unintentionally preserves its past ( Bourdieu, 1977 ; for reviews, see Hirst & Manier, 2008 ; Hirst & Meksin, 2008 ; Zerubavel, 1997 ). For many social scientists, memorials and commemorations are the prototypical memory practices ( Gillis, 1994 ). The practices of mass media in covering public, emotionally charged events and even the conversations people have about the event have also been treated as memory practices ( Assmann & Czaplicka, 1995 ; Dayan & Katz, 1992 ; Hirst & Manier, 2008 ; Hirst & Echterhoff, 2008 ; Hoskins, 2007 ; Johnson, 2007 ). For ensuing conversation, people may be inclined to share memories of emotionally intense events, in part because they believe that doing so will help them deal with the emotion ( Rimé, 2007a , 2007b ). They may also discuss such events because of a social mandate. When meeting someone who has lost a loved one, some conversational acknowledgment of the death is mandatory. A similar social mandate may hold for public, emotionally charged events such as 9/11 ( Mehl & Pennebaker, 2003 ). As we saw, the practice of ensuing conversation can vary across communities: The level of conversation in New York, for instance, differed from the level of non-New Yorkers. Within a community, however, memory practices, such as conversations and media attention, appeared to be more uniform.

A social interactional approach suggests that a key to the difference between our results for event memory and those of Bohannon and Symons (1992) may lie in the memory practices surrounding 9/11 and the Challenger explosion. Although we cannot contrast the amount of conversation that followed the Challenger explosion with what followed the 9/11 attack, we can examine attention to the media, at least indirectly, by looking at media coverage (see Shapiro, 2006 , for a similar analysis). Figure 3 plots the accuracy of event memory over a three-year period and a rough estimate of the amount of media coverage of the attack over the same time period. 3 We estimated media coverage by using the New York Times as a reference text on Lexus-Nexus to determine the number of articles in the Times in which the phrase “September 11” or the conjunction of “Challenger” and “explosion” appeared. We then calculated the proportion of mentions over the number of days in the targeted period. To facilitate comparison, we recalibrated both the accuracy scores and the media proportions to z-scores calculated across the three time periods. As Figure 3 indicates, the pattern of forgetting Bohannon and Symons and we observed for event memory nicely mirrors the level of media attention. We found a similar pattern when we used The Boston Globe and U.S. News and World Report as reference texts in Lexus-Nexus.

Relation between media coverage and memory accuracy for facts about the Challenger Explosion and the Terrorist Attack of September 11. Proportions of correctly remembered details were converted into z-scores, as were the frequencies with which an event was covered in the New York Times .

Memory practices might also help account for the differences in changes in content we found for both flashbulb memories and event memories. Event memories tended to be corrected over time. Such correction is what one would expect if a community is constantly retelling the story of the attack. Unlike the retellings, by an individual, which may be subject to cumulative source monitoring failures (e.g., Johnson, 2006 ), a community retelling, especially in the media, tends to be fact-checked, and, ceteris paribus , is presumed to be “correct.” That is, the media can serve a social/cultural reality monitoring function ( Johnson, 2007 ). The Michael Moore effect is a particularly vivid example of the ability of the media to correct inaccurate memories. The one exception to this general trend toward correction appears to be participants' memory for the names of the involved airlines. Memory for this fact continued to decline over the three-year period. This decline could also be explained by referring to community memory practices, if the names of airlines figured less critically in accounts of the 9/11 attack than, for instance, the number of planes. One could tell the story of 9/11 without mentioning the name of the airlines, but it would be much more difficult to avoid mentioning the locations of the attack or the number of planes involved. Films, such as United 93 , came out after the last survey.

Whereas the memory practices of a community no doubt shaped the content of event memories of 9/11, there is little reason to expect that they should have a similar effect on flashbulb memories of 9/11. The memory practice of a community might lead its members to undertake similar mnemonic processing when it comes to memories for events, but, as we noted, members are more likely to be left to their own devises when it comes to flashbulb memories. Moreover, inasmuch as flashbulb memories are unique, a community as a whole rarely retells a single member's flashbulb memory across the community. Even when sharing of a flashbulb memory does occur in a small group, there may be no way to verify the accuracy of many details of a reported memory. Consequently, at least for objective features of flashbulb memories, the errors made at the end of the first year tended to persist into the third year. If a person falsely remembered that she was at work the first year, she tended to continue to remember (falsely) into the third year that she was at work. There may be nothing to lead her to suspect otherwise.

In emphasizing the role of public memory practices to account for the shape of the forgetting of event memories, we have sought to understand what people remember and do not remember, not only in terms of individual internal cognitive processes, but also in terms of community activities. Both approaches are necessary to account for memory for public events. The different forgetting curves observed for event memories can be traced to the way the different events were covered by the media. Moreover, continuing media coverage can account for the corrections that took place over time with event memory. Clearly, an understanding of memories for public events such as the terrorist attack of 9/11 cannot be achieved by pointing only to internal cognitive processes or to social influences on memory, but to the interaction between the two.

Acknowledgments

We thank the many student coders without whom this research project would have been impossible, as well as Brett Sedgewick, who assisted with the supervision of this project.

Support from the James S. McDonnell Foundation and the National Institute of Mental Health, grant R01-MH0066972, is gratefully acknowledged.

Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/xge

1 There is much terminological confusion in the literature. First, the term flashbulb memory could be construed as implying an accurate representation of the circumstances in which one learned of the emotionally charged public event. Although we use this term here, we do not mean to imply that the memories are accurate. Second, as used in the flashbulb memory literature, the phrase event memories is rarely qualified, but it is not meant to refer to all event memories, only those that involve events that elicit flashbulb memories. One should more accurately refer to memories for flashbulb events . However, the phrase can, with repetition, become awkward and hence we adopt the convention of referring to memories for flashbulb events simply as event memories .

2 To be specific, we excluded from our classification of “experiencing personal loss or inconvenience,” columns 107, 108, 113–115, 117–121, and 124–126, using the column numbers from the coding manual for Survey 1.

3 Bohannon and Symons (1992) and we tested participants at slightly different delays. Hence, we discuss testing period rather specific testing delays.

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Introduction

Mike, a 35 year-old male, is presented to the emergency department with multiple puncture wounds to the right arm and bruising on the face. He arrived at the hospital via emergency medical services after calling 911.

Mike was playing with his dog, a German Shepherd, in front of his hoe one day when all of the sudden, his dog decides to bit his right arm and punch him in the face. He immediately takes off his jacket and notices blood all over his arm and calls 911. calling 911, Mike states that he has been bitten on his arm and punched in the face by his dog. The operator tells Mike that EMS will be there in 10 minutes and to clean the wounds with soap and water and to cover the wounds if possible.

On route to the hospital, EMS performs a primary assessment using the ABCDE approach.

• A irway: Patent
• B reathing: tachypneic with labored breath and breath sounds normal
• C irculation: pulses rapid and weak
• D isability (LOC): awake, alert, responds to pain and voice. GCS: 15
• E xposure: Site of wound exposed. Wounds on right arm and bruising on face noted

C-Spine Stabilization is not indicated.

Upon admission to the ED, the secondary assessment was performed. The patient’s vital signs were a BP: 92/54, HR: 120, RR: 22, T 100.7F, O2: 96% on room air, and a pain of 9/10. Performing a full head-to-toe assessment revealed:

• Neurological: Awake, alert and oriented x 4, GCS 15, full PERRLA
• Cardiovascular: Normal s1s2, pulses rapid and weak, cap refill <2 secs
• Respiratory: Tachypneic, labored breathing, normal breath sounds
• GI: Nondistended, soft, non-tender, bowel sounds active
• GU: No complaints of urinary problems
• Integumentary: Multiple right arm puncture wounds. Bruising on face. Site of wound warm and swollen. Skin is cool and pale.
• Musculoskeletal: weakness and pain in right arm
• Psychological: Possible PTSD

The patient’s medical history was gathered using the mnemonic device, AMPLE:

• A llergies: Latex
• M edications: Atorvastatin, metoprolol
• P ast medical history: Splenectomy 19 years ago
• L ast oral intake: a glass of water
• E vent leading to injury: playing with dog. Dog overexcited

Question 1: After reviewing the findings in the secondary assessment, what are some notable concerns to address in the assessment?

Question 2: Based on the secondary assessment, what interventions should the nurse expect to be ordered?

Question 3: After performing these interventions, should the patient be admitted into the hospital or discharged and given a follow up visit? Why?

Nursing Case Studies by and for Student Nurses Copyright © by jaimehannans is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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• March 2-4, 2022: Register today for Transform911’s next virtual convening.

TRANSFORM911 Transforming 911 Report: Chapter One

• Resource Hub
• Transforming 911 Report

911 Professional Career and Supports

download a PDF of this chapter

Table of Contents

Introduction.

911 professionals [1] —the operators, call takers, call handlers, and dispatchers in Emergency Communications Centers (ECCs) [2] throughout the United States—collectively respond to an enormous call load, estimated at 240 million calls annually. [3] This workload has increased considerably in recent years, with over half of all ECCs surveyed in 2017 reporting an uptick in the number of dispatched calls. [4] Staffing has not kept pace with increased demand for emergency services, [5] which has further spiked during the COVID-19 pandemic. [6] Much is asked of these 911 professionals, who are tasked with supporting people who are seeking information and guidance, navigating problems and conflicts, and experiencing crises and victimizations, often collecting information from a frightened or confused caller in a short conversation. With each incoming call, 911 professionals must be prepared to pivot to meet the needs of the caller. This may involve patiently assisting a senior experiencing problems with medication, calming a distressed mother whose tween has yet to return home from school, or responding empathetically to a traumatized victim of violence. Each call requires a different set of strategies. Regardless of the nature of the call, each one can be stressful from the perspective of the 911 professional and can be life-changing from the perspective of the caller and others.

In essence, 911 professionals are America’s true first responders, serving as gatekeepers to law enforcement, fire, and emergency medical services (EMS) responses to community calls for service, and applying their best judgment to discern the appropriate response. 911 professionals are required to understand and comply with a wide array of policies for how to handle specific call types. They also have a critical role in preparing responders—particularly police officers—to arrive on the scene in a manner that protects their safety without predisposing them to approach difficult events in a way that reflects implicit or explicit biases or aggravates the risk that responders will use excessive force. 911 professionals may also be able to reduce reliance on law enforcement, dispatching responses from social workers or mental health clinicians instead of police officers when appropriate.

This chapter describes the various roles 911 professionals play, with a focus primarily on those whose work includes interacting with police dispatchers and responders. After describing the current landscape of 911 professional recruitment, training, and retention, the research evidence on these topics as well as the job satisfaction and degree of stress experienced by 911 professionals is presented. The research questions at the end of this chapter put forth several important areas of inquiry that can inform strategies to improve the experiences and effectiveness of 911 professionals.

Types of 911 Professionals

Figure 1.1: Call-Taking and Dispatching Process

Call takers , also known as call handlers, telecommunicators, or operators in some locations, receive public requests for assistance via phone call, text message, or alarm system alert. Call takers assess the reason for and exigent nature of each call. They may resolve the call on their own by providing information or guidance to the caller, or they may refer it to a dispatcher or to another information or resource line. Recent research on the largest ECCs in the country found that call takers resolved half of all calls without having to refer to dispatch, by engaging in informal counseling and problem solving. [7] They also resolved one third of calls pertaining to property crimes and disorders that were not vice-related, and 22 percent of traffic-related calls. [8] As such, call takers play a critical role in diverting calls from police response. [9]

Dispatchers direct field responders to crime scenes and other incident sites, and provide crucial information about the context of the event and any changing dynamics that unfold until responders arrive and the issue is resolved. Dispatchers communicate with and monitor the progress of emergency unit responders and provide instructions, such as first aid advice and how to remain safe, to the caller until the response unit arrives. [10] In larger call centers, the roles of call taker and dispatcher are distinct and represent a career progression, whereas in smaller call centers one individual may serve in both roles owing to limited staff resources. [11]

While the job of 911 professional is occupationally categorized as administrative, [12] this designation misrepresents the true nature of this work. Studies have documented the complex and challenging nature of 911 jobs, which require strong communication skills, nuanced judgments, the technical literacy to interact with computer-aided dispatch systems, and the ability to faithfully comply with a dizzying array of policies. [13] 911 professionals are tasked with navigating critical situations that, particularly in smaller call center service areas, may involve their own colleagues, friends, and family members as both callers in need and field responders. [14] Importantly, the way in which 911 professionals interpret and resolve calls has implications for how field responders perceive the level of risk and nature of the incident. These communications could predispose responders to behave in certain ways that, in the best-case scenario, support the safe and efficient resolution for all parties, or—in the worst case—inadvertently prompt unnecessary force or aggravate racial or other biases. [15] Indeed, studies examining the nature of exchanges between callers and 911 professionals suggest that these interactions may compromise decision-making on the part of both 911 professionals and officers. [16] , [17] , [18]

State of Practice

Prior to the 1968 establishment of 911, call takers and dispatchers handling emergency calls for service had little to no training. [19] The field was already populated primarily by women (referred to as the “feminization of dispatch” [20] ) who were relegated as “complaint clerks” and lacked the authority to designate which calls warranted police response. [21] The rapid proliferation of 911 [22] prompted the field to become more formalized in terms of training and professionalization, particularly in the area of emergency medical dispatch, as the recognition of the life-saving aspects of both effective triage and verbal guidance (also known as “pre-arrival instructions”) by 911 professionals grew. [23]

As technological advances in 911 have evolved, so too has the sophistication of the 911 profession. The establishment of Enhanced 911 (E911) in the mid-1970s brought with it selective routing and the ability to discern the location and phone number of the caller, with selective transfer and alternate routing soon following. [24] These features enabled ECCs to automate aspects of their triage and dispatching processes, and required 911 professionals to possess the skills needed to navigate the new software systems and complex decision trees that accompanied them.

The field has continued to evolve, aided in part by the development of call-taking standards. The National Emergency Number Association (NENA) developed customizable Law Enforcement Dispatch Guide cards [25] and the Association of Public Safety Communications Officials (APCO) offers triage protocols that draw from the 911 professionals’ experience and judgment. [26] Relatedly, the Advanced Medical Protocol Dispatch System developed by the International Academies of Emergency Dispatch is widely used by emergency medical service 911 professionals. [27]

Training certification and state training requirements have also enhanced the expertise of 911 professionals, who may be certified as emergency medical, fire, or police dispatchers, with some 911 professionals certified for two or all three of these roles. [28] Managers and supervisors can also obtain certification as emergency number professionals or certified public-safety executives. [29] Training requirements vary considerably by state and municipality, as does compensation. While APCO International provides minimum training standards for 911 professionals, along with training and technical assistance, compliance with these standards is optional. It is unclear what share of ECCs adopt these standards.

In a survey conducted in 2019, about three in four of the 48 reporting states and territories indicated statewide minimum training requirements for 911 professionals overall, an increase from two-thirds in 2018. [30] Just 44 percent indicated statewide minimum training standards specifically for police dispatch. [31] Even among states that have minimum training requirements, standards vary considerably. North Carolina, for example, mandates a minimum of 47 hours of training, [32] whereas California requires 120 hours of classroom setting before simulation and sit-along training can commence. [33]

911 professionals also report insufficient training and lack of available resources with which to divert calls related to mental health concerns. A recent survey of ECCs across 27 states found that few 911 professionals were trained in how to handle behavioral crisis calls – about one in five lacked specialized resources, such as behavioral health clinicians, crisis-trained 911 professionals or field responder staff, or mobile crisis units. [34]

Uneven certification requirements may explain the wide range of compensation for various 911 professional roles. According to the U.S. Bureau of Labor Statistics (BLS), the median annual salary for public safety communicator was $43,290 in 2020. [35] However, the website ZipRecruiter illustrates the range of pay by geography, placing the average annual salary for a 911 dispatcher (a higher-level subcategory of 911 professionals) at $48,232, with a high of $53,650 in New York to a low of $35,408 in North Carolina. [36]

Issues of insufficient compensation collide with increases in calls for 911 and challenges in recruiting and retaining 911 professionals. BLS projects that the number of 911 professional jobs will grow by eight percent between 2020 and 2030. [37] Similarly, a 2017 study found that over half of all ECCs have experienced an increase in the number of dispatched calls, with all experiencing staffing challenges. [38] The report also noted the mounting issue of staff attrition, with an average 911 professional retention rate of only 71 percent. Study authors conjectured that recruitment is becoming more difficult given that millennials desire more flexible work hours and are less likely to trust governmental institutions. [39]

Efforts to reclassify 911 professionals from administrative staff to emergency responders could go a long way to further professionalize the field, increase pay equity, and attract new 911 professionals while retaining seasoned staff. However, efforts to lobby the Office of Management and Budget have been unsuccessful. [40] Related legislation passed the House of Representatives in 2019 but died in the Senate. [41] This reclassification bill was reintroduced in April 2021. [42]

Research Evidence

Attending to 911 professionals’ training, support, and needs is essential to promote public safety while minimizing unintended, harmful, and inequitable outcomes. The research evidence on this topic, while largely descriptive, pinpoints issues and challenges along with potential remedies.

Recruitment, Retention, and Training Given increased demands for 911 services and continued staffing difficulties experienced by ECCs, research on recruitment, retention, and training is particularly important.

Recruitment and Retention Academic studies of effective recruitment strategies for 911 professionals are virtually nonexistent. A 2017 APCO International survey of ECCs identified workplace flexibility, supervisor and coworker support, employee recognition, opportunities for promotion, and sufficient compensation as key factors in both recruitment and retention. [43]

Training Apart from how to handle calls pertaining to cardiac arrest, the topic of 911 professional training has garnered scant research attention. A systematic review of 149 studies pertaining to emergency dispatch research unearthed just two studies of training program efficacy, one in Sweden [44] and the other in Belgium. [45] Both studies found that quality assurance processes improved dispatch outcomes; however, one focused solely on cardiac arrest calls, and both are decades old. [46]

Training is important to ensure that 911 professionals comply with triaging and dispatching protocols. There is, however, a tradeoff between fidelity and competence in such protocols. Overly rigid policies can inhibit the ability of 911 professionals to apply experience-informed judgment regarding appropriate response. A recent study found that while 911 professionals resolve a large share of calls without need for officer dispatch, their decision-making is constrained by policies that require them to forward certain calls to dispatch based on event code, and sometimes these policies are even automated within the CAD system. [47] On the other hand, a lack of training may lead some 911 professionals to interpret calls in an inappropriately alarmist manner that can signal to police responders that the incident is a higher public safety threat than it actually is. [48]

The types of calls that often require dispatch  in accordance with ECC policies include domestic incidents, mental health concerns, and suspicious persons – many of the same call types that are associated with charges of excessive force and biased policing. [49] In some cases, a caller may demand and receive police response, even if that response conflicts with agency policy based on the nature of the event. [50] This is not to suggest that 911 professionals should be afforded full reign in deciding which calls to forward to dispatch. Even with the benefit of professional judgment, 911 professionals may interpret and communicate with callers and field responders in ways that negatively influence decisions surrounding whether an officer is dispatched and how the officer perceives the event. [51] , [52] , [53] This can produce misinterpretations of the level of risk and yield biased outcomes. [54] , [55] , [56] Training that employs concepts consistent with the tenets of procedural justice may effectively reduce these unintended outcomes, [57] but has not been subject to evaluation.

Job Satisfaction, Stress, and Resilience Factors Surveys indicate that most 911 professionals take great pride in their work, reporting relatively high job satisfaction and “compassion satisfaction,” the positive feelings one derives from helping others. [58] That said, 911 professionals face significant job stresses owing to the nature of the role, with one survey finding that respondents were exposed to roughly three in four types of traumatic events during the course of their careers. [59] , [60] 911 professionals are exposed to trauma on a daily basis, [61] and such exposure has been associated with compassion fatigue, [62] burnout, and secondary traumatic stress. [63] Other studies have found that stress levels and rates of post-traumatic stress disorders (PTSD) are higher among 911 professionals than among police officers or the general population, [64] with dispatchers who report low job satisfaction more likely to experience burnout. [65] Indeed, another study of 911 professionals found that they had greater rates of occupational burnout than members of the general public. [66]

Some stresses experienced by 911 professionals are likely born of the nature of shift work, which has been associated with a large array of mental and physical health risks including obesity, sleep disorders, diabetes, anxiety, depression, and cardiovascular disease. [67] The high vacancy rates in many ECCs can result in forced overtime, which may exacerbate these outcomes, creating disruptions in work routines and further compounding stress, compromising occupational wellness, and reducing retention. One study identified a rate of obesity among a sample of 911 professionals that was 50 percent higher than that of the general population, and identified a strong relationship between poor physical health and compromised mental health among 911 professionals. [68] Other research indicates that 911 professionals who felt over-extended had high levels of stress, and those who had greater abilities to recognize and process their stressful experiences and emotions had lower stress levels. [69]

Questions for Inquiry and Action

The research on 911 professionals is extremely limited. It is focused primarily on emergency medical responders rather than police dispatchers, and is typically conducted in a single jurisdiction or ECC. Even the more rigorous dispatch studies are largely retrospective, given the difficulties in conducting randomized controlled trials in emergency-driven settings. [72] Research specific to 911 professionals is largely descriptive, suffers from small sample sizes, or is entirely qualitative.

There are similar evidence gaps regarding the relative merits and impacts of various call-taking protocols, training and certification processes, and quality assurance and performance measurement standards. These evidence gaps call for increased partnerships between researchers and ECC administrators and operations personnel to build a more robust knowledge base. [73]

Research questions that, if answered rigorously, would fill critical knowledge gaps include the following:

• To what extent do existing training opportunities meet the needs of both 911 professionals and the demands of the job? Why do some 911 professionals pursue in-service training opportunities while others do not? What is the impact of certification and training requirements on 911 professionals’ capabilities and job performance, particularly with regard to resolving calls on their own and adherence to triage and dispatching policies and protocols?
• What are the most effective recruitment and retention strategies for 911 professionals? How does the effectiveness of these strategies vary by age, sex, geography, and other factors?
• To what degree does reclassification of 911 professionals from administrative to first responder facilitate recruitment and retention, increased job satisfaction, pay equity, and improve retention rates?
• To what degree does reclassification of 911 professionals from administrative to first responder facilitate better outcomes for field responders and for people who are the subject of calls?
• What would be the budgetary impact—both for independent multi-jurisdiction ECCs and for public safety agencies that manage emergency calling services—of creating career and compensation parity for 911 professionals on par with those for field responders and public safety officers?
• What are the impacts of improvements to 911 professionals’ supervision, wellness supports and resources, and compensation levels on their job satisfaction, job performance, and tenure?
• To what degree does co-location of nurses, mental health clinicians, or social workers at ECCs facilitate safer and more effective safety and health outcomes for people in need?
• To what extent would increased community awareness of and access to behavioral health resources and supports allow 911 professionals to divert more calls from police response?
• What internal (e.g., personality, coping) and external (e.g., work conditions, shift) factors increase the likelihood of resilience among 911 professionals?
• What is the impact of training 911 professionals in implicit bias and procedurally-just interactions with members of the public as measured by rate of 911 professional call resolution, share of calls resulting in police dispatch, nature of police response, and public safety and wellness outcomes?
• What are the advantages and disadvantages of giving 911 professionals more agency to divert calls from police dispatch? What is the impact of such diversion on public safety outcomes, use of excessive force, racial disparate policing, and community trust in the police?

[1] Bureau of Labor Statistics, “Occupational Outlook Handbook: Public Safety Telecommunicators,” accessed October 28, 2021, https://www.bls.gov/ooh/office-and-administrative-support/police-fire-and-ambulance-dispatchers.htm

[2] These entities are referred to by some as Public Safety Answering Points (PSAPs).

[3] National Emergency Number Association, “9-1-1 Statistics,” accessed November 22, 2021, https://www.nena.org/page/911Statistics .

[4] APCO International, “Project RETAINS: Staffing and Retention in Public Safety Answering Points (PSAPs): A Supplemental Study,” 2017, https://www.apcointl.org/services/staffing-retention/ ; C. Scott, “911 Has Its Own Emergency: Not Enough Call Takers and Dispatchers,” KDVR, May 24, 2021, https://kdvr.com/news/local/not-enough-911-call-takers-and-dispatchers/ .

[5] APCO International, “Project RETAINS.”

[6] Rachel Cardin, “911 Calls Surge With COVID-19 Cases, Thinly Staffed Firefighters Struggle To Keep Up,” CBS Baltimore, November 21, 2021, https://baltimore.cbslocal.com/2021/12/27/911-calls-surge-with-covid-19-cases-as-firefighters-struggle-to-keep-up/ ; Gwynne Hogan, “NYC EMS Faces Record Staffing Shortage As 911 Calls For COVID-Like Symptoms Surge,” Gothamist, December 29, 2021, https://gothamist.com/news/nyc-ems-faces-record-staffing-shortage-911-calls-covid-symptoms-surge ; Amanda Hari, “San Francisco Overwhelmed by 911 COVID-19 calls,” KRON4, January 8, 2022, https://www.kron4.com/news/bay-area/san-francisco-overwhelmed-by-911-covid-19-calls/ .

[7] Lum et al., “Constrained Gatekeepers.”

[8] Lum et al., “Constrained Gatekeepers.”

[9] Melissa Reuland, “A Guide to Implementing Police-based Diversion Programs for People with Mental Illness,” Rockville, MD: U.S. Department of Health and Human Services Substance Abuse and Mental Health Service Administration GAINS Center – Technical Assistance and Policy Analysis Center for Jail Diversion, 2004, https://perma.cc/LGM2-9S6G .

[10] Bureau of Labor Statistics, “Occupational Outlook Handbook,” September 15, 2021. https://www.bls.gov/ooh/ .

[11] S. Rebecca Neusteter et al., “Understanding Police Enforcement: A Multicity 911 Analysis,” Vera Institute of Justice, September 2020, https://www.vera.org/publications/understanding-police-enforcement-911-analysis .

[12] Bureau of Labor Statistics, “Occupational Outlook Handbook.”

[13] Heidi Kevoe-Feldman and Anita Pomerantz, “Critical timing of actions for transferring 911 calls in a wireless call center,” Discourse Studies 20, no. 4 (2018): 488-505; Balakrishan S. Manoj and Alexandra Hubenko Baker, “Communication challenges in emergency response,” Communications of the ACM 50, no. 3 (2007): 51-53, https://doi.org/10.1145/1226736.1226765 .

[14] Roberta Mary Troxell, “Indirect exposure to the trauma of others: The experiences of 9-1-1 telecommunicators,” (PhD diss., University of Illinois at Chicago, 2008), https://uic.figshare.com/account/projects/71123/articles/10898648 .

[15] Roge Karma, “Want to fix policing? Start with a better 911 system,” Vox, August 10, 2020, https://www.vox.com/2020/8/10/21340912/police-violence-911-emergency-call-tamir-rice-cahoots .

[16] Don H. Zimmerman, “Talk and its Occasion: The Case of Calling the Police,” in Meaning, Form and Use in Context: Linguistic Applications , ed. D. Schiffrin (Washington, D.C.: Georgetown University Press, 1984): 210-228.

[17] Don H. Zimmerman, “The Interactional Organization of Calls for Emergency Assistance,” in Talk at Work: Social Interaction in Institutional Settings , ed. P. Drew & J. Heritage (Cambridge, UK: Cambridge University Press, 1992), 418.

[18] Angela Cora Garcia and Penelope Ann Parmer. “Misplaced mistrust: The collaborative construction of doubt in 911 emergency calls.”  Symbolic Interaction  22, no. 4 (1999): 297-324.

[19] Isabel Gardett et al., “Past, Present, and Future of Emergency Dispatch Research: A Systematic Literature Review,” Annals of Emergency Dispatch & Response 29 (2016): 29-42, https://perma.cc/SQ3N-DEQW ; S. Rebecca Neusteter et al., “Understanding Police Enforcement.”.

[20] Jessica W. Gillooly, “How 911 callers and call‐takers impact police encounters with the public: The case of the Henry Louis Gates Jr. arrest,”  Criminology & Public Policy  19, no. 3 (2020): 787-804, https://doi.org/10.1111/1745-9133.12508 .

[21] Jessica W. Gillooly, “Police Encounters.”

[22] Industry Council for Emergency Response Technologies (iCERT), History of 911 and What It Means for the Future of Emergency Communications (Washington, DC: iCERT, 2015), 3, https://perma.cc/YL97-9J9C .

[23] Gardett et al., “Past, Present, and Future.”

[24] iCERT, “History of 911.”

[25] National Emergency Number Association PSAP Operations Committee 9-1-1 Call Processing Working Group, “NENA Standard for 9-1-1 Call Processing,” April 16, 2020,

https://cdn.ymaws.com/www.nena.org/resource/resmgr/standards/nena-sta-020.1-2020_911_call.pdf .

[26] APCO International, “Guidecards,” accessed December 3, 2021, https://www.apcointl.org/services/guidecards/ .

[27] Jeff. J. Clawson, “The DNA of Dispatch: The Reasons for a Unified Medical Dispatch Protocol,” Journal of Emergency Medical Services , 1997, https://perma.cc/5X87-4QQ9 ; Neusteter et al., “Understanding Police Enforcement.”

[28]  911.gov, “Telecommunicators & Training,” accessed December 3, 2021, https://www.911.gov/issue_telecommunicatorsandtraining.html .

[29]  911.gov, “Telecommunicators & Training.”

[30] 911.gov, “National 911 Annual Report 2019,” 2020, https://www.911.gov/pdf/National_911_Annual_Report_2019_Data.pdf .

[31] 911.gov, “National 911 Annual Report 2019.”

[32] North Carolina Department of Justice, “Minimum Training Standards: Telecommunicators,” NC DOJ, September 5, 2019, https://ncdoj.gov/law-enforcement-training/sheriffs/training-requirements/minimum-training-standards-telecommunicators/ .

[33] North Carolina Department of Justice, “Minimum Training Standards: Telecommunicators.”

[34] Pew Charitable Trusts, “911 Call Centers Lack Resources to Respond to Behavioral Health Crises,” 2021, https://www.pewtrusts.org/-/media/assets/2021/11/911-call-centers-lack-resources-to-handle-behavioral-health-crises.pdf .

[35] Bureau of Labor Statistics, “Outlook: Public Safety Telecommunicators.”

[36] ZipRecruiter, “Q: What Is the Average 911 Dispatcher Salary by State in 2021?,” accessed December 3, 2021, https://www.ziprecruiter.com/Salaries/What-Is-the-Average-911-Dispatcher-Salary-by-State .

[37] Bureau of Labor Statistics, “Outlook: Public Safety Telecommunicators.”

[38] APCO International, “Project RETAINS.”

[39] APCO International, “Project RETAINS.”

[40] RadioResource International, “Public Safety Groups Disappointed with OMB Decision not to Reclassify Telecommunicators,” November 29, 2017, https://www.rrmediagroup.com/News/NewsDetails/NewsID/16275/ .

[41] Andrea Fox, “House Passes 911 Dispatcher Reclassification,” Gov1, July 18, 2019, https://www.gov1.com/public-safety/articles/house-passes-911-dispatcher-reclassification-ZfQcPEwENt43G6m2/ .

[42] Laura French, “Legislators Reintroduce Bill to Change Job Classification of 911 Dispatchers Nationwide,” EMS1, April 1, 2021, https://www.ems1.com/communications-dispatch/articles/legislators-reintroduce-bill-to-change-job-classification-of-911-dispatchers-nationwide-ujPF8hi3WCbVIJcR/ .

[43] APCO International, “Project RETAINS.”

[44] Bo Brismar et al., “Training of Emergency Dispatch-Center Personnel in Sweden,”  Critical Care Medicine  12, no. 8 (1984): 679-680, https://doi.org/10.1097/00003246-198408000-00017 .

[45] Paul A. Calle et al., “Do Victims of an Out-of-Hospital Cardiac Arrest Benefit from a Training Program for Emergency Medical Dispatchers?,”  Resuscitation  35, no. 3 (1997): 213-218.

[46] Gardett et al., “Past, Present, and Future.”

[47] Lum et al., “Constrained Gatekeepers.”

[48] Jessica W. Gillooly, “‘Lights and Sirens:’ Variation in 911 Call‐Taker Risk Appraisal and its Effects on Police Officer Perceptions at the Scene,” Journal of Policy Analysis and Management (December 2021), https://doi.org/10.1002/pam.22369

[49] Gillooly, “Lights and Sirens.”

[50] Gillooly, “Lights and Sirens.”

[51] Zimmerman, “Talk and its Occasion.”

[52] Zimmerman, “Interactional Organization.”

[53] Gillooly, “Lights and Sirens.”

[54] Gillooly. “Police Encounters.”

[55] M.R. Whalen & D.H. Zimmerman, “Describing Trouble: Practical Epistemology in Citizen Calls to the Police,” Language in Society 19, no. 4, 465–492. doi:10.1017/S0047404500014779.

[56] Garcia and Parmer, “Misplaced Mistrust.”

[57] Michaela Flippin et al., “The Effect of Procedural Injustice During Emergency 911 Calls: A Factorial Vignette-based Study,” Journal of Experimental Criminology 15, no. 4 (2019): 651–660 https://doi.org/10.1007/s11292-019-09369-y ; Megan Quattlebaum, et al., “Principles of Procedurally Just Policing,” The Justice Collaboratory at Yale Law School, January, 2018, https://law.yale.edu/sites/default/files/area/center/justice/principles_of_procedurally_just_policing_report.pdf .

[58] Erik C. Cerbulis, “Job Attitudes of 911 Professionals: A Case Study of Turnover Intentions and Concerns Among Local Governments Throughout Central Florida,” Masters thesis, University of Central Florida (2001): 225. https://stars.library.ucf.edu/honorstheses1990-2015/225 .

[59] Michelle M. Lilly and Heather Pierce, “PTSD and Depressive Symptoms in 911 Telecommunicators: The Role of Peritraumatic Distress and World Assumptions in redicting risk,” Psychological Trauma: Theory, Research, Practice, and Policy 5 , no. 2 (2013): 135-141, https://doi.org/10.1037/a0026850 .

[60] Heather Pierce and Michelle M. Lilly, “Duty-related Trauma Exposure in 911 Telecommunicators: Considering the Risk for Posttraumatic Stress,” Journal of Traumatic Stres s 25, no. 2 (2012): 211-215. https://doi.org/10.1002/jts.21687 ;  Michelle M. Lilly and Christy E. Allen, “Psychological Inflexibility and Psychopathology in 9‐1‐1 Telecommunicators,” Journal of Traumatic Stress 28 , no. 3 (2015): 262-266.

[61] Dana Marie Dillard, “The Transactional Theory of Stress and Coping: Predicting Posttraumatic Distress in Telecommunicators,” PhD diss., Walden University (2019), https://scholarworks.waldenu.edu/dissertations/6719/ .

[62] Elizabeth Belmonte et al., “The Impact of 911 Telecommunications on Family and Social Interactions,” Gov1, February 5, 2020, https://www.gov1.com/emergency-management/articles/the-impact-of-911-telecommunications-on-family-and-social-interactions-t4fHEXWZMJCLfPdz/ .

[63] Troxell, “Indirect Exposure to Trauma.”

[64] Lilly and Allen, “Psychological Inflexibility;” Sandra L Ramey et al., “Evaluation of Stress Experienced By Emergency Telecommunications Personnel Employed in a Large Metropolitan Police Department,”  Workplace Health & Safety  65, no. 7 (2017): 287-294; Cheryl Regehr et al., “Predictors of Physiological Stress and Psychological Distress in Police Communicators,”  Police Practice and Research  14, no. 6 (2013): 451-463.

[65] Tod. W. Burke, “Dispatcher Stress and Job Satisfaction,” in Protect Your Life: A Health Handbook for Law Enforcement Professionals , ed. Davidson C. Umeh (Rockville: Looseleaf Law Publications, 1999), 79-86, https://www.ncjrs.gov/pdffiles1/Photocopy/143957NCJRS.pdf .

[66] Benjamin Trachik et al., “Is Dispatching to a Traffic Accident as Stressful as Being in One? Acute Stress Disorder, Secondary Traumatic Stress, and Occupational Burnout in 911 Emergency Dispatchers,” Annals of Emergency Dispatch & Response 3, No. 3 (2015): 27-38, https://www.aedrjournal.org/is-dispatching-to-a-traffic-accident-as-stressful-as-being-in-one-acute-stress-disorder-secondary-traumatic-stress-and-occupational-burnout-in-911-emergency-dispatchers .

[67] Malcolm J. Harrington, “Health Effects of Shift Work and Extended Hours of Work.”  Occupational and Environmental Medicine  58, no. 1 (2001): 68-72; Kate Sparks et al., “The Effects of Hours of Work on Health: a Meta‐Analytic Review,” Journal of Occupational and Organizational Psychology 70, no. 4 (1997): 391-408, https://doi.org/10.1111/j.2044-8325.1997.tb00656.x .

[68] Michelle M. Lilly et al., “Predictors of Obesity and Physical Health Complaints Among 911 Telecommunicators,”  Safety and Health at Work  7, no. 1 (2016): 55-62, https://doi.org/10.1016/j.shaw.2015.09.003 .

[69] Hendrika Meischke et al., “An Exploration of Sources, Symptoms and Buffers of Occupational Stress in 9-1-1 Emergency Call Centers,” Annals of Emergency Dispatch and Response 3, no. 2 (2015): 28-35, https://www.aedrjournal.org/an-exploration-of-sources-symptoms-and-buffers-of-occupational-stress-in-9-1-1-emergency-call-centers .

[70] Lilly et al., “Predictors of obesity;” Lilly and Pierce, “PTSD in 911 telecommunicators;” Pierce and Lilly, “Trauma Exposure in Telecommunicators.”

[71] Dillard, “Predicting Posttraumatic Distress in Telecommunicators.”

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Ex-assistant principal charged with child neglect in case of boy who shot teacher

The Associated Press

Signs stand outside Richneck Elementary School in Newport News, Va., Jan. 25, 2023. Denise Lavoie/AP hide caption

Signs stand outside Richneck Elementary School in Newport News, Va., Jan. 25, 2023.

NEWPORT NEWS, Va. — A former assistant principal at a Virginia elementary school has been charged with felony child neglect more than a year after a 6-year-old boy brought a gun to class and shot his first-grade teacher .

A special grand jury in Newport News found that Ebony Parker showed a reckless disregard for the lives of Richneck Elementary School students on Jan. 6, 2023, according to indictments unsealed Tuesday.

Parker and other school officials already face a $40 million negligence lawsuit from the teacher who was shot, Abby Zwerner. She accuses Parker and others of ignoring multiple warnings the boy had a gun and was in a "violent mood" the day of the shooting.

Criminal charges against school officials following a school shootings are quite rare, experts say. Parker, 39, faces eight felony counts, each of which is punishable by up to five years in prison.

The Associated Press left a message seeking comment Tuesday with Parker's attorney, Curtis Rogers.

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Court documents filed Tuesday reveal little about the criminal case against Parker, listing only the counts and a description of the felony charge. It alleges that Parker "did commit a willful act or omission in the care of such students, in a manner so gross, wanton and culpable as to show a reckless disregard for human life."

Newport News police have said the student who shot Zwerner retrieved his mother's handgun from atop a dresser at home and brought the weapon to school concealed in a backpack.

Zwerner's lawsuit describes a series of warnings that school employees gave administrators before the shooting. The lawsuit said those warnings began with Zwerner telling Parker that the boy "was in a violent mood," had threatened to beat up a kindergartener and stared down a security officer in the lunchroom.

The lawsuit alleges that Parker "had no response, refusing even to look up" when Zwerner expressed her concerns.

When concerns were raised that the child may have transferred the gun from his backpack to his pocket, Parker said his "pockets were too small to hold a handgun and did nothing," the lawsuit states.

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A guidance counselor also asked Parker for permission to search the boy, but Parker forbade him, "and stated that John Doe's mother would be arriving soon to pick him up," the lawsuit stated.

Zwerner was sitting at a reading table in front of the class when the boy fired the gun, police said. The bullet struck Zwerner's hand and then her chest, collapsing one of her lungs. She spent nearly two weeks in the hospital and has endured multiple surgeries as well as ongoing emotional trauma, according to her lawsuit.

Parker and the lawsuit's other defendants, which include a former superintendent and the Newport News school board, have tried to block Zwerner's lawsuit.

They've argued that Zwerner's injuries fall under Virginia's workers' compensation law. Their arguments have been unsuccessful so far in blocking the litigation. A trial date for Zwerner's lawsuit is slated for January.

Prosecutors had said a year ago that they were investigating whether the "actions or omissions" of any school employees could lead to criminal charges.

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Howard Gwynn, the commonwealth's attorney in Newport News, said in April 2023 that he had petitioned a special grand jury to probe if any "security failures" contributed to the shooting. Gwynn wrote that an investigation could also lead to recommendations "in the hopes that such a situation never occurs again."

It is not the first school shooting to spark a criminal investigation into school officials. For instance, a former school resource officer was acquitted of all charges last year after he was accused of hiding during the Parkland school massacre in 2018.

Chuck Vergon, a professor of educational law and policy at the University of Michigan-Flint, told The AP last year that it is rare for a teacher or school official to be charged in a school shooting because allegations of criminal negligence can be difficult to prove.

More often, he said, those impacted by school shootings seek to hold school officials liable in civil court.

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