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Continuous HRV analysis of HEMS emergency physicians to specify the work load over the different working days

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Abstract

Introduction

Up to date, there has been little research about the acute stress load of emergency physicians of the Helicopter Emergency Medical Service (HEMS). Therefore, this study investigates the physiological stress level between an air-rescue day, a clinic day, and a day off (control day). Furthermore, phases of activity and resting were compared to assess the activity of the autonomic nervous system (ANS).

Methods

In this field study (within-subjects design), heart rate variability (HRV) and self-perceived stress levels were monitored on an air-rescue day, a clinic day, and a control day of 20 HEMS EPs [three females, 17 males; age: mean (M) = 44.95, standard deviation (SD) = 4.80].

Results

When comparing the activity phases, significant differences were found for HR and HRV. The highest HR was found on the air-rescue day during the phase of landing at the operation site with M = 107.30 bpm (SD = 22.66 bpm), which was significantly higher than during activity phases of the clinic day (M = 88.28 bpm, SD = 11.81 bpm) and the control day (M = 83.28 bpm, SD = 14.83 bpm). The SDNN is significantly higher on the air-rescue day for the phase before the alarm (M = 72.23 ms, SD = 38.60 ms), the phase of the alarm (M = 77.52 ms, SD = 40.52 ms), and the average of all phases (M = 60.04 ms, SD = 34.07 ms) than on the clinic day (M = 38.42 ms, SD = 15.16 ms) and the control day, where the lowest value was reached (M = 39.11 ms, SD = 17.65 ms). The highest LF/HF was found during activity phases of the clinic day with M = 1281.84% (SD = 587.33%), which was significantly higher than the first five phases of the emergency operations and the average of all phases of the emergency operations of the air-rescue day, where a maximum of M = 896.57 ms (SD = 681.79 ms) during the phase before the alarm and a minimum of M = 764.69 ms (SD = 372.28 ms) during the phase of landing at the operation site. The lowest LF/HF for all testing days was found during the activity phases of the control day with M = 693.74% (SD = 404.73%). Overall, 60 observations were analyzed. In the psychological assessment, on average, the EPs shows lower values than the norm sample.

Discussion

In the comparison of the activity phases, significant effects were found on the clinic day and during the phases of the emergency operations of the air-rescue day for the HR and HRV. Hereby, a significant activation of the EPs ANS and an outweigh of the sympathetic nervous system could be shown, whereby the subjective stress load was reported mainly as low. For the resting phases, no significant differences were found between all testing days. We interpret this as a good sign for the ability of regeneration between the phases of high stress load.

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Abbreviations

ANS:

Autonomic nervous system

BMI:

Body mass index

df :

Degrees of freedom

DRF:

Deutsche Rettungsflugwacht [German Air Rescue Organization]

EP:

Emergency physician

ESC:

European Society of Cardiology

F :

Variation between sample means/variation within the samples

GSI:

Global severity index

HEMS:

Helicopter emergency medical services

HRV:

Heart rate variability

HR:

Heart rate

LF/HF:

Low–high frequency ratio

M :

Mean value

NASPE:

The North American Society of Pacing and Electrophysiology

PASA:

Primary appraisal secondary appraisal

PSDI:

Positive symptom distress index

PST:

Positive symptom total

p :

p value or calculated probability

RMSSD:

Root mean square successive differences

SCL-90-R:

Symptom Checklist-90-Revised

SD:

Standard deviation

SDNN:

Standard deviation of all NN intervals

TICS:

Trier inventory of chronic stress

USA:

United States of America

VAS:

Visual analog scale

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Authors and Affiliations

  1. Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine Mainz, Duesbergweg 6, 55128, Mainz, Germany

    Christian Schöniger, Benedict Herhaus & Katja Petrowski

  2. Clinic for Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Christian Schöniger, Martin Siepmann & Katja Petrowski

  3. Department of Trauma and Orthopedic Surgery, Elbland Hospital Radebeul, Heinrich-Zille-Str. 13, 01445, Radebeul, Germany

    Jaroslaw Pyrc

  4. University Center for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, 01307, Dresden, Germany

    Jaroslaw Pyrc

Authors
  1. Christian Schöniger
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  2. Jaroslaw Pyrc
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  3. Martin Siepmann
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  4. Benedict Herhaus
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  5. Katja Petrowski
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Contributions

CS and KP designed the study and tested the measuring devices. The recruitment was conducted by JP. The measurement and data entry was performed by CS. The statistical analysis was carried by CS, KP and BH. The manuscript was drafted by CS and KP. All the authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Christian Schöniger.

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The authors declare no conflicts of interest, financial or otherwise.

Ethical standards

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Ethics Committee of the Medical Faculty of the Technical University of Dresden, Germany (study protocol No #EK348092011) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Schöniger, C., Pyrc, J., Siepmann, M. et al. Continuous HRV analysis of HEMS emergency physicians to specify the work load over the different working days. Int Arch Occup Environ Health 93, 525–533 (2020). https://doi.org/10.1007/s00420-019-01507-3

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