Abstract
Purpose
The occupation of the emergency physicians (EPs) of helicopter emergency medical services (HEMS) can be characterized as a high-strain occupation (Karasek in Adm Sci Q 24(2):285–308. https://doi.org/10.2307/2392498, 1979). Therefore, the aim of this study was to measure and compare the stress load of the EPs of HEMS on duty on air ambulance workdays and on 2 control days.
Methods
In this field study (within-subjects design), hormonal, physiological, and self-perceived stress levels of 20 EPs [3 females, 17 males; mean age (M) = 44.95 years, SD = 4.80, 95% confidence interval (CI) (42.71, 47.19)] of HEMS, were recorded on different test days. Measurements of the cortisol awakening response (CAR) and the heart rate variability (HRV) were performed while on duty on the air ambulance and during workdays at the outpatient clinic as well as at home on days of rest.
Results
There were significant differences in the CAR (area under the curve with respect to ground F(2,38) = 12.81, p < 0.001) between the 3 test days with the highest values on the workday at the outpatient clinic [M = 81.24; 98.75% CI (61.24, 101.24)] and not on the air ambulance day [M = 61.82; 98.75% CI (45.18, 78.46)] or on the day of rest [M = 52.96; 98.75% CI (38.17, 67.76)]. In addition, the HRV parameter SDNN [F(2,38) = 6.369; p = 0.004] presented significant differences between the 3 test days with lower levels on the day at the outpatient clinic [M = 101.44; 98.75% CI (83.50, 119.38)] in contrast to the air ambulance day [M = 120.16; 98.75% CI (100.02, 140.30)] and to the resting day [M = 123.79; 98.75% CI (106.49, 141.10)]. Furthermore, there were significant differences in the HRV parameter LF/HF [F(2,38) = 6.215; p = 0.005] between the 3 testing days with the highest values on the workday at the outpatient clinic [M = 8.69; 98.75% CI (6.29, 11.09)] compared to the air ambulance day [M = 6.54; 98.75% CI (4.50, 8.57)] and the day of rest [M = 6.43; 98.75% CI (4.57, 8.29)].
Conclusions
Compared with the standard values and previous studies, EPs of HEMS have an increase in hormonal reactivity in the morning and a lack of recovery of the ANS. It can be concluded that—with respect to the psychobiological stress model by McEwen and Lasley (The end of stress as we know it, National Academic Press, Washington, 2003)—work-related stressors persist too long or the stress response is exaggerated (allostatic load) due to chronic stress induction and lack of recovery.
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Abbreviations
- ANS:
-
Autonomic nervous system
- AUC:
-
Area under the curve
- AUCG :
-
Area under the curve with respect to ground
- AUCI :
-
Area under the curve with respect to increase
- CAR:
-
Cortisol awakening response
- EPs:
-
Emergency physicians
- ESC:
-
The European Society of Cardiology
- HEMS:
-
Helicopter emergency medical services
- HF:
-
Power in high-frequency range 0.15–0.4 Hz
- Hf:
-
Heart frequency
- HRV:
-
Heart rate variability
- HPA-axis:
-
Hypothalamic–pituitary–adrenal-axis
- LF:
-
Power in low-frequency range 0.04–0.15 Hz
- LIA:
-
Luminescence immunoassay
- M:
-
Mean value
- NASPE:
-
The North American Society of Pacing and Electrophysiology
- ISPNE:
-
International Society of Psycho-neuroendocrinology
- PASA:
-
Primary appraisal secondary appraisal
- RMSSD:
-
Root-mean-square successive differences
- SDNN:
-
Standard deviation of all NN intervals
- TICS:
-
Trier Inventory of Chronic Stress
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Funding
This study was funded by the Roland Ernst Foundation Project “Identification of stressors due to organizational structures in airborne and ground-based emergency service”.
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The study protocol was approved by the local Ethics Committee of the Medical Faculty of the Technical University of Dresden, Germany (No#EK348092011).
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Petrowski, K., Herhaus, B., Schöniger, C. et al. Stress load of emergency service: effects on the CAR and HRV of HEMS emergency physicians on different working days (N = 20). Int Arch Occup Environ Health 92, 155–164 (2019). https://doi.org/10.1007/s00420-018-1362-z
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DOI: https://doi.org/10.1007/s00420-018-1362-z