Carried out by a research team from Quebec, Canada, this paper outlines the findings from a literature review of publications regarding the impact of emergency work on pre-hospital practitioners' health.
During a literature search on MEDLINE (Ovid, Pubmed, National Library of Medicine), 48 relevant articles published between 2000 and 2011 were identified. The authors applied specific inclusion and exclusion criteria to the retrieved papers and, ultimately, 25 studies were examined within this literature review.
The review draws upon research into emergency services across the globe, including Australia, Scandinavia, the US, UK, Germany, Hungary and Japan among others. Numbers of participants in the individual studies vary from 9 to 5567. Usefully, the titles and a synopsis of each of the 25 articles are presented.
In truth, all the papers would be worthy of reading in their own right. However the literature review removes this burden from time-pressed paramedics and synthesises the research.
The authors highlight two broad areas that can produce stressors in paramedic work. First, organisational issues such as the everyday stress of workload; pressure to achieve response times; rotating shift patterns; variable waiting times between calls.
Second, the psychosocial demands including exposure to traumatic events; caring for a dependent population; or managing the general public who themselves maybe in a stressed state at the time of the call.
Occupational stress is defined as when the requirements of the job overload the worker's adaptation capabilities. Exposure to stressors can stimulate an autonomic nervous system response with associated release of hormones such as cortisol, adrenaline (epinephrine) and noradrenaline (norepinephrine). Some studies reported that ambulance workers complaining of physical and emotional problems had elevated levels of cortisol in their bloodstream which in turn places physiological stress on their bodies.
The authors categorize the consequences of stress into: post traumatic stress disorder (PTSD), sleep problems, eating behaviours/obesity, and cardiovascular (CV) disease.
Some thought-provoking figures are revealed such as 20 % of emergency workers suffer symptoms of PTSD as opposed to 5 % of the general population. Consequences of PTSD were identified as compromised immune system, impaired social functioning and higher rates of depression.
There is a suggestion within the broader literature that risk of PTSD increases if sleep disturbances occur soon after trauma exposure. Following a traumatic event over 80% of workers report sleep difficulties immediately afterwards, with 70% in the same situation six months later. Despite extensive literature on the effects of shiftwork and the health of other workers, this paper highlights there is very little research around this topic pertaining to paramedics.
The authors point out that although several studies identify high prevalence of obesity in firefighters, there is little available evidence pertaining to ambulance staff. However readers are reminded that a combination of shift work, occupational stress and sleeping problems could contribute to obesity and physical inactivity which are increased risk factors for cardiovascular disease.
One study found that in a group of 85 paramedics, 48% of its participants self-reported high level risk for cardiovascular disease.
The authors conclude that more studies are needed to characterise the behaviour and health status of ambulance crews at work. With more knowledge, strategies could be developed to promote wellbeing and prevent health problems in the working population.
Although the review includes international research, it is relevant to the pre-hospital community in the UK. Currently, there are large gaps in the literature on emergency healthcare workers' health in the UK. Although studies have been carried out into the nature of healthcare labour and its impact on the wellbeing of staff in a variety of professions, the everyday work of ambulance crews comes with its own set of unique challenges and research into its impact on the health of paramedics, emergency medical technicians and support workers is long overdue. But who will step up, or should that be, step away from the plate?