A follow-up report of occupational stress in urban EMT-paramedics

Diversity, Equity, and Inclusion in the United States Emergency Medical Services Workforce: A Scoping Review

OBJECTIVE

Emergency medical services (EMS) workforce demographics in the United States do not reflect the diversity of the population served. Despite some efforts by professional organizations to create a more representative workforce, little has changed in the last decade. This scoping review aims to summarize existing literature on the demographic composition, recruitment, retention, and workplace experience of underrepresented groups within EMS.

METHODS

Peer-reviewed studies were obtained from a search of PubMed, CINAHL, Web of Science, ProQuest Thesis and Dissertations, and non-peer-reviewed ("gray") literature from 1960 to present. Abstracts and included full-text articles were screened by two independent reviewers trained on inclusion/exclusion criteria. Studies were included if they pertained to the demographics, training, hiring, retention, promotion, compensation, or workplace experience of underrepresented groups in United States EMS by race, ethnicity, sexual orientation, or gender. Studies of non-EMS fire department activities were excluded. Disputes were resolved by two authors. A single reviewer screened the gray literature. Data extraction was performed using a standardized electronic form. Results were summarized qualitatively.

RESULTS

We identified 87 relevant full-text articles from the peer-reviewed literature and 250 items of gray literature. Primary themes emerging from peer-reviewed literature included workplace experience (n = 48), demographics (n = 12), workforce entry and exit (n = 8), education and testing (n = 7), compensation and benefits (n = 5), and leadership, mentorship, and promotion (n = 4). Most articles focused on sex/gender comparisons (65/87, 75%), followed by race/ethnicity comparisons (42/87, 48%). Few articles examined sexual orientation (3/87, 3%). One study focused on telecommunicators and three included EMS physicians. Most studies (n = 60, 69%) were published in the last decade. In the gray literature, media articles (216/250, 86%) demonstrated significant industry discourse surrounding these primary themes.

CONCLUSIONS

Existing EMS workforce research demonstrates continued underrepresentation of women and non-White personnel. Additionally, these studies raise concerns for pervasive negative workplace experiences including sexual harassment and factors that negatively affect recruitment and retention, including bias in candidate testing, a gender pay gap, and unequal promotion opportunities. Additional research is needed to elucidate recruitment and retention program efficacy, the demographic composition of EMS leadership, and the prevalence of racial harassment and discrimination in this workforce.

Determinants of Stress, Depression, Quality of Life, and Intent to Leave in Washington State Emergency Medical Technicians During COVID-19

OBJECTIVES

This study characterizes determinants of stress, depression, quality of life, and intent to leave among emergency medical technicians (EMTs) in the Puget Sound region, Washington, during the COVID-19 pandemic and identifies areas for intervention on these outcomes.

METHODS

A cross-sectional survey measured stress, depression, quality of life, and intent to leave among EMTs ( N = 123). Regression models were developed for these outcomes.

RESULTS

A total of 23.8% of respondents were very likely to leave their position in the next 6 months. Job demands predicted stress and depression, and financial security predicted stress and quality of life. Intent to leave was predicted by stress, manager support, and length of employment.

CONCLUSIONS

Increased exposure to hazards has impacted EMT mental health. Emergency medical technicians are vital to healthcare, so improving EMT health and well-being is important, as attrition during a pandemic could impact public health.

Examining the quality of work-life of paramedics in northern Ontario, Canada: A cross-sectional study

BACKGROUND: Paramedics are exposed to multiple stressors in the workplace. They are more likely to develop occupational-related stress conditions compared to other occupations. This study focused on understanding the factors affecting QoWL of paramedics in northern Ontario, Canada; a particular focus was on understanding the personal and organizational factors, such as practicing community paramedicine (CP), which may be associated with Quality of Work Life (QoWL). METHODS: Paramedic QoWL was assessed using an online survey that was distributed to approximately 879 paramedics across northern Ontario. The survey included the 23-Item Work- Related Quality of Work Life Scale. Data analysis involved linear regressions with nine predictor variables deemed to be related to QoWL for paramedics with QoWL and its six subscales as dependent variables. Multiple linear regressions were used to assess the personal and organizational factors, such as practicing of CP, which predicted QoWL. RESULTS: One hundred and ninety-seven paramedics completed the questionnaire. Overall, the mean QoWL score of all paramedic participants was 73.99, and this average compared to relevant published norms for other occupations. Factors that were most associated with higher QoWL were, experience practicing CP (p < 0.05), number of sick days/year (p < 0.01), and higher self- rated mental health (p < 0.001). CONCLUSIONS: Higher paramedic QoWL appears to be associated with many factors such as number of sick days per year, self-rated mental health, and participation in CP. EMS organizations should consider establishing necessary workplace health promotion strategies that are targeted at improving QoWL for paramedics.

How do paramedics and student paramedics cope? A cross-sectional study

Despite threats to wellbeing inherent in paramedicine, little is known about how paramedics cope. This study explored the breadth of healthy and unhealthy coping strategies used by paramedics and student paramedics. A convenience sample of 198 paramedics and student paramedics completed an online survey. Wellbeing was measured using WHO-5 and coping using the Coping Index. Primary outcomes were summarised using descriptive statistics. Most of the sample had wellbeing (68%); student paramedics had significantly better wellbeing than paramedics. There was no significant difference between paramedics and student paramedics on healthy or unhealthy coping. Participants with ill-being had significantly fewer healthy and more unhealthy coping strategies than those with wellbeing, and relatively few used professional support (28%). Internationally, few studies have reported coping strategies in paramedics. This study expands our understanding of healthy and unhealthy coping strategies used by paramedics and student paramedics. The results support research that shows paramedic work affects wellbeing, however not that paramedics are at greater risk of unhealthy coping than students or the general population. The results have implications for both the prevention of overwhelming distress in the workplace and the need to increase the use of professional support to prevent unhealthy coping, including suicidality.

The Impact of Virtual Reality Exposure on Stress Level and Sense of Competence in Ambulance Workers

Virtual reality (VR) exposure is used in clinical psychology to treat anxiety disorders. It is also used to enhance resilience in soldiers by allowing them to confront virtual combat environments to help fortify them against the negative consequences of trauma exposure. Most VR studies have focused on military and emergency medical staff; however, thus far, none have investigated VR in ambulance workers (AWs), who are confronted with traumatic situations daily. The current study aimed to assess the impact of a single VR exposure session on self-perceived competence and stress level in a sample of AWs. Participants (N = 40) were randomly assigned to either a VR immersion (i.e., experimental group, n = 20) or an audio immersion (i.e., control group, n = 20) of a shooting attack situation. We hypothesized that compared to controls, VR participants would report decreased anxiety, as measured using visual analog scales, as well as an increased sense of competence. The results showed a significant reduction in fear in both groups, d = 0.33, and an increased sense of competence in VR participants, d = 0.35. Although our hypotheses were only partially confirmed, the observed beneficial effects of VR and the audio immersion on stress levels in AWs suggest that VR exposure could be a useful way to increase resilience in AWs.

112 Ambulans Çalışanlarının Hizmet ve Sosyal Durumlarının Değerlendirilmesi

Aim: 112 Emergency Health Services (EHS) is crucial for preventing deaths and injuries with early intervention and has significant impacts on survival. Many factors like shift working, occupational dissatisfaction, safety concern, and stress adversely affect 112 EHS workers. This study aimed to evaluate working conditions, expectations, job satisfaction, service and social conditions of 112 EHS staff working in the city of XX, to determine the difficulties they face and to provide suggestions for more efficient working condition. Method: This study was conducted with health workers working at 112 EHS in the city of XX. A survey form was developed to investigate their service and social conditions. It was converted into an electronic survey consisting of 29 questions via Google Forms. 252 health workers participated in study by filling the electronic survey. Results: The most important factors affecting the job performance of workers were job satisfaction/respect and the level of salary. Workers reported the majority of the cases encountered during a 24-hour shift were green zone patients.The average arrival time to the cases and the delivery time of the patients to the hospital are mostly within 0-10 minutes. Emergency room physician's approach and the lack of allied health personnel were the most common problems during patients' delivery to hospital. Most workers stated that protective measures on occupational safety in the EHS were insufficient and that they were subjected to physical assault. Conclusion: As a result of our study, it was determined that 112 employees experienced job dissatisfaction.The reasons for this situation are the level of salary, lack of dignity, fear of security.However, there are some deficiencies regarding the use and organization of 112 emergency health services. It is necessary to immediately improve 112 EHS workers’ working conditions and the coordination of EHS.

Social Prestige of the Paramedic Profession

Background: There is a lack of research on social image, prestige, and the position of the paramedic profession in the social structure. The main objective of the study was to determine the place of the paramedic profession in the hierarchy of prestige of professions as viewed by the public. In operationalizing the term ‘prestige’, we deemed the word ‘respect’ to best fit the sense of the subjective evaluation of prestige with regard to a profession. Material and methods: The data comes from cross-sectional survey-based research. The research was carried out on a group of 600 people over 18 years of age. The sample was of a random nature, and the selection of respondents was calculated on the basis of them being representative of the Polish population. Results: The median of respect declared for the paramedic profession, on a scale of 1 to 5, was 4.49, which placed the profession in fourth place in the ranking. The assessment of respect for paramedics among other medical professions placed them in third place, directly after doctors and midwifes. Conclusions: The profession of paramedic is characterized by high social prestige, locating it at the forefront of the medical profession and other examined professions, but its social position, expressed by objective measures (earnings, structural possibilities, social power), is significantly lower.

Alcohol/substance use and occupational/post-traumatic stress in paramedics

Background:

Paramedics work in high-pressure environments and experience traumatic events, which contribute to high levels of occupational and post-traumatic stress. Such stress can result in alcohol and substance misuse in other health professionals, but this relationship has not been examined in paramedics. This review is the first exploration of the literature on this.

Methods:

A systematic literature review was conducted using PRISMA guidelines, with databases searched using terms relevant to paramedics and alcohol/substance use. Studies were analysed using descriptive statistics for quantitative data and thematic analysis for qualitative information.

Findings:

Eleven studies were identified. Nine studies examined alcohol use; seven examined substance use; five examined both. Alcohol and smoking may be linked to occupational stress.

Conclusions:

The nature and extent of alcohol and substance use in relation to occupational and post-traumatic stress among paramedics need further investigation to facilitate advice and support.

Psychosocial risk and protective factors for the health and well-being of professionals working in emergency and non-emergency medical transport services, identified via questionnaires

Background

Medical transport (MT) professionals are subject to considerable emotional demands due to their involvement in life-or-death situations and their exposure to the serious health problems of their clients. An increase in the demand for MT services has, in turn, increased interest in the study of the psychosocial risk factors affecting the health of workers in this sector. However, research thus far has not distinguished between emergency (EMT) and non-emergency (non-EMT) services, nor between the sexes. Furthermore, little emphasis has been placed on the protective factors involved. The main objective of the present study is to identify any existing differential exposure – for reasons of work setting (EMT and non-EMT) or of gender – to the various psychosocial risk and protective factors affecting the health of MT workers.

Methods

Descriptive and transversal research with responses from 201 professionals.

Results

The scores obtained on the various psychosocial scales in our study – as indicators of future health problems – were more unfavourable for non-EMT workers than they were for EMT workers. Work setting, but not gender, was able to account for these differences.

Discussion

The scores obtained for the different psychosocial factors are generally more favourable for the professionals we surveyed than those obtained in previous samples.

Conclusion

The significant differences observed between EMT and non-EMT personnel raise important questions regarding the organization of work in companies that carry out both services at the same time in the same territory. The relationships among the set of risk/protective factors suggests a need for further investigation into working conditions as well as a consideration of the workers’ sense of coherence and subjective well-being as protective factors against occupational burnout syndrome.

Compensation of Emergency Medical Technician (EMT)-Basics and Paramedics

Objectives

The objective of this paper is to identify factors associated with compensation for Emergency Medical Technician (EMT)-Basics and Paramedics and assess whether these associations have changed over the period 1999-2008.

Methods

Data obtained from the Longitudinal EMT Attributes and Demographic Study (LEADS) surveys, a mail survey of a random, stratified sample of nationally certified EMT-Basics and Paramedics, were analyzed. For the 1999-2003 period, analyses included all respondents providing Emergency Medical Services (EMS). With the addition of a survey in 2004 about volunteers, it was possible to exclude volunteers from these analyses.

Results

Over 60% of EMT-Basics reported being either compensated or noncompensated volunteers in the 2004-2008 period. This was substantially and significantly greater than the proportion of EMT-Paramedic volunteers (<25%). The EMT-Paramedics earned significantly more than EMT-Basics, with differentials of $11,000-$18,000 over the course of the study. The major source of earnings disparity was type of organization: respondents employed by fire-based EMS agencies reported significantly higher earnings than other respondents, at both the EMT-Basic and EMT-Paramedic levels. Males also earned significantly more than females, with annual earnings differentials ranging from $7,000 to $15,000.

Conclusions

There are a number of factors associated with compensation disparities within the EMS profession. These include type of service (ie, fire-based vs. other types of agencies) and gender. The reasons for these disparities warrant further investigation.

StudnekJR. Compensation of Emergency Medical Technician (EMT)-Basics and Paramedics. Prehosp Disaster Med. 2016;31(Suppl. 1):s87–s95.

Relationship Between Low Back Pain With Quality of Life, Depression, Anxiety and Stress Among Emergency Medical Technicians

Background:

Musculoskeletal disorders have become increasingly common among healthcare providers. They have become the most common cause of work-related disabilities among nurses.

Objectives:

The current cross-sectional study aimed to measure the prevalence of back pains among emergency medical technicians (EMTs), and association of back pain with quality of life, depression, anxiety and stress.

Materials and Methods:

One hundred and eighty registered nurses working as EMTs at the Hamadan Emergency Medical Center were selected by consensus. Data collection tools were Demographic, Perceived Quality-of-Life, Short Form Health Survey (SF-36), and Depression Anxiety Stress Scales (DAS21) and pain scale measurements.

Results:

Data showed that while 50.7% of the participants had an average awareness of the basic principles of back care, the majority (71.8%) had at least one type of back pain. There were associations between the prevalence of pain and depression (P = 0.049), pain and awareness (P = 0.035), and stress and job satisfaction (P = 0.024).

Conclusions:

A large number (about two-thirds) of EMTs had some sort of back pain; it is highly recommended to promote the attitude and motivation of the individuals to take care to prevent back injury and inform them of the principles of back care. Implications for primary prevention and care practice include encouraging EMTs to apply accurate principles of back care.

Providers' HIV-related avoidance attitude and patient satisfaction

OBJECTIVES

This article explores the associations between medical care providers' attitudes towards patients living with HIV (PLH) and the service satisfaction reported from general patients.

METHODS

Data were collected from 40 county-level hospitals in China, including 1760 service providers and 1000 patients receiving medical services from the hospitals. Provider and patient assessments were conducted by self-administered questionnaires and face-to-face interviews, respectively. Random-effect regression models were used to examine relationships between the providers' avoidance attitudes and patient satisfaction at the hospital level while taking into account variations in demographics and professional experience within each hospital.

RESULTS AND CONCLUSIONS

Service providers' avoidance attitudes towards PLH were negatively associated with general patients' satisfaction with service providers at the hospital level. The relationship was strong and significant whether or not adjustments were made for background characteristics. Medical care providers' stigmatizing attitudes towards PLH could be a reflection of the providers' general outlook with all patients. This study underscores a broader focus for HIV-related stigma reduction interventions in medical settings at both individual and institutional levels, targeting attitudes towards both patients with HIV/AIDS and the general patient population.

Physical and psychosocial work environment factors and their association with health outcomes in Danish ambulance personnel - a cross-sectional study

BACKGROUND

Reviews of the literature on the health and work environment of ambulance personnel have indicated an increased risk of work-related health problems in this occupation. The aim of this study was to compare health status and exposure to different work environmental factors among ambulance personnel and the core work force in Denmark. In addition, to examine the association between physical and psychosocial work environment factors and different measures of health among ambulance personnel.

METHODS

Data were taken from a nationwide sample of ambulance personnel and fire fighters (n = 1,691) and was compared to reference samples of the Danish work force. The questionnaire contained measures of physical and psychosocial work environment as well as measures of musculoskeletal pain, mental health, self-rated health and sleep quality.

RESULTS

Ambulance personnel have half the prevalence of poor self-rated health compared to the core work force (5% vs. 10%). Levels of mental health were the same across the two samples whereas a substantially higher proportion of the ambulance personnel reported musculoskeletal pain (42% vs. 29%). The ambulance personnel had higher levels of emotional demands and meaningfulness of and commitment to work, and substantially lower levels of quantitative demands and influence at work. Only one out of ten aspects of physical work environment was consistently associated with higher levels of musculoskeletal pain. Emotional demands was the only psychosocial work factor that was associated with both poorer mental health and worse sleep quality.

CONCLUSIONS

Ambulance personnel have similar levels of mental health but substantially higher levels of musculoskeletal pain than the work force in general. They are more exposed to emotional demands and these demands are associated with higher levels of poor mental health and poor sleep quality. To improve work environment, attention should be paid to musculoskeletal problems and the presence of positive organizational support mechanisms that can prevent negative effects from the high levels of emotional demands.

Occupational Stress among Japanese Emergency Medical Technicians: Hyogo Prefecture

Introduction:

As prehospital care became emphasized in emergency medical services in Japan, qualification as a “paramedic” was established in 1991 as a requirement for national qualification as a emergency medical technician (EMT).With recent increases in emergency transportation, the responsibilities of paramedics have become more complex and demand a higher level of competency; however, no method of evaluating occupational stress among Japanese EMTs currently exists.

Methods:

A questionnaire survey of the working conditions and health of 2,017 EMTs in Hyogo Prefecture was conducted. To analyze stress levels among these EMTs, the survey was divided into two categories: (1) physical stress; and (2) mental stress.

Results:

The number of responses was 1,551 (76.9%) and the average age of the respondents was 35.4 years. The lower back, neck, and shoulders were most frequently subjected to physical stress, which was related to the daily operations as an EMT. Mental stress was reported more frequently by those who were older or qualified paramedics.

Discussion:

The high frequency of lower back pain suggests the need for improvement in the work environment and periodic education.

Conclusions:

Although job satisfaction among paramedics was high, they were exposed to greater mental stress. Therefore, systematic management of stress must be developed and established.

Survey of Emergency Medical Technicians' Ability to Cope with the Deaths of Patients During Prehospital Care

Hypothesis:

Emergency medical technicians (EMTs) find that the death of patients in their care is stressful.

Population:

Random sample of certified EMTs in one state (Levels I–IV).

Methods:

A blinded, self-administered survey was sent to a random sample of 2,500 EMTs. Demographic data obtained were: level of training; hours worked each month; population of area served; age; gender; number of deaths per year; training for coping prehospital deaths; and availability of protocols and on-line medical advice for out-of-hospital deaths. A five-point, Likert scale was used to rate the frequency of perceived stress experienced by EMTs in specific situations and the routine practice for notification of survivors. Univariable analysis was performed using Spearman's Rank correlation, Kruskal-Wallis test, and Mann-Whitney U-test. Multivariable correlations were performed using forward and backward step-wise logistic regression analysis. A significance level of 0.05 was used throughout.

Results:

There were 654 respondents with a mean age of 35.5±8.3 yr; 83% were men. Their highest level of training was: 4% EMT-I, 43% EMT-II, 18% EMT-III, 33% EMT-IV. They saw an average of 9.6 deaths/year and spent an average of 20±17 minutes with survivors. 62 % found treatment of a patient that was dying or died in their care was commonly a stressful experience. Factors that made notification of the family about the prehospital death emotionally difficult included: fewer hours worked/month; working in a smaller community; lower level of EMT training; female gender; and fewer deaths seen during the previous year. The same factors were associated with general emotional difficulty in treatment of a patient who died during prehospital care. Online [direct] medical direction by physicians was common (73%), but did not lessen the difficulty of notification. It did reduce the emotional difficulty for specific clinical situations. Written protocols for not attempting resuscitation were common (66%), but only 44% had protocols for termination of resuscitation. Resuscitation of the clearly dead for the benefit of the family (10%) or for the EMT (5%) was practiced infrequently. Most (67%) respondents had some formal training in dealing with death and the dying patient. Such training did not correlate with less difficulty in notification of survivors or in coping with the deaths of patients in their care.

Conclusion:

EMTs perceive they have emotional difficulty when prehospital deaths occur and survivors must be notified. Less experience and a lower level of EMT training correlate with more difficulty in coping with patient death. Protocols and on-line [direct] medical control can provide support for the EMT in coping with out-of-hospital deaths. Most notification of survivors is handled by EMTs with formal training to cope with patients that are dying or who die during prehospital care.

Stress Levels in EMS Personnel: A National Survey

Objective:

The purpose of this study was to evaluate stress levels in emergency medical services personnel across the United States.

Design:

Confidential, 20-question survey tool, Medical Personnel Stress Survey-Abbreviated (MPSS-R). A total score of 50 indicates average stress levels. A score of 12.5 on the subset measurements of somatic distress, job dissatisfaction, organizational stress, and negative attitudes towards patients indicates average levels of stress. Data were analyzed using ANOVA and t-test.

Interventions:

None.

Results:

A total of 658 of 3,000 emergency medical technicians (EMTs) (22%) completed the survey. The mean value of 69.3±6.3 for the total stress scores was very high Mean values for the subset scores were: somatic distress = 19.6±3.3; organizational stress = 17.3±2.4; job dissatisfaction = 17.0±2.6; negative attitudes towards patients = 15.5±2.3. Characteristics predicting higher stress were EMT-basic (A) licensure, basic life support (BLS) only service provider, volunteer status, new employee working in a small EMS organization, and providing service to a small town.

Conclusion:

Stress levels in EMS personnel were very high, were manifested primarily as somatic distress, secondarily as organizational stress and job dissatisfaction, and lastly as negative patient attitudes. Stress levels and subset manifestations of occupational stress among EMS personnel varied depending on gender, marital status, age, level of training and function, on salaried or volunteer status, length of time as an EMT, and size of the organization, city, and population served. Care should be taken to address stresses peculiar to individual EMS system needs.

Predictors of Job Satisfaction Among Rural Emergency Medical Technicians

This study investigated the capacity of selected personal and work environment characteristics, in combination with occupational stress, to predict job satisfaction for 495 emergency medical technicians (EMTs) who provided emergency medical services in a rural area in the United States. Using data obtained during a three-year survey, multiple regression analysis identified work group cohesiveness and effective supervisory behavior as the best predictors of job satisfaction. The perceived level of occupational stress and years of experience as an EMT were inversely related to job satisfaction, but EMTs who responded to the survey as they were preparing to enroll in advanced training programs were more satisfied with their jobs than were other subgroups. These results suggest that job satisfaction can be enhanced by reinforcing cooperation and cohesiveness within EMS work groups, by establishing and maintaining effective communication networks between EMS administrators and EMTs, and by providing opportunities for professional growth and development for EMTs.

Evaluation of occupational injuries in an urban emergency medical services system before and after implementation of electrically powered stretchers

Musculoskeletal injuries are frequently reported among Emergency Medical Services (EMS) professionals. The objective of this study was to evaluate occupational injuries in an urban EMS system before and after implementation of hydraulic stretchers. Data for this analysis were obtained from Austin Travis County EMS (A/TCEMS). In December 2006, A/TCEMS placed into service electrically powered patient stretchers. The pre-intervention period was between 01/01/1999 and 12/31/2006, and the post-intervention period was between 01/01/2007 and 4/30/2008. Incidence rate calculations were performed for four injury sub-groups and rate ratios (RRs) and corresponding 95% confidence interval (CI) were presented. There were 2087 and 706 person-years of observation pre- and post-intervention, respectively. The incidence rates for overall injury pre-intervention and post-intervention were 61.1 and 28.8 per 100 FTE, with a corresponding RR of 0.47 (95% CI 0.41-0.55) indicating a significant decrease in the rate of injury. The subcategory of stretcher-related injuries had the lowest RR (0.30; 95% CI 0.17-0.52) when comparing pre- and post-intervention time periods.

A comparison of general and ambulance specific stressors: predictors of job satisfaction and health problems in a nationwide one-year follow-up study of Norwegian ambulance personnel

Objectives

To address the relative importance of general job-related stressors, ambulance specific stressors and individual characteristics in relation to job satisfaction and health complaints (emotional exhaustion, psychological distress and musculoskeletal pain) among ambulance personnel.

Materials and methods

A nationwide prospective questionnaire survey of ambulance personnel in operational duty at two time points (n = 1180 at baseline, T1 and n = 298 at one-year follow up, T2). The questionnaires included the Maslach Burnout Inventory, The Job Satisfaction Scale, Hopkins Symptom Checklist (SCL-10), Job Stress Survey, the Norwegian Ambulance Stress Survey and the Basic Character Inventory.

Results

Overall, 42 out of the possible 56 correlations between job stressors at T1 and job satisfaction and health complaints at T2 were statistically significant. Lower job satisfaction at T2 was predicted by frequency of lack of leader support and severity of challenging job tasks. Emotional exhaustion at T2 was predicted by neuroticism, frequency of lack of support from leader, time pressure, and physical demands. Adjusted for T1 levels, emotional exhaustion was predicted by neuroticism (beta = 0.15, p < .05) and time pressure (beta = 0.14, p < 0.01). Psychological distress at T2 was predicted by neuroticism and lack of co-worker support. Adjusted for T1 levels, psychological distress was predicted by neuroticism (beta = 0.12, p < .05). Musculoskeletal pain at T2 was predicted by, higher age, neuroticism, lack of co-worker support and severity of physical demands. Adjusted for T1 levels, musculoskeletal pain was predicted neuroticism, and severity of physical demands (beta = 0.12, p < .05).

Conclusions

Low job satisfaction at T2 was predicted by general work-related stressors, whereas health complaints at T2 were predicted by both general work-related stressors and ambulance specific stressors. The personality variable neuroticism predicted increased complaints across all health outcomes.

Occupational Injuries among Emergency Medical Services Personnel

BACKGROUND

Emergency medical services (EMS) personnel treat 22 million patients a year in the United States, yet little is known of their injury risks.

OBJECTIVES

To describe the epidemiology of occupational injuries among EMS personnel, calculate injury rates, and compare the findings with those for other occupational groups.

METHODS

This was a retrospective review of injury records kept by two urban agencies. The agencies submitted all 617 case reports for three periods between January 1, 1998, and July 15, 2002. The agency personnel worked an estimated 2,829,906 hours during the study periods. Cases were coded according to U.S. Department of Labor (DOL) criteria.

RESULTS

Four hundred eighty-nine cases met the DOL inclusion criteria. The overall injury rate was 34.6 per 100 full-time (FT) workers per year (95% confidence interval [CI] 31.5-37.6). "Sprains, strains, and tears" was the leading category of injury; the back was the body part most often injured. Of the 489 cases, 277 (57%) resulted in lost workdays, resulting in a rate of 19.6 (95% CI 17.3-21.9) per 100 FT workers; in comparison, the relative risks for EMS workers were 1.5 (95% CI 1.35-1.72) compared with firefighters, 5.8 (95% CI 5.12-6.49) compared with health services personnel, and 7.0 (95% CI 6.22-7.87) compared with the national average.

CONCLUSIONS

The injury rates for EMS workers are higher than rates reported by DOL for any industry in 2000. Funding and additional research are critical to further defining the high risks to EMS workers and developing interventions to mitigate this serious problem.

Occupational stressors and its organizational and individual correlates: a nationwide study of Norwegian ambulance personnel

Background

High levels of stress among ambulance personnel have been attributed to the conditions of ambulance work. However, there is little research to support this notion, and it has been questioned whether ambulance work is inherently stressful. We compared the severity and frequency level of organizational and ambulance-specific stressors, and studied their relationship to organizational conditions and individual differences

Methods

A comprehensive nationwide questionnaire survey of ambulance personnel (n = 1180) in operational duty. The questionnaire included the Job Stress Survey, the Norwegian Ambulance Stress Survey, the Basic Character Inventory, General Self-Efficacy Scale, and questions addressing organizational conditions.

Results

Serious operational tasks and physical demands were identified as the two most severe stressors. Lack of support from co-workers was the most severe and frequent organizational stressor. Higher frequency of stressors was most strongly associated with size of service districts (beta ranging between .18 and .30, p < .01) and working overtime (beta ranging from .13 to .27, p < .05). Stressor severity was related to lack of support after exposure to critical event (beta ranging from .11 to .24, p < .01) and working overtime. Neuroticism (beta ranging from .09 to .17, p < .01) and low general self-efficacy (beta ranging from -.12 to -.16, p < .001) were equally strongly related to severity of stressors, as were organizational conditions.

Conclusion

Ambulance-specific stressors were reported as both more severe and more frequently occurring stressors than were organizational stressors. Organizational working conditions were more strongly related to frequency of job stressors than were individual differences. In general, the relationship between occupational stressors and individual differences was weak.

Factors associated with back problems among emergency medical technicians

INTRODUCTION

Back problems are a common complaint among emergency medical technicians (EMTs). It is hypothesized that the likelihood of reporting back problems will be associated with the individual and work-related characteristics of a national sample of EMTs.

METHODS

A case-control analysis was performed on 579 EMTs wherein cases were the 104 subjects who reported new back problems in 2004. Controls were 475 subjects who reported no back problems in 2003 and 2004.

RESULTS

EMTs dissatisfied with their current assignment were significantly more likely to report back problems (OR = 9.33; 95% CI = 3.04-28.67), as were EMTs reporting good or fair fitness when compared to excellent fitness (OR = 3.39; 95% CI = 1.54-7.45, OR = 3.43; 95% CI = 1.37-8.56).

CONCLUSIONS

Results from this analysis suggest that there are two modifiable factors associated with self-reported back problems among EMTs, satisfaction with current assignment and self-reported physical fitness.

Health status in the ambulance services: a systematic review

Background

Researchers have become increasingly aware that ambulance personnel may be at risk of developing work-related health problems. This article systematically explores the literature on health problems and work-related and individual health predictors in the ambulance services.

Methods

We identified the relevant empirical literature by searching several electronic databases including Medline, EMBASE, PsychINFO, CINAHL, and ISI Web of Science. Other relevant sources were identified through reference lists and other relevant studies known by the research group.

Results

Forty-nine studies are included in this review. Our analysis shows that ambulance workers have a higher standardized mortality rate, higher level of fatal accidents, higher level of accident injuries and a higher standardized early retirement on medical grounds than the general working population and workers in other health occupations. Ambulance workers also seem to have more musculoskeletal problems than the general population. These conclusions are preliminary at present because each is based on a single study. More studies have addressed mental health problems. The prevalence of post-traumatic stress symptom caseness was > 20% in five of seven studies, and similarly high prevalence rates were reported for anxiety and general psychopathology in four of five studies. However, it is unclear whether ambulance personnel suffer from more mental health problems than the general working population.

Conclusion

Several indicators suggest that workers in the ambulance services experience more health problems than the general working population and workers in other health occupations. Several methodological challenges, such as small sample sizes, non-representative samples, and lack of comparisons with normative data limit the interpretation of many studies. More coordinated research and replication are needed to compare data across studies. We discuss some strategies for future research.

Longitudinal Emergency Medical Technician Attribute and Demographic Study (LEADS): an interim report

OBJECTIVES

This ten-year longitudinal study examines various attributes and demographic characteristics of emergency medical technicians (EMTs) and paramedics to identify factors that influence their careers, to identify trends in emergency medical services (EMS), and to provide data on why individuals report leaving the EMS career field.

METHODS

A 46-item core survey and a 16-item cross-sectional survey were administered to EMT-basics and EMT-paramedics who were randomly selected and placed in cohort groups stratified by duration of continuous registration at each level and by race. The core survey focused on five broad areas of attributes and demographics, including general, professional, educational, personal, and financial. Case weights were calculated for respondents in each stratum, reflecting the individual's probability of selection. These case weights were adjusted, within strata, for nonresponse. The survey will be administered annually. The cross-sectional survey focused on EMS education.

RESULTS

This interim report is descriptive of the overall responses of EMT-basics and EMT-paramedics to core survey items. The demographic characteristics of EMT-basics and EMT-paramedics are described as well as a description of their work activities, working conditions, and job satisfaction

CONCLUSIONS

The initial EMT and paramedic attribute and demographic data have been collected, analyzed, and reported. The longitudinal nature of this study requires further data collection and analysis to accurately present trends in EMS, as well as correlations and associations between identified attributes and other factors that influence the careers of EMTs and paramedics. Further reports of the findings will be necessary.

Life in recovery: rebuilding from trauma

Trauma can cause visible, often profound physical injuries for patients. The emotional and social drain that families and health care providers experience can also be life-altering. REBUILD is a program designed by a level 1 trauma center that incorporates former patients and their families in a support group to aid previous and new patients, their families, and care providers by sharing mutual experiences and learning from each other. Health care providers have found that participating in the program has been personally gratifying and professionally beneficial by preventing burn-out.

Anxiety levels in EMS providers: effects of violence and shifts schedules

We tried to measure anxiety levels in emergency medical service (EMS) providers to determine the effects of (1) having had a violent encounter during a shift and (2) different shift schedules, conducting a prospective observational study over 3 months in an urban EMS system setting. A convenience sample of 23 EMTs and 40 EMT-Ps was observed. Anxiety levels were measured using the Spielberger State-Trait Anxiety Inventory. A total of 99 inventories were completed by 63 EMS providers. The mean state (32.6+/-8) and trait (31.7+/-7.1) scores were less than normative scores (35.7+/-10.4 and 34.9+/-9.2 respectively) for working adult males (P = .004 and .007, respectively). Paramedics had lower anxiety scores than basic EMTs (P = .015 and .039) and years of experience also decreased anxiety scores (P < .0001). There was no significant difference in state scores between those EMS providers who had encountered violence during the preceding 12 hours and those providers who had not. Comparisons of state scores of providers assessed at hour 12 of a 12 hour shift, hour 12 of a 24 hour shift, and hour 24 of a 24 hour shift failed to show any significant differences. Although the working environment of the EMS provider contains numerous stressors and uncertainties, this population of providers were no more anxious than the general working public. Advanced training and years of experience decreased anxiety. Violent encounters during a shift did not appear to affect anxiety levels. There was no difference in anxiety levels in providers who worked 12 and 24 hour shifts.

Emergency Medical Workers' Responses to Death

Four aspects of emergency medical workers' exposure to death in a mass casualty shooting incident were related to their reactions to the incident and their reported psychological and psychosomatic symptoms. This study assessed thirty-six emergency medical workers' psychological and psychosomatic symptoms self-rated for the weeks before and after the shooting; thirty-one responded again one month post-event. Obsessive-Compulsive, Hostility, Depression, Anxiety, and Global Severity Index SCL90R Scales showed acute elevations that resolved within a month except for the first two. Objective and subjective exposure to the twenty-one on-scene deaths was related to acute increases in Obsessive-Compulsive and Depression self-ratings; stress from triage decisions was also related to the former, and was best relieved by help from coworkers. A task-focused first reaction was associated with more positive outcomes than was an initial shock reaction.

The effects of stressors on emergency medical technicians (Part II): A critical review of the literature, and a call for further research

Part I of this series of articles about stress among emergency medical technicians (EMTs) reviewed the potential sources of EMT stress. This article investigates the other side of the stress equation and provides a critical review of the empirical literature on the effects of stressors on EMTs. It is subdivided into sections corresponding to trends in the research, including: 1) predictors of higher stress levels; 2) differences in stress responses among EMTs, other health professionals, and firefighters; and 3) various physiologic, psychologic, and job performance responses. It identifies some of the methodologic flaws found in the EMT-stress literature that are noted in Part I, and provides further direction for future research. To maintain homogeneity, this review is limited to those articles published in scholarly journals. Studies investigating constructs such as job dissatisfaction and burnout were not included unless the study also included a measure of stress or stressors.

Sources of stress among emergency medical technicians (Part I): What does the research say?

Research repeatedly has demonstrated that organisms exhibit adaptive physiological, emotional, and behavioral responses when exposed to noxious or threatening environmental stimuli. However, when the noxious stimuli are excessive or prolonged, efforts to cope may become overwhelmed, and the adaptive responses can turn into maladaptive reactions (e.g., illness, depression, and impaired performance). According to this model of stress, people who work in occupations that continually place them in danger or repeatedly force them to encounter psychologically demanding or distressing situations would appear to be at greater risk for developing adverse stress reactions. Both anecdotal evidence and empirical research suggest that prehospital emergency medical services (EMS) may be a particularly high-stress field, placing emergency medical technicians (EMTs) at risk for developing such maladaptive stress reactions. This article reviews and synthesizes the empirical literature investigating the sources of stress among EMTs, and concludes with critical comments and guidelines for future research. The authors intend this review to be a resource for investigators conducting research in this area, as well as a convenient summary for anyone interested in learning more about the stressors EMTs experience, particularly mental health professionals and EMS administrators coordinating stress-management programs for EMTs.

Posttraumatic stress disorder, ego defense mechanisms, and empathy among urban paramedics

Although numerous studies have indicated that paramedics experience high occupational stress, there has been a lack of research addressing the mental health implications of this elevated stress on these emergency workers. Related constructs such as the coping mechanisms and personality characteristics of paramedics have also been neglected. Groups of experienced paramedics (n = 120) and paramedic students (n = 105) were, therefore, assessed for Posttraumatic Stress Disorder, the extent and mode of ego defense utilization, and empathy. Analyses indicated that 20% of the experienced paramedics and 22% of the paramedic students appear to be suffering from trauma as measured by the MMPI-2 PK Scale. Denial and Repression scores were significantly high compared to normative samples for both groups, while Regression and Reaction Formation scores were significantly low. Both the paramedics and paramedic students had significantly low scores on Empathy. It is suggested that paramedics may be predisposed to these personality traits and that high denial and low empathy serve as functionally adaptive mechanisms in a chronically stressful work environment.

Patient care and daily stress among emergency medical technicians

INTRODUCTION

There is conflicting research regarding the extent to which patient care is a source of stress for emergency medical technicians (EMTs). Some research indicates that it is important, whereas other studies suggest that it takes a "back seat" to administrative and organizational problems. This study sought to explore this issue further by investigating the relationship between caring for patients, daily workday stress, and daily non-workday stress among EMTs.

METHODS

All EMTs employed by East Baton Rouge Parish Emergency Medical Services were eligible for participation. After the study was described, subjects completed a demographic information sheet and informed consent was obtained. Participants then completed 30 days of monitoring with a standardized measure of daily stress (the Daily Stress Inventory) and a measure of patient care stress designed for use in this study (Emergency Call Questionnaire).

RESULTS

A very large portion of the variance in the EMTs' overall daily workday stress was associated with patient care (r = 0.677, p < 0.001). Additionally, patient care stress on workdays significantly predicted overall daily stress on the following nonworkday (i.e., postworkday) (r = 0.633, p < 0.001). Finally, EMTs who had stressful pre-workdays rated their patient care as more stressful on the following workday (r = 0.512, p < 0.01).

CONCLUSIONS

Results suggest that patient care is a critical factor in daily stress among EMTs, both on workdays and post-workdays, providing preliminary evidence for a carryover effect. Evidence also suggests that stress on the day before work may influence EMTs' perceptions of their patients on workdays.

Mental health case management: characteristics, job function, and occupational stress

Although case management is an important component of treatment for persons with major mental illnesses, little is known about who works in case management, what functions are performed and how much occupational stress case managers experience. Mental health care managers (CM's) throughout the state of Oregon (N = 216) completed an inventory of case management functions and the job dissatisfaction and occupational stress scales of the Medical Personnel Stress Survey-Revised. The average expected tenure for a CM was 11 years, although one fifth expect to be a CM for four years or less. CM's spend 36% of their time performing administrative tasks, 20% in therapy, 17% with skills training, and 18% in case coordination tasks. CM level of education was associated with a different distribution of effort across case management functions. Greater job dissatisfaction was associated with specialized training, larger case load size and greater intention to leave the position. Consumer CM's demonstrated equivalent levels of job satisfaction as their non-consumer colleagues. The relevance of the project's findings for human resource management are discussed.

Sources of disagreement among public and private agency paramedics

INTRODUCTION

The purpose of the study was to document the occurrence and causes of disagreements between paramedics in a tiered-response emergency medical services (EMS) system. METHODS. This cohort analysis of disagreements between paramedics sampled 63 male public agency, 90 male private agency, and 41 female private agency paramedics. Paramedics responded to Likert-type items and one open-ended item concerning the occurrence of conflict between paramedics.

RESULTS

On-scene conflict between EMS personnel from public and private agencies was reported by 70% of the respondents. Conflicts that interfered with patient care were reported to occur more frequently between paramedics from different types of agencies. The most commonly mentioned subject of disagreement was patient treatment, followed by patient transport, interpersonal and interagency conflicts, and patient assessment.

CONCLUSION

A majority of paramedics have experienced on-scene disagreements with other paramedics. Disagreements occur more frequently between paramedics from different agencies and encompass a wide range of issues concerning patient care and interpersonal relationships.

Stress levels in EMS personnel: a longitudinal study with work-schedule modification

OBJECTIVE

To determine if stress levels of emergency medical services (EMS) personnel can be reduced by adjusting work schedules to personnel preferences.

METHODS

A prospective, longitudinal, cohort study with a work-schedule modification intervention was performed. All EMS personnel employed by the City of Cleveland EMS were eligible for participation. EMS employees voluntarily completed an abbreviated medical personnel stress survey (MPSS-R), a 20- question validated stress-assessment tool, in September 1989, February 1991, and September 1991. A new scheduling pattern was introduced March 1991. At that time, 27 EMS employees volunteered to work the new schedule (12 hours/ shift: 3 days on/2 days off/2 days on/3 days off). The remaining 109 EMS employees remained on the old schedule (8 hours/shift: 6 days on/2 days off).

RESULTS

Mean MPSS-R stress scores increased significantly from September 1990 (61.9 +/- 7.87) to September 1991 (65.08 +/- 7.23) (p < 0.05). In September 1991, mean stress scores of EMS personnel working the new schedule (64.39 +/- 7.82) were not significantly lower than stress scores of EMS personnel working the old schedule (65.25 +/- 7.10).

CONCLUSION

Stress in EMS personnel increased despite a new schedule pattern designed to accommodate the preferences of EMS personnel.

Job satisfaction of paramedics: the effects of gender and type of agency of employment

STUDY OBJECTIVES

To document specific factors important in paramedic job satisfaction and job performance. DESIGN AND TYPE OF PARTICIPANTS: A cohort analysis sampled 63 male public-agency paramedics and 131 private-agency paramedics (90 male, 41 female).

METHODS

Three scales from the Michigan Organizational Assessment Questionnaire measured total job satisfaction. A four-item scale assessed attitudes toward paramedic job performance.

RESULTS

Fire paramedics reported highest levels of overall satisfaction, followed by male and female private-agency paramedics. Fire paramedics reported higher levels of intrinsic job satisfaction (eg, opportunity to learn new things) than private-agency paramedics. Differences in extrinsic job satisfaction (eg, pay, benefits) were even greater between fire paramedics and private-agency paramedics. Fire paramedics reported higher satisfaction than female private-agency paramedics with the social rewards of work (eg, the way they are treated by their coworkers). These findings were not explained by age, race, education level, and years on the job. Analysis of the attitudes toward paramedic job performance scale suggested that male paramedics are more likely to believe that female paramedics are not as capable of performing certain job functions.

CONCLUSION

Type of agency and gender affect job satisfaction. Male public-agency paramedics are most satisfied, and female private-agency paramedics are least satisfied with their jobs.

Sources of occupational stress among firefighter/EMTs and firefighter/paramedics and correlations with job-related outcomes

INTRODUCTION/OBJECTIVE

This paper reports the results of an initial effort to develop and test a measure of the various sources of job-related stress in firefighter and paramedic emergency service workers.

METHODS

A 57-item paper and pencil measure of occupational stressors in firefighter/Emergency Medical Technicians (EMTs) and firefighter/paramedics was developed and administered by anonymous mail survey.

RESULTS

More than 2,000 (50% rate of return) emergency service workers completed and returned the surveys. The responses of 1,730 firefighter/EMTs and 253 firefighter/paramedics were very similar in terms of the degree to which job stressors were bothersome. A factor analysis of replies yielded 14 statistically independent "Occupational Stressor" factors which together accounted for 66.3% of the instrument's variance. These Sources of Occupational Stress (SOOS) factor scale scores essentially did not correlate with a measure of the social desirability test-taking bias. Finally, SOOS factors were identified that correlated with job satisfaction and work-related morale of the respondents. Conflict with administration was the job stressor factor that most strongly correlated with reports of low job satisfaction and poor work morale in both study groups.

CONCLUSION

The findings suggest that firefighter and paramedic job stress is very complicated and multi-faceted. Based on this preliminary investigation, the SOOS instrument appears to have adequate reliability and concurrent validity.

An evaluation of physiological parameters of stress in the emergency department

Seven physiological parameters previously used in stress research were studied to determine which would be able to quantitate levels of stress and study interventions in the emergency department setting. Eighteen emergency medicine personnel were prospectively studied. Sequential measurements of heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, skin temperature, serum norepinephrine, and serum epinephrine were recorded during multiple shifts in the emergency department. These parameters were assessed in repeated measures analysis of variance models with the subject's stress score of the shift and a calculated stress score of the shift. Respiratory rate demonstrated a significant association with the score of the shift over time within subjects (P = .0228). Skin temperature showed a significant trend over time (P = .0001) and in relation to how stressful the subject perceived the shift to be (P = .0006). A significant association was detected between epinephrine change over the shift and the subject's perception of the stress of the shift (P = .0217), and the stress score of the shift (P = .0009). Sequential serum epinephrine appears to be an objective measure of both perceived stressfulness of a shift and objective stress scoring of the shift. Respiratory rate changes and skin temperature changes over a shift may also be useful to measure stress in individuals in this setting.