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Health problems and work-related stress in Swedish ambulance personnel
Jönköping University, School of Health and Welfare, HHJ. ADULT.ORCID iD: 0000-0003-4626-5824
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Previous studies have shown a high incidence of both acute and post-traumatic stress among ambulance personnel. It has been shown that ambulance personnel are at a higher risk of being affected of heart disease, high blood pressure and cancer. Studies have also seen a higher incidence of substance abuse and suicide. One cause of these health problems can be work-related stress. No previous research has focused on the body's physical reactions in the form of changes in heart rate and stress hormones in ambulance personnel in connection with work-related stress. Nor is there any overall picture of what actually affects Swedish ambulance personnel in terms of reported morbidity.

Aim: The overall aim of the thesis is to investigate health problems in Swedish ambulance personnel and to study if there are any factors related to the work environment and the special conditions occurring in the prehospital environment that can be linked to the findings that appear.

The questions that should be answered are: Are there health problems that affect Swedish ambulance personnel to a higher extent than other professions in Sweden? Are there any factors relating to morbidity that can be linked to the profession and can be regarded as potentially dangerous? If so, are there methods to prevent health problems that can be implemented in daily work?

Methods: Studies I, II and III were all studies where stress markers (heart rate and cortisol levels) were measured during different conditions linked to the profession. Study I was a study where this was measured during physical exertion e.g. to carry a stretcher. Study II was a validated theoretical stress test to see how the ambulance personnel reacted to unknown factors. Study III meant measuring stress markers during priority-1 alarms. Study IV was carried out as a longitudinal register study where data about ICD-codes was collected from Statistics Sweden and the National Board of Health and Welfare.

Results: In study I it was shown that the use of lifting aids reduced the measurable stress in the form of both reduced heart rate and decreased cortisol levels. Study II showed that personnel were stressed of the unknown test though women had the highest salivary cortisol levels before the Trier social stress test while the highest value for men occurred 10 to 20 minutes after the test. Study III showed that there was an increase in heart rate during priority-1 alarms that could not be linked to physical activity. It also indicated/showed that traffic accidents, patients with heart attacks in need of acute PCI or thrombectomy and alarms regarding children generate the highest stress onset seen as prolonged elevation of cortisol levels. This was seen regardless of gender, age, education or experience in all three studies. Study IV showed that Swedish ambulance personnel run the risk of being affected by certain diseases such as cardiac arrhythmias and injuries as arthrosis of the knee, dorsopathies and intervertebral disc disorders to a greater extent compared to other health care workers and other professions in Sweden.

Conclusion: Swedish ambulance personnel have a higher incidence of certain health problems and diseases such as paroxysmal tachycardia, atrial fibrillation and flutter, other cardiac arrhythmias, high blood pressure, of the knee and dorsopathies and intervertebral disc disorders compared to other professions. These conditions can be caused by work-related stress, although they are not the only cause. Some factors that cause a stress reaction that can be linked to the ambulance profession have emerged in the studies. But the extent to which these factors alone cause the health problems that Swedish ambulance personnel suffer from is more difficult to determine with certainty based on these studies. Using shoulder straps reduces both heart rate and cortisol secretion.

Clinical implications: Greater use of aids both in terms of lifting, moving and carrying heavy loads should mean that the physical load on the body would be reduced. These aids could also prevent some musculoskeletal problems that have emerged in this thesis by relieving and distributing the burden throughout the body. An important aspect in preventing work-related stress is that sufficient time is given for recovery. The organizations need to be dimensioned so that there is sufficient standby time so that there is time for recovery and reflection but also time for education and training. This is something that is far from reality in many Swedish ambulance organizations. It is also time to seriously discuss what is an actual reality in many countries, namely that employees in the ambulance service can benefit from a lower retirement age after a certain number of years of service.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2020. , p. 74
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 105
Keywords [en]
work-related stress, ambulance personnel, cortisol, heart rate
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-50636ISBN: 978-91-88669-04-9 (print)OAI: oai:DiVA.org:hj-50636DiVA, id: diva2:1467939
Public defence
2020-10-26, Forum Humanum, School of Health and Welfare, Jönköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2020-09-16 Created: 2020-09-16 Last updated: 2020-09-16Bibliographically approved
List of papers
1. Using shoulder straps decreases heart rate variability and salivary cortisol concentration in Swedish ambulance personnel
Open this publication in new window or tab >>Using shoulder straps decreases heart rate variability and salivary cortisol concentration in Swedish ambulance personnel
2016 (English)In: SH@W Safety and Health at Work, ISSN 2093-7911, E-ISSN 2093-7997, Vol. 7, no 1, p. 32-37Article in journal (Refereed) Published
Abstract [en]

Background: Previous research has shown that paramedics are exposed to risks in the form of injuries to the musculoskeletal system. In addition, there are studies showing that they are also at increased risk of cardiovascular disease, cancer, and psychiatric diseases, which can partly be explained by their constant exposure to stress. The aim of this study is to evaluate whether the use of shoulder straps decreases physical effort in the form of decreased heart rate and cortisol concentration.

Methods: A stretcher with a dummy was carried by 20 participants for 400 m on two occasions, one with and one without the shoulder straps. Heart rate was monitored continuously and cortisol samples were taken at intervals of 0 minutes, 15 minutes, 30 minutes, 45 minutes, and 60 minutes. Each participant was her or his own control.

Results: A significant decrease in heart rate and cortisol concentration was seen when shoulder straps were used. The median values for men (with shoulder straps) at 0 minutes was 78 bpm/21.1 nmol/L (heart rate/cortisol concentration), at 15 minutes was 85 bpm/16.9 nmol/L, and at 60 minutes was 76 bpm/15.7 nmol/L; for men without shoulder straps, these values were 78 bpm/21.9 nmol/L, 93 bpm/21.9 nmol/L, and 73 bpm/20.5 nmol/L. For women, the values were 85 bpm/23.3 nmol/L, 92 bpm/20.8 nmol/L, and 70 bpm/18.4 nmol/L and 84 bpm/32.4 nmol/L, 100 bpm/32.5 nmol/L, and 75 bpm/25.2 nmol/L, respectively.

Conclusion: The use of shoulder straps decreases measurable physical stress and should therefore be implemented when heavy equipment or a stretcher needs to be carried. An easy way to ensure that staff use these or similar lifting AIDS is to provide them with personalized, well-adapted shoulder straps. Another better option would be to routinely sewn these straps into the staff's personal alarm jackets so they are always in place and ready to be used.

Place, publisher, year, edition, pages
Occupational Safety and Health Research Institute, 2016
Keywords
ambulance personnel, heart rate, saliva cortisol, shoulder straps, stretcher
National Category
Occupational Health and Environmental Health Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-34668 (URN)10.1016/j.shaw.2015.09.005 (DOI)000399096000005 ()27014488 (PubMedID)2-s2.0-84960895582 (Scopus ID)
Available from: 2017-01-11 Created: 2017-01-11 Last updated: 2020-09-16Bibliographically approved
2. Stress response in swedish ambulance personnel evaluated by Trier social stress test
Open this publication in new window or tab >>Stress response in swedish ambulance personnel evaluated by Trier social stress test
2019 (English)In: Journal of Health and Environmental Research, ISSN 2472-3584, Vol. 5, no 1, p. 14-23Article in journal (Refereed) Published
Abstract [en]

According to previous research, ambulance personnel often consider themselves as healthy, but at the same time several studies show that they suffer from several stress-related illnesses, take early retirement and even suffer early death. The aim of this study was to explore mental stress during the Trier Social Stress Test. Questions were whether heart rate measurement could replace cortisol concentration in saliva as an indicator of stress and if there were differences between genders. During 20 Trier Social Stress Tests heart rate and salivary cortisol concentrations were measured. Heart rate was measured every 15 seconds and salivary cortisol was collected at seven occasions. Fourteen men and six women (sixteen ambulance nurses and four paramedics) participated. A questionnaire with background data was collected. Statistical analysis used was non-parametric tests to adjust for misalignment. During the Trier Social Stress Test women had their highest salivary cortisol concentration before start of test while the maximum values for men were 10 to 20 minutes after start. In contrast, there was no difference in heart rhythm before, during and after test between genders. No correlation between heart rate and salivary cortisol was found. There was no significant difference in stress response according to personnel’s age or level of education. Women and men exhibit different hormonal stress responses when it comes to performing unfamiliar actions, something that has not been seen before. Since no correlation could be seen between heart rate and salivary cortisol concentration they cannot replace each other as indicators of stress.

Place, publisher, year, edition, pages
Science Publishing Group, 2019
Keywords
Ambulance Personnel, Heart Rate, Salivary Cortisol, Stress, Trier Social Stress Test
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:hj:diva-43482 (URN)10.11648/j.jher.20190501.13 (DOI)POA HHJ 2019 (Local ID)POA HHJ 2019 (Archive number)POA HHJ 2019 (OAI)
Available from: 2019-04-17 Created: 2019-04-17 Last updated: 2020-09-16Bibliographically approved
3. Stress response in Swedish ambulance personnel during priority-1 alarms
Open this publication in new window or tab >>Stress response in Swedish ambulance personnel during priority-1 alarms
2020 (English)In: Australasian Journal of Paramedicine, E-ISSN 2202-7270, Vol. 17, p. 1-7Article in journal (Refereed) Published
Abstract [en]

Introduction

Ambulance personnel consider themselves as being healthy, but studies show they often suffer from stress-related illnesses. However, research on the causes of these stress-related illnesses is limited. This study aimed to examine the stress response of Swedish of ambulance personnel during priority-1 alarms.

Methods

During 90 priority-1 alarms salivary cortisol concentrations were measured at alarm and after end of alarm, and heart rates measured every 15 seconds. Thirteen men and six women participated in the study. A questionnaire with background data was collected. Non-parametric statistical tests were used.

Results

Elevated heart rate (median +34.7%) was associated with the actual priority-1 alarm, and during the alarm for women. Median salivary cortisol concentrations at alarm and after end of alarm (14.0 and 14.2 nmol/L respectively) showed non-significant differences. There were individual non-identical responses to the alarms. Alarms concerning traffic accidents, fast track and children generated the highest cortisol concentrations. The stress response showed non-significant differences in age, gender or level of education. Salivary cortisol concentrations and response were lower in the afternoon shift (2pm to 8pm).

Conclusion

The alarm causes increased heart rate at the group level but with individual different responses. Predefined fast track schedules and traffic accidents appear to generate measurable stress. Cortisol concentration follows normal diurnal variation of cortisol regarding time point for priority-1 alarms. Time of day does not affect the heart rate.

Place, publisher, year, edition, pages
Faculty of Health, Engineering and Science, Edith Cowan University, 2020
Keywords
alarms; ambulance personnel; cortisol; heart rate; stress response
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-50579 (URN)10.33151/ajp.17.776 (DOI)2-s2.0-85091538601 (Scopus ID)POA HHJ 2020 (Local ID)POA HHJ 2020 (Archive number)POA HHJ 2020 (OAI)
Available from: 2020-09-09 Created: 2020-09-09 Last updated: 2020-10-08Bibliographically approved
4. Health problems among Swedish ambulance personnel: long-term risks compared to other professions in Sweden - a longitudinal register study
Open this publication in new window or tab >>Health problems among Swedish ambulance personnel: long-term risks compared to other professions in Sweden - a longitudinal register study
Show others...
2022 (English)In: International Journal of Occupational Safety and Ergonomics, ISSN 1080-3548, E-ISSN 2376-9130, Vol. 28, no 2, p. 1130-1135Article in journal (Refereed) Published
Abstract [en]

Objectives. This study aimed to investigate whether Swedish ambulance personnel differ in the extent of suffering fromhealth problems compared to other occupational groups.

Methods. Two cohorts of ambulance personnel from 2001 and2008, with 1778 and 2753 individuals, respectively, were followed regarding assignment of diagnostic coding (InternationalClassification of Diseases codes) until 2016. These two cohorts represent all who were employed as ambulance personnel bypublic employers during these years. Two comparison groups were added: other healthcare workers and other professions.All data were retrieved from national registers. The χ2 test was were used for statistical calculation.

Results. Swedishambulance personnel are at a significantly higher risk of being affected by ‘Paroxysmal tachycardia, atrial fibrillation andflutter, other cardiac arrhythmias’, by ‘Other intervertebral disc disorders’ and by ‘Arthropathies’, when compared to bothcomparison groups in both cohorts. Almost similar results were seen for ‘Gonarthrosis’ and for ‘Dorsopathies’.

Conclusions. Swedish ambulance personnel run the risk of being affected by certain diseases and injuries to a greater extent compared toother professions.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
Ambulance personnel, occupational injury, work-related diseases, work-related stress, register study
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-50635 (URN)10.1080/10803548.2020.1867400 (DOI)000624748700001 ()33533685 (PubMedID)2-s2.0-85128002402 (Scopus ID)HOA;;1467929 (Local ID)HOA;;1467929 (Archive number)HOA;;1467929 (OAI)
Available from: 2020-09-16 Created: 2020-09-16 Last updated: 2023-01-20Bibliographically approved

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