This thesis in health and care sciences focuses on factors related to working in the ambulance service and their association with health.

For patients in need of emergency medical care outside healthcare facilities, ambulance personnel are, following the dispatch centre, the first link in the chain to providing good health and care on equal terms for the entire population, in accordance with the Health and Medical Services Act. Registered nurses and emergency medical technicians in the ambulance service provide advanced prehospital care that is available around the clock. The job includes several factors that may negatively affect health, such as shift work, long work hours, heavy lifting, sedentary work, stress, and the risk of exposure to threats and violence. Previous research suggests that this occupational group may be at increased risk of cardiovascular disease, mental health issues, and musculoskeletal disorders; however, the evidence is limited.

The overall aim of this thesis was to describe and analyse work- and leisure-related factors and their association with health among ambulance personnel.

To achieve the overall aim of this thesis, four studies with quantitative designs were conducted (Papers I-IV). Ambulance personnel from an ambulance service in the south of Sweden were invited to participate. Paper I (n=106) described work-, lifestyle-, and health-related factors among ambulance personnel, using health examinations, blood samples, questionnaires, and physical capacity tests. Paper II (n=79) analysed hair cortisol levels as an indicator of long-term stress and their relationship to work factors, using hair samples and questionnaires. Paper III (n=63) described and analysed patterns of physical behaviours using accelerometry and questionnaires. Paper IV analysed blood pressure variation using ambulatory monitoring and questionnaires. Additionally, Papers I, II, and IV described and analysed differences between women and men, and Papers III and IV analysed associations with different work shifts.

The main findings in this thesis indicate that ambulance personnel were exposed to several work-related factors which could negatively impact health, such as physically demanding work, psychosocial demands (for example work stress and risk of threats and violence), and shift work. Despite this, the participants reported overall good self-rated health, high self-rated work ability, high physical capacity, a high level of physical activity during leisure time, and few other lifestyle-related risk factors. However, the findings identified a high prevalence of hypertension, elevated cholesterol levels, and high body mass index among the ambulance personnel. A larger proportion of women, compared to men, reported physically demanding work; however, women performed better in the physical capacity tests and had lower ambulatory blood pressure than men. Different shift types did not appear to affect the pattern of physical behaviours.

The findings in this thesis can be related to the World Health Organization’s (WHO) framework for healthy workplaces comprising the physical and psychosocial work environment and personal health resources. Indirectly, the thesis also relates to the fourth area, which includes interaction with the surrounding society.

In conclusion, this thesis presents a multifaceted picture in relation to health for personnel working in the Swedish ambulance service.