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Occupational Risk Factors in the Emergency Medical Services

Published online by Cambridge University Press:  28 June 2012

Elizabeth Donnelly*
Affiliation:
College of Social Work, Florida State University, Tallahassee, Florida, USA
Darcy Siebert
Affiliation:
College of Social Work, Florida State University, Tallahassee, Florida, USA
*
296 Champions Way, College of Social Work, UCC 2500, Florida State University, Tallahassee, Florida 32306-2570 USA, E-mail: ead06c@fsu.edu

Abstract

Introduction:

During a medical emergency, the American public often relies on the expertise of emergency medical technicians (EMTs). These professionals face a number of occupational hazards, and the literature suggests that EMTs are at a greater risk of developing physical and mental stress-related disorders. The purpose of this paper is to systematically examine gaps in the extant literature and to present a theoretically driven conceptual model to serve as a basis for future intervention and research efforts.

Methods:

A systematic review of the literature was conducted utilizing rele-vant databases (e.g., PsychInfo, Medline). All empirical articles regarding emergency medical responders were reviewed, but given the limited research available, relevant theoretical and conceptual literature on the constructs of interest in other, related populations also were included. Based on this extensive review, a modification of the stress process model is suggested to explain the relationships among occupational stress exposure, post-traumatic stress disorder (PTSD), and high-risk alcohol and other drug use.

Results:

Exposure to traumatic events was reported to be between 80% and 100% among EMTs, and rates of PTSD are >20%. High-risk alcohol and drug use rates among other emergency response professionals were reported to be as high as 40%. The proposed model suggests direct linkages between occupationally related stress exposure, including chronic and critical incident stress, PTSD, and high-risk alcohol and other drug use. Social support and personal resources (e.g., coping, locus of control) are proposed to have mediating and moderating influences on the three main constructs, and cohesion is introduced as an important, idiosyncratic influence in this population. The moderating influences of gender, age, ethnicity, marital status, and socioeconomic status, level of training, and years of service are included in the proposed model.

Conclusions:

High-risk alcohol and other drug use and post-traumatic symptomatology pose substantial risks for EMTs, and consequently, for the patients they serve. It is imperative that researchers develop and test a theoretically grounded model of risk and protective factors that will guide intervention development and future study. The model suggested in this paper, based on a comprehensive literature review and development of theory, represents a critical first step in the intervention research process.

Type
Comprehensive Review
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2009

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References

1.Maguire, BJ, Hunting, KL, Smith, GS, Levick, NR: Occupational fatalities in emergency medical services: A hidden crisis. Ann Emerg Med 2002;40:625632.CrossRefGoogle ScholarPubMed
2.Beaton, RD, Murphy, S, Pike, K, Jarrett, M: Stress-Symptom Factors in Firefighters and Paramedics. In Sauter, SL, Murphy, LR (eds), Organizational Risk Factors for Job Stress. Washington, DC: American Psychological Association, 1995, pp 227245.CrossRefGoogle Scholar
3.Weiss, DS, Marmar, CR, Metzler, TJ, Ronfeldt, HM: Predicting symptomatic dis-tress in emergency services personnel. J Consult Clin Psychol 1995;63:361368.CrossRefGoogle ScholarPubMed
4.Clohessy, S, Ehlers, A: post-traumatic stress disorder symptoms, response to intrusive memories and coping in ambulance service workers. Br J Clin Psychol 1999;38(3):251265.CrossRefGoogle ScholarPubMed
5.Regehr, C., Goldberg, G, Hughes, J: Exposure to human tragedy, empathy, and trauma in ambulance paramedics. Am J Orthopsychiatry 2002;72:505513.CrossRefGoogle ScholarPubMed
6.Haslam, C., Mallon, K: A preliminary investigation of post-traumatic stress symptoms among firefighters. Work & Stress 2003;17:277285.CrossRefGoogle Scholar
7.Carlier, I, Lamerts, RD, Gersons, B: Risk factors for posttraumatic stress symptomatology in police officers: A prospective analysis. J Nerv Ment Dis 1997;185:498506.CrossRefGoogle ScholarPubMed
8.Chilcoat, HD, Breslau, N: Posttraumatic stress disorder and drug disorders: Testing causal pathways. Arch Gen Psychiatry 1998;55:913917.CrossRefGoogle ScholarPubMed
9.Pearlin, LI: The sociological study of stress. J Health Soc Behav 1989;30:241256.CrossRefGoogle ScholarPubMed
10.Lopez, B, Turner, RJ, Saavedra, LM: Anxiety and risk for substance dependence among late adolescents/young adults. J Anxiety Disord 2005;19:275294.CrossRefGoogle ScholarPubMed
11.Baron, RM, Kenny, DA: The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considera-tions. J Pers Soc Psychol 1985;51:11731182.CrossRefGoogle Scholar
12.Ward, CL, Lombard, CJ, Gwebushe, N: Critical incident exposure in South African emergency services personnel: Prevalence and associated mental health issues. Emerg Med J 2006;23:226231.CrossRefGoogle ScholarPubMed
13.Pirallo, RG, Levine, R, Dickison, PD: Behavioral health risk factors of United States emergency medical technicians: the LEADS project. Prehosp Disaster Med 2005;20:235242.CrossRefGoogle Scholar
14.Violanti, JM: Predictors of police suicide ideation. Suicide Life Threat Behav 2004;34:277283.CrossRefGoogle ScholarPubMed
15.Violanti, JM, Marshall, JR, Howe, B: Stress, coping, and alcohol use: The police connection Journal of Police Science and Administration 1985;13:106110.Google Scholar
16.Violanti, J, Marshall, J, Howe, B: Police occupational demands, psychological distress and the coping function of alcohol. J Occup Environ Med 1983;25:455458.CrossRefGoogle ScholarPubMed
17.Gershon, RR, Lin, S, Li, X: Work stress in aging police officers. J Occup Environ Med 2002;44:160167.CrossRefGoogle ScholarPubMed
18.Richmond, RL, Wodak, A, Kehoe, L, Heather, N: How healthy are the police? A survey of life-style factors. Addiction 1998;93:17291737.CrossRefGoogle Scholar
19.Davey, JD, Obst, PL, Sheehan, MC: Developing a profile of alcohol con-sumption patterns of police officers in a large scale sample of an Australian police service. Eur Addict Res 2000;6:205212.CrossRefGoogle Scholar
20.McNeill, M, Wilson, C: Alcohol and the Police Workplace. Payneham: Australasian Center for Policing Research, 1993.Google Scholar
21.Davey, JD, Obst, PL, Sheehan, MC: It goes with the job: Officers' insights into the impact of stress and culture on alcohol consumption within the policing occupation. Drugs: Education, Prevention & Policy 2001;8:141149.Google Scholar
22.Dietrich, J, Smith, J: Nonmedical use of drugs including alcohol among police personnel—A critical literature review. Journal of Police Science and Administration 1986;14:200206.Google Scholar
23.Al-Humaid, H, el-Guebaly, N, Lussier, D: Substance use and the police: An international workplace experience. Addictive Disorders & Their Treatment 2007;6:107115.CrossRefGoogle Scholar
24.Obst, PL, Davey, JD, Sheehan, MC: Does joining the police service drive you to drink? A longitudinal study of the drinking habits of police recruits. Drugs: Education, Prevention & Policy 2001;8:347357.Google Scholar
25.Boxer, PA, Wild, D: Psychological distress and alcohol use among fire fight-ers. Scand J Work Environ Health 1993;19:121125.CrossRefGoogle Scholar
26.North, CS, Tivis, L, McMillen, JC, et al. : Psychiatric disorders in rescue work-ers after the Oklahoma City bombing. Am J Psychiatry 2002;159:857859.CrossRefGoogle Scholar
27.Murphy, SA, Beaton, RD, Pike, KC, Johnson, LC: Occupational stressors, stress responses, and alcohol consumption among professional firefighters: A prospective longitudinal analysis. Int J Stress Manag 1999;6:179196.CrossRefGoogle Scholar
28.Mirowsky, J, Ross, CE: Psychiatric diagnosis as reified measurement. J Health Soc Behav 1989;30:1126.CrossRefGoogle ScholarPubMed
29.American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Text revision (4 ed). Washington DC: American Psychiatric Association; 2000Google Scholar
30.Alexander, DA, Klein, S: Ambulance personnel and critical incidents: Impact of accident and emergency work on mental health and emotional well-being. Br J Psychiatry 2001;178:7681.CrossRefGoogle Scholar
31.Regehr, C., Goldberg, G, Glancy, GD, Knott, T: Posttraumatic symptoms and disability in paramedics. Can J Psychiatry 2002;47:953958.CrossRefGoogle ScholarPubMed
32.Kessler, RC, Sonnega, A, Bromet, E, et al. : Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995;52:10481060.CrossRefGoogle ScholarPubMed
33.Bennett, P, Williams, Y, Page, N, et al. : Associations between organizational and incident factors and emotional distress in emergency ambulance person-nel. Br J Clin Psychol 2005;44:215226.CrossRefGoogle Scholar
34.Bennett, P, Williams, Y, Page, N, et al. : Levels of mental health problems among UK emergency ambulance workers. Emerg Med J 2004;21:235236.CrossRefGoogle ScholarPubMed
35.Grevin, F: Posttraumatic stress disorder, ego defense mechanisms, and empa-thy among urban paramedics. Psychol Rep 1996;79:483495.CrossRefGoogle ScholarPubMed
36.Marmar, CR, Weis, DS, Metzler, TJ, Ronfeldt, HM, Foreman, C: Stress responses of emergency services personnel to the Loma Prieta earthquake interstate 880 collapse and control traumatic incidents. J Trauma Stress 1996;9:6385.CrossRefGoogle Scholar
37.Jonsson, A, Segesten, K, Mattsson, B: Post-traumatic stress among Swedish ambulance personnel. Emerg Med J 2003;20:7984.CrossRefGoogle ScholarPubMed
38.van der Ploeg, E, Klebe, RJ: Acute and chronic job stressors among ambulance personnel: predictors of health symptoms. Occup Environ Med 2003;60 Suppl 1:i40–i46.CrossRefGoogle ScholarPubMed
39.Berger, W, Figueira, I, Maurat, AM, et al. : Partial and full post-traumatic stress disorder in Brazilian ambu-lance workers: Prevalence and impact on health and on quality of life. J Trauma Stress 2007;20:637642.CrossRefGoogle ScholarPubMed
40.Lowery, K, Stokes, MA: Role of peer support and emotional expression on post-traumatic stress disorder in student paramedics. J Trauma Stress 2005;18:171179.CrossRefGoogle ScholarPubMed
41.Del Ben, KS, Scotti, JR, Chen, Y, Fortson, BL: Prevalence of posttraumatic stress disorder symptoms in firefighters. Work Stress 2006;20:3748.CrossRefGoogle Scholar
42.Corneil, W, Beaton, R, Murphy, S, et al. : Exposure to traumatic incidents and prevalence of posttraumatic stress symptomatology in urban firefighters in two countries. J Occup Health Psychol 1999;4:131141.CrossRefGoogle ScholarPubMed
43.Robinson, HM, Sigman, MR, Wilson, JP: Duty-related stressors and post-traumatic stress disorder symptoms in suburban police officers. Psychol Rep 1997;81:835845.CrossRefGoogle ScholarPubMed
44.Kessler, RC, Berglund, P, Demler, O, et al. : Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:593602.CrossRefGoogle ScholarPubMed
45.Regehr, C., Hill, J, Goldberg, G, Hughes, J: Postmortem inquiries and trauma responses in paramedics and firefighters. J Interpers Violence 2003;18:607622.CrossRefGoogle Scholar
46.Maia, D, Marmar, C., Metzle, T, et al. : Post-traumatic stress symptoms in an elite unit of Brazilian police officers: Prevalence and impact on psychosocial functioning and on physical and mental health. J Affect Disord 2007;97: 241245.CrossRefGoogle Scholar
47.Zlotnick, C., Franklin, CL, Zimmerman, M: Does “subthreshold” posttraumatic stress disorder have any clinical relevance? Compr Psychiatry 2002;43:413419.CrossRefGoogle Scholar
48.Boudreaux, E, Mandry, C: Sources of stress among emergency medical technicians (Part I): What does the research say? Prehosp Disaster Med 1996;11:296301.CrossRefGoogle ScholarPubMed
49.Boudreaux, E, Mandry, C: The effects of stressors on emergency medical technicians (Part II): A critical review of the literature, and a call for further research. Prehosp Disaster Med 1996;11:302–307. discussion 307308.CrossRefGoogle Scholar
50.Sterud, T, Ekeberg, O, Hem, E: Health status in the ambulance services: A sys-tematic review. BMC Health Serv Res 2006;6:82.CrossRefGoogle Scholar
51.Beaton, RD, Murphy, S, Pike, K: Work and nonwork stressors, negative affec-tive states and pain complaints among firefighters and paramedics. Int J Stress Manag 1996;3:223237.CrossRefGoogle Scholar
52.Young, KM, Cooper, CL: Occupational stress in the ambulance service: A diagnostic study. Health Manpow Manage 1997;23:140147.Google Scholar
53.Regehr, C., Millar, D: Situation critical: High demand, low control, and low support in paramedic organizations. Traumatology 2007;13:4958.CrossRefGoogle Scholar
54.Beaton, RD, Murphy, SA, Pike, KC, Corneil, W: Social support and network conflict in firefighters and paramedics. West J Nurs Res 1997;19:297313.CrossRefGoogle Scholar
55.Leiss, JK, Ratcliffe, JM, Lyden, JT, et al. : Blood exposure among paramedics: Incidence rates from the national study to prevent blood exposure in para-medics. Ann Epidemiol 2006;16:720725.CrossRefGoogle Scholar
56.Rischitelli, G, Harris, J, McCauley, L, et al. : The risk of acquiring hepatitis B or C among public safety workers: A systematic review. Am J Prev Med 2001;20:299306.CrossRefGoogle ScholarPubMed
57.Rischitelli, G, Lasarev, M, McCauley, L: Career risk of hepatitis C virus infec-tion among U.S. emergency medical and public safety workers. J Occup Environ Med 2005:47:11741181.CrossRefGoogle Scholar
58.Brough, P: Workplace violence experienced by paramedics: Relationships with social support, job satisfaction, and psychological strain. Australasian Journal of Disaster and Trauma Studies 2005; 2:[np].Google Scholar
59.Suserud, BO, Blomquist, M, Johansson, I: Experiences of threats and violence in the Swedish ambulance service. Accid Emerg Nurs 2002;10:127135.CrossRefGoogle ScholarPubMed
60.Becker, LR, Zaloshnja, E, Levick, N, et al. : Relative risk of injury and death in ambu-lances and other emergency vehicles. Accident Analysis & Prevention 2003;35:941948.CrossRefGoogle ScholarPubMed
61.Mitchell, JT: When disaster strikes…he critical incident stress debriefing process. JEMS 1983;8:3639.Google ScholarPubMed
62.Beaton, RD, Murphy, S, Johnson, C., et al. : Exposure to duty-related incident stres-sors in urban firefighters and paramedics. J Trauma Stress 1998;11:821828.CrossRefGoogle Scholar
63.Bryant, RA, Harvey, AG: Posttraumatic stress reactions in volunteer firefight-ers. J Trauma Stress 1996;9:5162.CrossRefGoogle Scholar
64.Langford, CPH, Bowsher, J, Maloney, JP, Lillis, PP: Social support: A concep-tual analysis. J Adv Nurs 1997;25:95100.CrossRefGoogle Scholar
65.Hyman, O: Perceived social support and secondary traumatic stress symptoms in emergency responders. J Trauma Stress 2004;17:149156.CrossRefGoogle ScholarPubMed
66.Brown, J, Grover, J: The role of moderating variables between stressor exposure and being distressed in a sample of serving police officers. Pers Individ Dif 1998;24:181185.CrossRefGoogle Scholar
67.Brewin, CR, Andrews, B, Valentine, JD: Meta-analysis of risk factors for post-traumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 2000;68:748766.CrossRefGoogle ScholarPubMed
68.Greene, P, Kane, D, Christ, G, et al. : FDNY Crisis Counseling. Hoboken, NJ: John Wiley and Sons, Inc., 2006.Google Scholar
69.Siebold, GL, Kelly, D: Development of the Combat Platoon Cohesion Questionnaire (Technical Report 817). Alexandria, Virginia: US Army Research Institute for the Behavioral and Social Sciences, 1988.CrossRefGoogle Scholar
70.Griffith, J, Vaitkus, M: Relating cohesion to stress, strain, disintegration, and performance: An organizing framework. Mil Psychol 1999;11:2755.CrossRefGoogle Scholar
71.Moran, C., Massam, M: An evaluation of humour in emergency work. The Australasian Journal of Disaster and Trauma Studies 1997;3:[np].Google Scholar
72.Fullerton, CS, McCarroll, JE, Ursano, RJ, Wright, KM: Psychological responses of rescue workers: Firefighters and trauma. Am J Orthopsychiatry 1992;62:371378.CrossRefGoogle Scholar
73.Folkman, S: Personal control and coping processes: A theoretical analysis. J Pers Soc Psychol 1984;46:839852.CrossRefGoogle ScholarPubMed
74.Rotter, JB: Generalized expectancies for internal versus external control of reinforcement. Psychol Monogr 1966;80:128.CrossRefGoogle ScholarPubMed
75.Rotter, JB: Some problems and misconceptions related to the construct of internal versus external control of reinforcement. J Consult Clin Psychol 1975;43:5667.CrossRefGoogle Scholar
76.Peacock, EJ, Wong, PTP: Anticipatory stress: The relation of locus of control, optimism, and control appraisals to coping. J Res Pers 1996;30:204222.CrossRefGoogle Scholar
77.Fairbank, JA, Hansen, DJ, Fitterling, JM: Patterns of appraisal and coping across different stressor conditions among former prisoners of war with and without posttraumatic stress disorder. J Consult Clin Psychol 1991;59:274281.CrossRefGoogle ScholarPubMed
78.Solomon, Z, Mikulincer, M, Avitzur, E: Coping, locus of control, social support, and combat related posttraumatic stress disorder: A prospective study. J Pers Soc Psychol 1988;55:279285.CrossRefGoogle ScholarPubMed