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Stress load of emergency service: effects on the CAR and HRV of HEMS emergency physicians on different working days (N = 20)

  • Katja Petrowski
  • Benedict Herhaus
  • Christian Schöniger
  • Mark Frank
  • Jaroslaw Pyrc
Original Article

Abstract

Purpose

The occupation of the emergency physicians (EPs) of helicopter emergency medical services (HEMS) can be characterized as a high-strain occupation (Karasek in Adm Sci Q 24(2):285–308.  https://doi.org/10.2307/2392498, 1979). Therefore, the aim of this study was to measure and compare the stress load of the EPs of HEMS on duty on air ambulance workdays and on 2 control days.

Methods

In this field study (within-subjects design), hormonal, physiological, and self-perceived stress levels of 20 EPs [3 females, 17 males; mean age (M) = 44.95 years, SD = 4.80, 95% confidence interval (CI) (42.71, 47.19)] of HEMS, were recorded on different test days. Measurements of the cortisol awakening response (CAR) and the heart rate variability (HRV) were performed while on duty on the air ambulance and during workdays at the outpatient clinic as well as at home on days of rest.

Results

There were significant differences in the CAR (area under the curve with respect to ground F(2,38) = 12.81, p < 0.001) between the 3 test days with the highest values on the workday at the outpatient clinic [M = 81.24; 98.75% CI (61.24, 101.24)] and not on the air ambulance day [M = 61.82; 98.75% CI (45.18, 78.46)] or on the day of rest [M = 52.96; 98.75% CI (38.17, 67.76)]. In addition, the HRV parameter SDNN [F(2,38) = 6.369; p = 0.004] presented significant differences between the 3 test days with lower levels on the day at the outpatient clinic [M = 101.44; 98.75% CI (83.50, 119.38)] in contrast to the air ambulance day [M = 120.16; 98.75% CI (100.02, 140.30)] and to the resting day [M = 123.79; 98.75% CI (106.49, 141.10)]. Furthermore, there were significant differences in the HRV parameter LF/HF [F(2,38) = 6.215; p = 0.005] between the 3 testing days with the highest values on the workday at the outpatient clinic [M = 8.69; 98.75% CI (6.29, 11.09)] compared to the air ambulance day [M = 6.54; 98.75% CI (4.50, 8.57)] and the day of rest [M = 6.43; 98.75% CI (4.57, 8.29)].

Conclusions

Compared with the standard values and previous studies, EPs of HEMS have an increase in hormonal reactivity in the morning and a lack of recovery of the ANS. It can be concluded that—with respect to the psychobiological stress model by McEwen and Lasley (The end of stress as we know it, National Academic Press, Washington, 2003)—work-related stressors persist too long or the stress response is exaggerated (allostatic load) due to chronic stress induction and lack of recovery.

Keywords

Stress load Cortisol awakening response (CAR) Heart rate variability (HRV) Emergency physicians (EPs) Helicopter emergency medical services (HEMS) 

Abbreviations

ANS

Autonomic nervous system

AUC

Area under the curve

AUCG

Area under the curve with respect to ground

AUCI

Area under the curve with respect to increase

CAR

Cortisol awakening response

EPs

Emergency physicians

ESC

The European Society of Cardiology

HEMS

Helicopter emergency medical services

HF

Power in high-frequency range 0.15–0.4 Hz

Hf

Heart frequency

HRV

Heart rate variability

HPA-axis

Hypothalamic–pituitary–adrenal-axis

LF

Power in low-frequency range 0.04–0.15 Hz

LIA

Luminescence immunoassay

M

Mean value

NASPE

The North American Society of Pacing and Electrophysiology

ISPNE

International Society of Psycho-neuroendocrinology

PASA

Primary appraisal secondary appraisal

RMSSD

Root-mean-square successive differences

SDNN

Standard deviation of all NN intervals

TICS

Trier Inventory of Chronic Stress

Notes

Funding

This study was funded by the Roland Ernst Foundation Project “Identification of stressors due to organizational structures in airborne and ground-based emergency service”.

Compliance with ethical standards

Ethical approval

The study protocol was approved by the local Ethics Committee of the Medical Faculty of the Technical University of Dresden, Germany (No#EK348092011).

Informed consent

All participants signed the informed consent.

Conflict of interest

The authors have no conflict of interest to disclose.

Supplementary material

420_2018_1362_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Katja Petrowski
    • 1
    • 2
  • Benedict Herhaus
    • 2
  • Christian Schöniger
    • 1
  • Mark Frank
    • 3
    • 4
  • Jaroslaw Pyrc
    • 5
  1. 1.Department of Psychotherapy and Psychosomatic MedicineUniversity Hospital Carl Gustav Carus Dresden, Technische Universitaet DresdenDresdenGermany
  2. 2.Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and PsychotherapyUniversity Medicine MainzMainzGermany
  3. 3.Department of Emergency MedicineCity Hospital GörlitzGörlitzGermany
  4. 4.DRF Stiftung Luftrettung gemeinnützige AG, Air Rescue Base DresdenDresdenGermany
  5. 5.University Center for Orthopaedics and Traumatology, University Medicine Carl Gustav Carus DresdenDresdenGermany

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