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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)

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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.

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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

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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”.

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Authors and Affiliations

  1. Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universitaet Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Katja Petrowski & Christian Schöniger

  2. Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine Mainz, Duesbergweg 6, 55128, Mainz, Germany

    Katja Petrowski & Benedict Herhaus

  3. Department of Emergency Medicine, City Hospital Görlitz, Görlitz, Germany

    Mark Frank

  4. DRF Stiftung Luftrettung gemeinnützige AG, Air Rescue Base Dresden, Dresden, Germany

    Mark Frank

  5. University Center for Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Dresden, Germany

    Jaroslaw Pyrc

Authors
  1. Katja Petrowski
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  2. Benedict Herhaus
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  3. Christian Schöniger
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  4. Mark Frank
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Corresponding author

Correspondence to Katja Petrowski.

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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).

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All participants signed the informed consent.

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The authors have no conflict of interest to disclose.

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Petrowski, K., Herhaus, B., Schöniger, C. et al. Stress load of emergency service: effects on the CAR and HRV of HEMS emergency physicians on different working days (N = 20). Int Arch Occup Environ Health 92, 155–164 (2019). https://doi.org/10.1007/s00420-018-1362-z

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