| dc.description.abstract | Emergency medical services (EMS) provide a prehospital medical response 24 hours a day, 365 days a year, in all seasons. Physician staffed EMS (P-EMS) complement EMS, and in Norway, both helicopters from Helicopter EMS (HEMS) and physician staffed search and rescue (SAR) comprise the P-EMS response.
The missions, that these services perform, are multifaceted, complicated, and not without risk. The purpose of this thesis is therefore to describe the effects that potential stressors have on personnel who work in a prehospital environment, including their psychological wellbeing. There has been little scientific attention on this topic concerning P-EMS in Norway, and this setting is the main focus of the thesis. Medical and operational characteristics contribute as independent factors to the overall burden of stress in these services, and therefore studies 1-3 in this thesis aim to provide a contextual understanding of the heterogeneity and complexity that characterize the prehospital emergency medical environment. Studies 4-6 focus specifically on stressors and mental health status in this environment.
Study 1 was a prospective observational study at six P-EMS bases in Norway. We examined the physiologic profile of patients, and furthermore how this profile was related to on-scene time expenditure and critical care interventions. Of included patients, nearly half were considered severely ill or injured and almost one third were severely deranged physiologically. With increasing on-scene time fewer patients deteriorated and a greater proportion of patients improved.
Study 2 was a retrospective observational study of primary prehospital missions with patient contact performed in a Norwegian P-EMS. The primary aim of this study was to investigate the degree of inter-disciplinary cooperation between P-EMS and other emergency services. We found that the P-EMS cooperated with other agencies in the vast majority of cases, most extensively with the Ground-EMS (GEMS). During the study period, on-scene cooperation with general practitioners (GP‘s) decreased, whereas there was an increased cooperation with the fire service in a “first-responder” role during cardiac arrest missions.
Study 3 was a retrospective observational study of SAR and remote medevac missions performed at a Norwegian SAR helicopter and HEMS base. This study showed that the SAR helicopter, compared to HEMS, performed longer searches, had longer mission times and undertook a greater number of rescue extractions by performing hoist operations. By contrast, HEMS performed more remote medevac missions and advanced medical procedures. We concluded that both SAR and HEMS services perform SAR and remote medevac missions extensively. However, the mission profiles are different.
The first three studies provide an understanding of the operational complexity of P-EMS. In study 4 we performed a cross-sectional, anonymous, web-based survey of Norwegian P-EMS physicians. The aim of this survey was to study to what extent P-EMS physicians report the influence of specific stressors. In this study, Norwegian P-EMS physicians working in a prehospital environment reported an exposure to several environmental stressors, both danger-based and non-danger-based stressors, including exposure to accidents, threatening patient behaviour, and fatigue. However, there appeared to be very few serious incidents in the services, and the vast majority of physicians reported high job satisfaction.
In study 5 we performed a cross-sectional, anonymous, web-based survey among operative personnel employed in the Ground-EMS. G-EMS is the service that P-EMS cooperates most extensively with, and to a large degree, G-EMS treats the same patient population in similar operative settings, indicating that this service is also exposed to several of the same stressors found in P-EMS. Questions reported mental health status, including depression, anxiety, posttraumatic stress symptoms and descriptions of posttraumatic emotional change. This study indicated a prevalence of posttraumatic stress symptoms and depression, which was slightly higher for men, and lower for the female proportion in this study, when compared to an adult Norwegian population. The vast majority of respondents reported personal growth because of their work experience, and both the degree of peer support and having a partner seemed to influence levels of posttraumatic stress and -development.
In study 6 we applied the same survey concept as in study 5 to physicians and rescue paramedics employed in P-EMS. In this study, rescue paramedics and physicians in both services reported a lower prevalence of posttraumatic stress symptoms compared to a Norwegian adult population. The same applied for anxiety and depression. The majority of the participants described posttraumatic growth as a consequence of their work experience. Formalized, peer-to-peer support efforts, especially for physicians, could be improved.
Together, these six studies describe an operative and clinical context which is characterized by time constraints and the need to cooperate on a major scale, at times with elevated risk. At the same time, the aim of the services is to care for seriously ill and injured patients in an optimal manner. Personnel working within this context report high job satisfaction, and despite a potentially stressful, -challenging and -dangerous work climate, the majority of personnel in these services appear to be coping adequately with the mental strain. | en_US |
