Literature reports that paramedics represent an at-risk occupation for the development of health problems. At least half of the paramedic population presents at least one risk factor associated with a negative health condition. These reports may suffer a “mono-method bias” where most reported outcomes are based on a single screening tool approach (may attenuate or inflate the prevalence).
OBJECTIVE:
The current study characterizes the health status of a cohort of twenty-five experienced New Brunswick (Canadian province) paramedics.
METHODS:
To understand possible limitations of past research, health status was characterized using four different methods: two methods using only one health measure and two were combined methods, integrating outcomes from at least two health measures to determine the prevalence of a given health status.
RESULTS:
Mono-bias was observed when using the single health measure methods. The difference among the four methods highlighted that a third of the cohort seemed unaware of their health condition. This result shed additional light on paramedics’ health, where a high proportion of paramedics worked without knowledge of their health conditions. Based on a two health measures combined method, it was observed that only two-fifths of the current sample had no health conditions or could otherwise be considered as a “healthy”.
CONCLUSIONS:
Because the literature has focused on single screening methods, our results were difficult to compare. However, there was a consensus that paramedics represent an at-risk occupation comprised of health problems. This study was exploratory and should be the basis for further research.
PekE, FugeK, MartonJ, BanfaiB, GombosGC, BetlehemJ. Cross-sectional survey on self-reported health of ambulance personnel. Scand J Trauma Resusc Emerg Med. 2015;23:14.
2.
PirralloRG, LevineR, DickisonPD. Behavioral health risk factors of United States emergency medical technicians: the LEADS Project. Prehosp Disaster Med. 2005;20(4):235–42.
3.
DropkinJ, MolineJ, PowerPM, KimH. A qualitative study of health problems, risk factors, and prevention among Emergency Medical Service workers. Work. 2015;52(4):935–51.
4.
JenkinsN, SmithG, StewartS, KamphuisC. Pre-employment physical capacity testing as a predictor for musculoskeletal injury in paramedics: A review of the literature. Work. 2016;55(3):565–75.
5.
PattersonPD, JonesCB, HubbleMW, CarrM, WeaverMD, EngbergJ, et al.The longitudinal study of turnover and the cost of turnover in EMS. Prehosp Emerg Care. 2010;14(2):209–21.
6.
PattersonPD, ProbstJC, LeithKH, CorwinSJ, PowellMP. Recruitment and retention of emergency medical technicians: a qualitative study. J Allied Health. 2005;34(3):153–62.
7.
StilwellJA, StilwellPJ. Sickness absence in an ambulance service. J Soc Occup Med. 1984;34(3):96–9.
8.
Health & Social Care Information Centre (HSCIC), Workforce and Facilities Team. NHS Sickness Absence Rates. 2016 Jul.
9.
GraingerCR. Mortality data of ambulancemen. J R Soc Health. 1985;105(1):28–30.
10.
MaguireBJ, HuntingKL, SmithGS, LevickNR. Occupational fatalities in emergency medical services: a hidden crisis. Ann Emerg Med. 2002;40(6):625–32.
11.
Hegg-DeloyeS, BrassardP, PrairieJ, LaroucheD, JauvinN, PoirierP, et al. Prevalence of risk factors for cardiovascular disease in paramedics. Int Arch Occup Environ Health. 2015;1-8.
12.
Hegg-DeloyeS, BrassardP, JauvinN, PrairieJ, LaroucheD, PoirierP, et al. Current state of knowledge of post-traumatic stress, sleeping problems, obesity and cardiovascular disease in paramedics. Emerg Med J. 2014;
13.
Bureau of Labor Statistics, U.S. Department of Labor. Nonfatal occupational injuries and illnesses requiring days away from work, 2014. New Release USDL 15-2205; 2015.
14.
Government of Canada, Canadian Centre for Occupational Health and Safety.Canadian Centre for Occupational Health and Safety (CCOHS) [Internet]. 2018 [cited 2018 Jul 21]. Available from: http://www.ccohs.ca/
15.
U.S. Department of Health & Human Services, Centers for Disease Control and Prevention (CDC). The National Institute for Occupational Safety and Health (NIOSH) [Internet]. 2018 [cited 2018 Jul 21]. Available from: https://www.cdc.gov/niosh/index.htm
16.
HansenCD, RasmussenK, KyedM, NielsenKJ, AndersenJH. Physical and psychosocial work environment factors and their association with health outcomes in Danish ambulance personnel –a cross-sectional study. BMC Public Health. 2012;12(1):534.
17.
OkadaN, IshiiN, NakataM, NakayamaS. Occupational stress among Japanese emergency medical technicians: Hyogo Prefecture. Prehosp Disaster Med. 2005;20(2):115–21.
18.
SterudT, EkebergØ, HemE. Health status in the ambulance services: a systematic review. BMC Health Serv Res. 2006;6:82.
19.
SterudT, HemE, EkebergO, LauB. Health problems and help-seeking in a nationwide sample of operational Norwegian ambulance personnel. BMC Public Health. 2008;8:3.
20.
CarletonRN, AfifiTO, TurnerS, TaillieuT, DuranceauS, LeBouthillierDM, et al.Mental Disorder Symptoms among Public Safety Personnel in Canada. Can J Psychiatry. 2018;63(1):54–64.
21.
StommelM, SchoenbornCA. Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001–2006. BMC Public Health. 2009;9:421.
22.
LenderinkAF, ZoerI, van der MolenHF, SpreeuwersD, Frings-DresenMHW, van DijkFJH. Review on the validity of self-report to assess work-related diseases. Int Arch Occup Environ Health. 2012;85(3):229–51.
23.
SpectorPE, RosenCC, RichardsonHA, WilliamsLJ, JohnsonRE. A New Perspective on Method Variance: A Measure-Centric Approach. Journal of Management. 201730;0149206316687295.
24.
KuorinkaI, JonssonB, KilbomA, VinterbergH, Biering-SørensenF, AnderssonG, et al.Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233–7.
25.
CrawfordJO. The Nordic Musculoskeletal Questionnaire. Occup Med (Lond). 2007;57(4):300–1.
26.
DickinsonCE, CampionK, FosterAF, NewmanSJ, O’RourkeAM, ThomasPG. Questionnaire development: an examination of the Nordic Musculoskeletal questionnaire. Appl Ergon. 1992;23(3):197–201.
27.
BlanchardEB, Jones-AlexanderJ, BuckleyTC, FornerisCA. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther. 1996;34(8):669–73.
28.
WilkinsKC, LangAJ, NormanSB. Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depress Anxiety. 2011;28(7):596–606.
29.
JohnsonDC, PolusnyMA, ErbesCR, KingD, KingL, LitzBT, et al.Development and initial validation of the Response to Stressful Experiences Scale. Mil Med. 2011;176(2):161–9.
30.
AntonovskyA. The structure and properties of the sense of coherence scale. Soc Sci Med. 1993;36(6):725–33.
31.
ErikssonM, LindstromB. Validity of Antonovsky’s sense of coherence scale: a systematic review. J Epidemiol Community Health. 2005;59(6):460–6.
32.
ErikssonM, LindströmB. Antonovsky’s sense of coherence scale and the relation with health: a systematic review. J Epidemiol Community Health. 2006;60(5):376–81.
33.
ErikssonM, LindströmB. Antonovsky’s sense of coherence scale and its relation with quality of life: a systematic review. J Epidemiol Community Health. 2007;61(11):938–44.
34.
IbrahimSA, ScottFE, ColeDC, ShannonHS, EylesJ. Job strain and self-reported health among working women and men: an analysis of the /5 Canadian National Population Health Survey. Women Health. 2001;33(1–2):105–24.
35.
CookG, BurtonL, HoogenboomB. Pre-Participation Screening: The Use of Fundamental Movements as an Assessment of Function –Part 1. N Am J Sports Phys Ther. 2006;1(2):62–72.
36.
LismanP, O’ConnorFG, DeusterPA, KnapikJJ. Functional movement screen and aerobic fitness predict injuries in military training. Med Sci Sports Exerc. 2013;45(4):636–43.
37.
PerryFT, KoehleMS. Normative data for the functional movement screen in middle-aged adults. J Strength Cond Res. 2013;27(2):458–62.
38.
BonazzaNA, SmuinD, OnksCA, SilvisML, DhawanA. Reliability, Validity, and Injury Predictive Value of the Functional Movement Screen: A Systematic Review and Meta-analysis. Am J Sports Med. 2016;
39.
BeckerDE. Fundamentals of Electrocardiography Interpretation. Anesth Prog. 2006;53(2):53–64.
40.
KleigerRE, SteinPK, BiggerJTJr.. Heart rate variability: measurement and clinical utility. Ann Noninvasive Electrocardiol. 2005;10(1):88–101.
41.
HillebrandS, GastKB, de MutsertR, SwenneCA, JukemaJW, MiddeldorpS, et al.Heart rate variability and first cardiovascular event in populations without known cardiovascular disease: meta-analysis and dose-response meta-regression. Europace. 2013;15(5):742–9.
42.
BeutnerF, UbrichR, ZachariaeS, EngelC, SandriM, TerenA, et al.Validation of a brief step-test protocol for estimation of peak oxygen uptake. Eur J Prev Cardiol. 2015;22(4):503–12.
43.
KaschFW, PhillipsWH, RossWD, CarterJE, BoyerJL. A comparison of maximal oxygen uptake by treadmill and step-test procedures. J Appl Physiol. 1966;21(4):1387–8.
44.
LaukkanenJA, RauramaaR, SalonenJT, KurlS. The predictive value of cardiorespiratory fitness combined with coronary risk evaluation and the risk of cardiovascular and all-cause death. J Intern Med. 2007;262(2):263–72.
45.
GuptaS, RohatgiA, AyersCR, WillisBL, HaskellWL, KheraA, et al.Cardiorespiratory Fitness and Classification of Risk of Cardiovascular Disease Mortality. Circulation. 2011;123(13):1377–83.
46.
Health Canada. CanadianGuidelines for BodyWeight Classification in Adults: Quick Reference Tool for Professionals. 2003.
47.
MolfinoA, FiorentiniA, TubaniL, MartuscelliM, FanelliFR, LavianoA. Body mass index is related to autonomic nervous system activity as measured by heart rate variability. Eur J Clin Nutr. 2009;63(10):1263–5.
48.
PrinslooGE, RauchHGL, DermanWE. A brief review and clinical application of heart rate variability biofeedback in sports, exercise, and rehabilitation medicine. Phys Sportsmed. 2014;42(2):88–99.
49.
DekkerJM, CrowRS, FolsomAR, HannanPJ, LiaoD, SwenneCA, et al.Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC Study. Atherosclerosis Risk In Communities. Circulation. 2000;102(11):1239–44.
50.
SteinPK, DomitrovichPP, HuikuriHV, KleigerRE, Cast Investigators. Traditional and nonlinear heart rate variability are each independently associated with mortality after myocardial infarction. J Cardiovasc Electrophysiol. 2005;16(1):13–20.
51.
DennisPA, WatkinsL, CalhounPS, OddoneA, SherwoodA, DennisMF, et al.Posttraumatic Stress, Heart-Rate Variability, and the Mediating Role of Behavioral Health Risks. Psychosom Med. 2014;76(8):629–37.
52.
GreenKT, DennisPA, NealLC, HobkirkAL, HicksTA, WatkinsLL, et al.Exploring the relationship between posttraumatic stress disorder symptoms and momentary heart rate variability. J Psychosom Res. 2016;82:31–4.
53.
KarpyakVM, RomanowiczM, SchmidtJE, LewisKA, BostwickJM. Characteristics of heart rate variability in alcohol-dependent subjects and nondependent chronic alcohol users. Alcohol Clin Exp Res. 2014;38(1):9–26.
54.
RomanowiczM, SchmidtJE, BostwickJM, MrazekDA, KarpyakVM. Changes in heart rate variability associated with acute alcohol consumption: current knowledge and implications for practice and research. Alcohol Clin Exp Res. 2011;35(6):1092–105.
55.
KempAH, QuintanaDS. The relationship between mental and physical health: insights from the study of heart rate variability. Int J Psychophysiol. 2013;89(3):288–96.
56.
KoenigJ, LoerbroksA, JarczokMN, FischerJE, ThayerJF. Chronic Pain and Heart Rate Variability in a Cross-Sectional Occupational Sample: Evidence for Impaired Vagal Control. Clin J Pain. 2016;32(3):218–25.
57.
ErickPN, SmithDR. A systematic review of musculoskeletal disorders among school teachers. BMC Musculoskelet Disord. 2011;12:260.
58.
MontezJK, HummerRA, HaywardMD. Educational Attainment and Adult Mortality in the United States: A Systematic Analysis of Functional Form. Demography. 2012;49(1):315–36.
59.
KarmakarCK, KhandokerAH, VossA, PalaniswamiM. Sensitivity of temporal heart rate variability in Poincaré plot to changes in parasympathetic nervous system activity. Biomed Eng Online. 2011;10:17.
60.
ShafferF, GinsbergJP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017;5.
61.
BrydgesM, DentonM, AgarwalG. The CHAP-EMS health promotion program: a qualitative study on participants’ views of the role of paramedics. BMC Health Serv Res. 2016;16(1):435.
62.
GarrisonM, WestrickR, JohnsonMR, BenensonJ. Association Between the Functional Movement Screen and Injury Development in College Athletes. Int J Sports Phys Ther. 2015;10(1):21–8.
63.
AasaU, Barnekow-BergkvistM, AngquistKA, BrulinC. Relationships between work-related factors and disorders in the neck-shoulder and low-back region among female and male ambulance personnel. Journal of occupational health. 2005;47(6):481–9.
64.
BarrettTW, NortonVC, BusamM, BoydJ, MaronDJ, SlovisCM. Self-reported cardiac risk factors in emergency department nurses and paramedics. Prehosp Disaster Med. 2000;15(2):14–7.
65.
KalesSN, TsismenakisAJ, ZhangC, SoteriadesES. Blood pressure in firefighters, police officers, and other emergency responders. Am J Hypertens. 2009;22(1):11–20.
66.
TsismenakisAJ, ChristophiCA, BurressJW, KinneyAM, KimM, KalesSN. The obesity epidemic and future emergency responders. Obesity (Silver Spring). 2009;17(8):1648–50.
67.
RodgersLM. A five-year study comparing early retirements on medical grounds in ambulance personnel with those in other groups of health service staff. Part I: Incidences of retirements. Occup Med (Lond). 1998;48(1):7–16.
68.
BergerW, CoutinhoESF, FigueiraI, Marques-PortellaC, LuzMP, NeylanTC, et al.Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Soc Psychiatry Psychiatr Epidemiol. 2012;47(6):1001–11.
69.
LiCY, SungFC. A review of the healthy worker effect in occupational epidemiology. Occup Med (Lond). 1999;49(4):225–9.
70.
ChowdhuryR, ShahD, PayalAR. Healthy Worker Effect Phenomenon: Revisited with Emphasis on Statistical Methods –A Review. Indian J Occup Environ Med. 2017;21(1):2–8.
71.
MalikM, BiggerJT, CammAJ, KleigerRE, MallianiA, MossAJ, et al.Heart rate variability Standards of measurement, physiological interpretation, and clinical use. Eur Heart J. 1996;17(3):354–81.
72.
HallmanDM, EkmanAH, LyskovE. Changes in physical activity and heart rate variability in chronic neck–shoulder pain: monitoring during work and leisure time. Int Arch Occup Environ Health. 20141;87(7):735–44.
73.
AasaU, BrulinC, ÄngquistK, Barnekow-BergkvistM. Work-related psychosocial factors, worry about work conditions and health complaints among female and male ambulance personnel. Scandinavian Journal of Caring Sciences. 2005;19(3):251–8.
74.
BronieckiM, EstermanA, MayE, GranthamH. Musculoskeletal disorder prevalence and risk factors in ambulance officers. Journal of Back & Musculoskeletal Rehabilitation. 2010;23(4):165–74.
