College of Social Work, Florida State University, Tallahassee, Florida, USA.
Prehosp Disaster Med. 2009 Sep-Oct;24(5):422-9. doi: 10.1017/s1049023x00007251.
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.
A systematic review of the literature was conducted utilizing relevant 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.
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.
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.
在医疗急救中，美国公众往往依赖急救医疗技术员（EMT）的专业知识。这些专业人员面临着许多职业危害，文献表明 EMT 更有可能患上与身体和精神压力相关的疾病。本文旨在系统地检查现有文献中的差距，并提出一个理论驱动的概念模型，作为未来干预和研究工作的基础。
利用相关数据库（如 PsychInfo、Medline）对文献进行系统综述。综述了所有关于紧急医疗救援人员的实证文章，但由于研究有限，还包括了其他相关人群中感兴趣的构念的相关理论和概念文献。基于这一广泛的综述，建议修改应激过程模型，以解释职业应激暴露、创伤后应激障碍（PTSD）以及高风险酒精和其他药物使用之间的关系。
据报道， EMT 接触创伤性事件的比例为 80%至 100%，PTSD 发生率超过 20%。其他紧急救援专业人员的高风险酒精和药物使用率高达 40%。所提出的模型表明，职业相关应激暴露与 PTSD 以及高风险酒精和其他药物使用之间存在直接联系，包括慢性和重大事件应激。社会支持和个人资源（如应对、控制源）被提议对三个主要构念具有中介和调节作用，凝聚力被引入到这个群体中作为一个重要的、特殊的影响因素。该模型还包括性别、年龄、种族、婚姻状况和社会经济地位、培训水平和服务年限等调节因素的影响。
高风险酒精和其他药物使用以及创伤后症状对 EMT 构成了重大风险，因此也对他们所服务的患者构成了重大风险。研究人员必须开发和测试一个基于风险和保护因素的理论模型，以指导干预措施的制定和未来的研究。本文提出的模型，基于对文献的全面综述和理论的发展，代表了干预研究过程中的关键第一步。
