Wilson Centre and Faculty of Dentistry, Factor-Inwentash Faculty of Social Work and Department of Medicine, University of Toronto, Ontario, Canada.
Prehosp Disaster Med. 2012 Aug;27(4):369-74. doi: 10.1017/S1049023X12001021. Epub 2012 Jul 25.
Substantial research demonstrates that the stressors accompanying the profession of paramedicine can lead to mental health concerns. In contrast, little is known about the effects of stress on paramedics' ability to care for patients during stressful events. In this study, we examined paramedics' acute stress responses and performance during simulated high-stress scenarios.
Twenty-two advanced care paramedics participated in simulated low-stress and high-stress clinical scenarios. The paramedics provided salivary cortisol samples and completed an anxiety questionnaire at baseline and following each scenario. Clinical performance was videotaped and scored on a checklist of specific actions and a global rating of performance. The paramedics also completed patient care documentation following each scenario.
The paramedics demonstrated greater increases in anxiety (P < .05) and salivary cortisol levels (P < .05) in response to the high-stress scenario compared to the low-stress scenario. Global rating scores were significantly lower in the high-stress scenario than in the low-stress scenario (P < .05). Checklist scores were not significantly different between the two scenarios (P = .12). There were more errors of commission (reporting information not present in the scenario) in the patient care documentation following the high-stress scenario than following the low-stress scenario (P < .05). In contrast, there were no differences in omission errors (failing to recall information present in the scenario) between the two scenarios (P = .34).
Clinical performance and documentation appear vulnerable to the impact of acute stress. This highlights the importance of developing systems and training interventions aimed at supporting and preparing emergency workers who face acute stressors as part of their every day work responsibilities.
大量研究表明，伴随急救医学职业而来的压力源会导致心理健康问题。相比之下，人们对压力对急救人员在紧张事件中照顾患者的能力的影响知之甚少。在这项研究中，我们研究了急救人员在模拟高压力情景下的急性应激反应和表现。
22 名高级护理急救人员参与了模拟的低压力和高压力临床情景。急救人员在基线和每个情景后采集唾液皮质醇样本并完成焦虑问卷。临床表现通过特定操作清单和整体表现评分进行录像和评分。急救人员还在每个情景后完成患者护理文件记录。
与低压力情景相比，急救人员在高压力情景下表现出更大的焦虑（P<.05）和唾液皮质醇水平升高（P<.05）。高压力情景下的整体评分明显低于低压力情景（P<.05）。清单评分在两个情景之间没有显著差异（P=.12）。高压力情景下的患者护理文件记录中出现更多的错误（报告情景中不存在的信息）（P<.05）。相比之下，两个情景之间遗漏错误（未能回忆情景中存在的信息）没有差异（P=.34）。
临床表现和文件记录似乎容易受到急性压力的影响。这凸显了开发系统和培训干预措施的重要性，旨在支持和准备每天工作中面临急性压力源的应急人员。
