Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universitaet Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine Mainz, Duesbergweg 6, 55128, Mainz, Germany.
Int Arch Occup Environ Health. 2019 Feb;92(2):155-164. doi: 10.1007/s00420-018-1362-z. Epub 2018 Oct 12.
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.
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.
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)].
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.
直升机紧急医疗服务（HEMS）的急诊医师（EP）职业可以被描述为一种高压力职业（Karasek 在 Adm Sci Q 24(2):285-308. https://doi.org/10.2307/2392498, 1979）。因此，本研究的目的是测量和比较 HEMS 值班的 EP 在航空救护工作日和 2 个对照日的应激负荷。
在这项现场研究（自身对照设计）中，记录了 20 名 HEMS 的 EP[3 名女性，17 名男性；平均年龄（M）=44.95 岁，SD=4.80，95%置信区间（CI）（42.71，47.19）]在不同测试日的皮质醇觉醒反应（CAR）和心率变异性（HRV）的激素、生理和自我感知的应激水平。在航空救护和门诊工作日以及休息日在家时进行了 CAR（相对于地面的曲线下面积 F(2,38)=12.81，p<0.001）和 HRV（参数 SDNN F(2,38)=6.369；p=0.004）的测量。
在这 3 个测试日之间，CAR（相对于地面的曲线下面积 F(2,38)=12.81，p<0.001）存在显著差异，门诊工作日的最高值[M=81.24；98.75%置信区间（61.24，101.24）]与航空救护日[M=61.82；98.75%置信区间（45.18，78.46）]和休息日[M=52.96；98.75%置信区间（38.17，67.76）]不同。此外，HRV 参数 SDNN [F(2,38)=6.369；p=0.004]在这 3 个测试日之间也存在显著差异，门诊工作日的水平较低[M=101.44；98.75%置信区间（83.50，119.38）]与航空救护日[M=120.16；98.75%置信区间（100.02，140.30）]和休息日[M=123.79；98.75%置信区间（106.49，141.10）]不同。此外，HRV 参数 LF/HF [F(2,38)=6.215；p=0.005]在这 3 个测试日之间也存在显著差异，门诊工作日的最高值[M=8.69；98.75%置信区间（6.29，11.09）]与航空救护日[M=6.54；98.75%置信区间（4.50，8.57）]和休息日[M=6.43；98.75%置信区间（4.57，8.29）]不同。
与标准值和以往研究相比，HEMS 的 EP 在早上的激素反应性增加，而自主神经系统的恢复不足。可以得出结论，根据 McEwen 和 Lasley 的心理生物学应激模型（我们所知道的应激的终结，国家学术出版社，华盛顿，2003 年），工作相关的应激源持续时间过长，或由于慢性应激诱导和缺乏恢复，应激反应被夸大（适应性负荷）。
