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The Impact of Stress on Paramedic Performance During Simulated Critical Events

Published online by Cambridge University Press:  25 July 2012

Vicki R LeBlanc ,
Cheryl Regehr ,
Walter Tavares ,
Aristathemos K. Scott RN ,
Russell MacDonald  and
Kevin King
Vicki R LeBlanc*
Affiliation:
Wilson Centre and Faculty of Dentistry, Factor-Inwentash Faculty of Social Work and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Cheryl Regehr
Affiliation:
Factor-Inwentash Faculty of Social Work and Institute for Medical Sciences, University of Toronto, Toronto, Ontario, Canada
Walter Tavares
Affiliation:
Paramedic Program, School of Community & Health Studies, Centennial College, Toronto, Ontario, Canada
Aristathemos K. Scott RN
Affiliation:
Advanced Medical Solutions, Yellowknife, Northwest Territories, Canada
Russell MacDonald
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada and Ornge Transport Medicine, Mississauga, Ontario, Canada
Kevin King
Affiliation:
CAE Healthcare, Toronto, Ontario, Canada
*
Correspondence: Vicki R. LeBlanc, PhD Factor-Inwentash Faculty of Social Work and Department of Medicine University of Toronto 200 Elizabeth Street, 1ES-565 Toronto, Ontario M5G 2C4 E-mail vicki.leblanc@utoronto.ca
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Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusion

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.

LeBlanc VR, Regehr C, Tavares W, Scott AK, MacDonald R, King K. The impact of stress on paramedic performance during simulated critical events. Prehosp Disaster Med. 2012;27(4):1-6.

Keywords

cortisolparamedicperformancestress
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 4 , August 2012 , pp. 369 - 374
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

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References

1. Young, KM, Cooper, CL. Stress in ambulance personnel. In: Firth-Cozen J, Payne RL, eds. Stress in Health Professionals. Chichester, England, UK: John Wiley & Sons; 1999:119-132.Google Scholar
2. Regehr, C, Goldberg, G, Glancy, G, Knott, T. Post-traumatic stress and disability in paramedics. Can J Psychiatry. 2002;47(10):953-958.CrossRefGoogle ScholarPubMed
3. Regehr, C. Bringing home the trauma: spouses of paramedics. Journal of Loss and Trauma. 2005;10(2):97-114.CrossRefGoogle Scholar
4. Roth, SG, Moore, CD. Work-family fit: the impact of emergency medical services work on the family system. Prehosp Emerg Care. 2009;13(4):462-468.CrossRefGoogle ScholarPubMed
5. Stiell, IG, Wells, GA, Field, BJ, et al. . Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support. JAMA. 1999;281(13):1175-1181.CrossRefGoogle ScholarPubMed
6. Stiell, IG, Nesbitt, L, Wells, GA, et al. . Multi-center controlled clinical trial to evaluate the impact of advanced life support on out of hospital chest pain patients. Acad Emerg Med. 2003;10:501a-502a.CrossRefGoogle Scholar
7. Metzger, JC, Eastman, AL, Benitez, FL, Pepe, E. The lifesaving potential of specialized on-scene medical support for urban tactical operations. Prehosp Emerg Care. 2009;13(4):528-531.CrossRefGoogle ScholarPubMed
8. Kemeny, ME. The psychobiology of stress. Current Directions in Psychological Science. 2003;12(4):124-129.CrossRefGoogle Scholar
9. Lazarus, RS, Folkman, S. Stress, Appraisal and Coping. New York: Springer; 1984.Google Scholar
10. Harvey, A, Nathens, AB, Bandiera, G, LeBlanc, VR. Threat and challenge: cognitive appraisal and stress responses in simulated trauma resuscitations. Med Educ. 2010;44(6):587-594.CrossRefGoogle ScholarPubMed
11. Tomaka, J, Blascovich, J, Kelsey, RM, Leitten, CL. Subjective, physiological, and behavioral effects of threat and challenge appraisal. J Pers Soc Psychol. 1993;65(2):248-260.CrossRefGoogle Scholar
12. Tomaka, J, Blascovich, J, Kibler, J, Ernst, JM. Cognitive and physiological antecedents of threat and challenge appraisal. J Pers Soc Psychol. 1997;73(1):63-72.CrossRefGoogle ScholarPubMed
13. Takahashi, T, Ikeda, K, Ishikawa, M, et al. . Social stress-induced cortisol elevation acutely impairs social memory in humans. Neurosci Lett. 2004;363(2):125-130.CrossRefGoogle ScholarPubMed
14. Lieberman, HR, Tharion, WJ, Shukitt-Hale, B, Speckman, KL, Tulley, R. Effects of caffeine, sleep loss, and stress on cognitive performance and mood during U.S. Navy SEAL training. Psychopharmacology. 2002;164:250-261.CrossRefGoogle ScholarPubMed
15. Eysenck, MW, MacLeod, C, Mathews, A. Cognitive functioning and anxiety. Psychol Res. 1987;49(2-3):189-195.CrossRefGoogle ScholarPubMed
16. LeBlanc, V, Bandiera, G. The effects of examination stress on the performance of emergency medicine residents. Med Educ. 2007;41:556-564.CrossRefGoogle ScholarPubMed
17. Buchanan, TW, Tranel, D. Stress and emotional memory retrieval: effects of sex and cortisol response. Neurobiol Learn Mem. 2008;89(2):134-141.CrossRefGoogle ScholarPubMed
18. Regehr, C, LeBlanc, VR, Jelley, RB, Barath, I. Acute stress and performance in police recruits. Stress and Health. 2008;24(4):295-303.CrossRefGoogle Scholar
19. LeBlanc, VR. The effects of acute stress on performance: implications for health professions education. Acad Med. 2009;84(10):S25-S33.CrossRefGoogle ScholarPubMed
20. Kirschbaum, C, Klauer, T, Filipp, S-H, Hellhammer, DH. Sex-specific effects of social support on cortisol and subjective responses to acute psychological stress. Psychosom Med. 1995;57(1):23-31.CrossRefGoogle ScholarPubMed
21. Domes, G, Heinrichs, M, Rimmele, U, Reichwald, U, Hautzinger, M. Acute stress impairs recognition for positive words-association with stress induced cortisol secretion. Stress. 2004;7(3):173-181.CrossRefGoogle ScholarPubMed
22. National Occupancy Competency Profile. Kamloops, Canada: Paramedic Association of Canada, 2001.Google Scholar
23. LeBlanc, VR, MacDonald, RD, McArthur, B, King, K, Lepine, T. Paramedic performance in calculating drug dosages following stressful scenarios in a human patient simulator. Prehosp Emerg Care. 2005;9(4):439-444.CrossRefGoogle Scholar
24. Kudielka, BM, Schommer, NC, Hellhammer, DH, Kirschbaum, C. Acute HPA axis responses, heart rate, and mood changes to psychosocial stress (TSST) in humans at different times of day. Psychoneuroendocrinology. 2003;29(8):983-992.CrossRefGoogle Scholar
25. Dickerson, S, Kemeny, M. Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychol Bull. 2004;130(3):355-391.CrossRefGoogle ScholarPubMed
26. Spielberger, CD. Manual for the State-Trait Anxiety Inventory. Palo Alto, California USA: Consulting Psychologists Press; 1983.Google Scholar
27. Harris, B, Watkins, S, Cook, N, Walker, RF, Read, GF, Riad-Fahmy, D. Comparisons of plasma and salivary cortisol determinations for the diagnostic efficacy of the dexamethasone suppression test. Biol Psychiatry. 1990;27(8):897-904.CrossRefGoogle ScholarPubMed
28. Dressendorfer, RA, Kirschbaum, C, Rohde, W, Stahl, F, Strasburger, CJ. Synthesis of a cortisol-biotin conjugate and evaluation as a tracer in an immunoassay for salivary cortisol measurement. J Steroid Biochem Mol Biol. 1992;43(7):683-692.CrossRefGoogle Scholar
29. Thompson, M. Considering the implication of variations within Delphi research. Fam Pract. 2009;26(5):420-424.CrossRefGoogle ScholarPubMed
30. Regehr, G, MacRae, H, Reznick, RK, Szalay, D. Comparing the psychometric properties of checklists and global rating scales for assessing performance on an OSCE-format examination. Acad Med. 1998;73(9):993-997.CrossRefGoogle Scholar
31. Hodges, B, Herold McIlroy, J. Analytic global OSCE ratings are sensitive to level of training. Med Educ. 2003;37(11):1012-1016.CrossRefGoogle ScholarPubMed
32. Willingham, DT. Cognition: The Thinking Animal. Second Edition. Upper Saddle River, New Jersey: Pearson Prentice Hall; 2004.Google Scholar
33. Patterson, PD, Huang, DT, Fairbanks, RJ, Simeone, S, Weaver, M, Wang, HE. Variation in emergency medical services workplace safety culture. Prehosp Emerg Care. 2010;14(4):448-460.CrossRefGoogle ScholarPubMed
34. Inzana, CM, Driskell, JE, Salas, E, Johnston, JH. Effects of preparatory information on enhancing performance under stress. J Appl Psychol. 1996;81(4):429-435.CrossRefGoogle ScholarPubMed
35. Meichenbaum, D. Stress inoculation training for coping with stressors. Clin Psychol. 1996;49:4-7.Google Scholar
36. Gaab, J, Sonderegger, L, Scherrer, S, Ehlert, U. Psychoneuroendocrine effects of cognitive-bahavioral stress management in a naturalistic setting- a randomized controlled trial. Psychoneuroendocrinology. 2006;31(4):428-438.CrossRefGoogle Scholar
37. Saunders, T, Driskell, JE, Johnston, JH, Salas, E. The effects of stress inoculation training on anxiety and performance. J Occup Health Psychol. 1996;1(2):170-186.CrossRefGoogle ScholarPubMed