A new study published in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine assessed the psychobiological demands of high-fidelity training in pre-hospital emergency medicine.
“Individuals who provide emergency medical services mount physiological responses including activation of the nervous and endocrine systems,” study author Mark Wetherell told us. “These responses are highly adaptive and provide the energy resources to deal with the situation, however, frequent and sustained responding, with little opportunity for recovery, causes wear and tear on the body and this can lead to increased risk of stress-related illness.”
It is difficult to assess these responses in real life, so observing training scenarios provides a viable alternative. It is particularly useful if these training scenarios are realistic, so that observations are representative of what would happen in real life emergency situations. The training course run by Great North Air Ambulance is high fidelity. It mimics real life environments and allowed the researchers to get a comprehensive understanding of how individuals function while providing emergency medical care.
“The training course is designed to be challenging and high fidelity,” Wetherell told us. “We know that these scenarios would lead to increases in physiological responding, so we were expecting to observe high levels of biological (heart rate and cortisol) and psychological (anxiety, demand) markers. Situations where levels of demand are high, but people do not feel in control, tend to be perceived as more stressful. We were therefore expecting to see higher levels of physiological responding on demanding days with lower perceived control.”
Emergency medicine is an extremely important discipline. The people who work in this area are extremely talented and dedicated, however, the work is highly demanding and associated with high levels of stress and burnout.
“We therefore need to have a better understanding of how the demands of this job can impact on psychological and physical wellbeing,” Wetherell told us. “As I live in the Northeast, I was interested in the work of the Great North Air Ambulance Service. When I learnt about their high-fidelity training, I saw a great opportunity to assess the demands of emergency medicine in a realistic environment that wouldn’t impact on patient care. I worked alongside the course directors to see how we could most effectively assess functioning without impacting on the training.”
Wetherell developed a protocol that allowed him to assess the physiological systems involved in stress responding; measuring heart rate using smartwatches to observe the nervous system and measuring the hormone cortisol in saliva samples to observe the endocrine system. Alongside diaries completed after waking ad before bed, Wetherell was able to get a comprehensive overview of the biological and psychological functioning of people during the course. Wetherell could then look at these response in relation to expected demands of the training scenarios carried out each day.
“The physiological and psychological responses demonstrated that the course is demanding and is a good representation of how people would function in real life emergency situations,” Wetherell told us. “The greatest levels of physiological responding and highest levels of stress were observed on those day perceived as the most demanding and with the lowest level of perceived control.”
This occurred on the days that were most representative of emergency responding in the real world. The lowest levels of physiological responding and stress were observed on non-training days. These were also perceived as days with the least demand and where people through they had more control.
“This in itself is not surprising, but the lower levels of physiological responding on rest days clearly demonstrates the importance of recovery,” Wetherell told us. “When people have the opportunity for recovery, their physiological systems can rest and reset, and this may prevent the negative effects of stress and burnout that are observed in this profession.”
The results show that physiological responding is not a bad thing. In situations of high demand, physiological responding is really important and ensures that people can function appropriately.
“This is exactly what we need in those delivering emergency medical care,” Wetherell told us. “But the results also highlight the importance of recovery. We can’t continually respond and need opportunities for recovery. This is known by those in the profession, but it needs to be supported.”
The use of smartwatches allowed the research team to measure physiological responding continuously. So far, they have analyzed what responding looks like on particular training days, but next they will analyze what physiological responding looks like before and after training events – if people are worried about what is going to happen, or what has happened, what impact does this have on their physiological responses. This next stage will give researchers a really important insight into how people prepare and recover in emergency medicine.