Effects of an Unwell Workforce

EMS providers are critical to the nation’s healthcare and public health infrastructure, but their jobs are enormously difficult. Working daily under stressful situations, they often neglect their own health and welfare for reasons such as fatigue, lack of access to services, and lack of knowledge about how to care for themselves.

Providers report being concerned about not having enough information or resources to help patients, being exposed to aggressive patients, responding to mass-casualty incidents, being exposed to contaminants, and sustaining physical injuries, among many other worries. 

This can all lead to high levels of physical and mental stress that can translate into job injuries, chronic medical problems, and missed workdays. Physical, mental, and emotional health are deeply intertwined.

A study recently published in Prehospital Emergency Care delved into the physical wellness of EMS providers in North Carolina.¹ Its findings were concerning and may point toward the need for a more systematic agency-level approach to provider wellness. 

In the study a total of 452 EMS providers were assessed as they delivered patients to four of North Carolina’s tertiary care trauma centers. Participants agreed to measurements of height, weight, and blood pressure; they also completed a survey measuring their personal wellness habits, including activity levels, alcohol consumption, smoking, and medical history. 

The study found surprising levels of overweight and obese EMS providers (80.3%). This prevalence is significantly higher than that of the general U.S. population (70.8%).

While only 18.3% of participants in the study reported a history of hypertension, 65.1% of them had elevated BP measurements. 

Alcohol consumption in the past 30 days among participants (55.4%) was slightly higher than state estimates (48.0%) and similar to national estimates (57.1%).

Heavy drinking (22.2%) and binge drinking (28.8%) were reported at much higher rates than national estimates (6.6% and 18.3% respectively). Use of tobacco products was similar to national estimates: 21.5% currently smoked, vs. 21.2% nationally; 48.8% had tried to quit, vs. 55.7%.

The proportion of EMS providers meeting the CDC’s activity guidelines (49.6%) was similar to that found in the general U.S. population (48%). 

Engaging a Healthy Workforce

Weight—The study suggests a number of areas for attention and intervention in EMS provider wellness. Eight of every 10 providers weighed were overweight or obese. Five fell into the superobese category, with BMIs greater than 50. 

Maintaining a healthy weight can be extremely difficult for EMS providers, who may not be able to return to a station during mealtimes. Providers often eat fast food or graze on snacks to sustain themselves on shift. Additionally, they often do not have access to exercise equipment in the station and are more sedentary than is ideal.

Providers work long and often unpredictable shifts, frequently getting off late due to late calls. EMS is a 24/7 business, so providers work night shifts and are often not allowed to sleep during downtimes. Night-shift workers have been found to be more overweight than other shift workers.² Obese and overweight persons are more prone to hypertension, cardiovascular disease, stroke, and musculoskeletal ailments such as injury, back strain, and arthritis. All of these can prematurely end an EMS provider’s career. 

EMS agencies may want to preserve their highly trained workforce with a number of strategies. Wake County EMS in Raleigh, N.C., recently installed exercise equipment in their stations to provide an opportunity to exercise while on duty. While many EMS agencies may not have the financial resources for equipment, simple encouragements to walk while on duty or to develop fitness teams may pay big dividends in provider wellness and retention. 

Hypertension—While only 18.3% of participants in the study reported a history of hypertension, 65.1% had elevated blood pressure measurements. Providers with elevated BP measurements were more likely to be overweight and sedentary. Similar findings have been reported in the fire service. 

Hypertension is sometimes called “the silent killer,” as people are not aware they have it until it affects their heart, kidneys, or brain. EMS agencies should encourage providers to have regular primary care appointments. Information sessions on common health problems could be a regular feature of continuing education programs as well. 

Health habits—Alcohol use in the PEC study was similar to national estimates, with 55.4% of the study sample having consumed alcohol in the last 30 days. Unfortunately, heavy drinking (22.2%) and binge drinking (28.8%) were reported at much higher rates than national estimates (6.6% and 18.3% respectively). Tobacco use was reported in a fifth of the study population, a rate that has been steadily decreasing over the past several decades. 

Interestingly, given the rate of overweight and obese subjects, providers reported exercising at a rate similar to national estimates. EMS agencies could provide information on healthy habits for personnel. Most agencies do not have the authority or ability to influence a provider’s off-hours, so this requires creative solutions. Agencies can also provide substance use counseling and support. 

Overall Health

The National Wellness Institute promotes six dimensions of wellness: emotional, occupational, physical, social, intellectual, and spiritual.³ It defines wellness as “an active process through which people become aware of, and make choices toward, a more successful existence.” 

Wellness is more than not being ill; it’s a dynamic process that focuses on keeping the body in good condition. Resilience is the process of adapting well in the face of adversity and stress—the ability to bounce back from difficult experiences. Resilient people cope better and more rapidly resume their lives after facing trauma, tragedy, threats, or significant stress. Some people may be more resilient than others, but it’s a set of skills that involves behavior, thoughts, and actions that can be taught and learned by anyone. 

A combination of factors contributes to resilience, which includes having caring and supportive relationships, the capacity to make realistic plans, a positive view and confidence in one’s strengths, and the ability to stay balanced and manage strong or difficult emotions. Since these sets of skills and behavior that construct resilience can be learned, it is a fertile area for EMS agencies interested in the wellness of their providers. 

Providing EMS is a high-stress job. Providers work with aggressive patients, face infectious disease, and work long and unusual hours that contribute to family stress. EMS agencies should engage their providers in discussions of wellness and provide a setting that encourages and promotes good physical, mental, and emotional health.  

References

1. Brice JH, Cyr JM, Hnat AT, et al. Assessment of key health and wellness indicators among North Carolina emergency medical service providers. Prehosp Emerg Care, 2019 Mar–Apr; 23(2): 179–86.

2. Sun M, Feng W, Wang F, et al. Meta-analysis on shift work and risks of specific obesity types. Obes Rev, 2018 Jan; 19(1): 28–40. 

3. National Wellness Institute. The Six Dimensions of Wellness, www.nationalwellness.org/page/Six_Dimensions.

Mariecely Luciano Feijoó, MD, is an emergency medicine physician in Chapel Hill, N.C.

Jane H. Brice, MD, MPH, is chair of the Department of Emergency Medicine and director of the EMS fellowship program at the University of North Carolina in Chapel Hill, N.C., as well as a member of the EMS World editorial advisory board.