Differences in Cardiovascular Health Metrics in Emergency Medical Technicians Compared to Paramedics: A Cross-Sectional Study of Emergency Medical Services Professionals

Abstract

Background:Emergency Medical Services (EMS) professionals face high physical demands in high-stress settings; however, the prevalence of cardiovascular health (CVH) risk factors in this health care workforce has not been explored. The primary objective of this study was to compare the distribution of CVH and its individual components between a sample of emergency medical technicians (EMTs) and paramedics. The secondary objective was to identify associations between demographic and employment characteristics with ideal CVH in EMS professionals.Methods:A cross-sectional survey based on the American Heart Association’s (AHA; Dallas, Texas USA) Life’s Simple 7 (LS7) was administered to nationally-certified EMTs and paramedics. The LS7 components were scored according to previously described cut points (ideal = 2; intermediate = 1; poor = 0). A composite CVH score (0-10) was calculated from the component scores, excluding cholesterol and blood glucose due to missing data. Multivariable logistic regression was used to estimate odds ratios (OR; 95% CI) for demographic and employment characteristics associated with optimal CVH (≥7 points).Results:There were 24,708 respondents that were currently practicing and included. More EMTs achieved optimal CVH (n = 4,889; 48.8%) compared to paramedics (n = 4,338; 40.6%). Factors associated with higher odds of optimal CVH included: higher education level (eg, college graduate or more: OR = 2.26; 95% CI, 1.97-2.59); higher personal income (OR = 1.26; 95% CI, 1.17-1.37); and working in an urban versus rural area (OR = 1.31; 95% CI, 1.23-1.40). Paramedic certification level (OR = 0.84; 95% CI, 0.78-0.91), older age (eg, 50 years or older: OR = 0.65; 95% CI, 0.58-0.73), male sex (OR = 0.54; 95% CI, 0.50-0.56), working for a non-fire-based agency (eg, private service: OR = 0.68; 95% CI, 0.62-0.74), and providing medical transport service (OR = 0.81; 95% CI, 0.69-0.94) were associated with lower odds of optimal CVH.Conclusions:Several EMS-related characteristics were associated with lower odds of optimal CVH. Future studies should focus on better understanding the CVH and metabolic risk profiles for EMS professionals and their association with incident cardiovascular disease (CVD), major cardiac events, and occupational mortality.Cash RE, Crowe RP, Bower JK, Foraker RE, Panchal AR. Differences in cardiovascular health metrics in emergency medical technicians compared to paramedics: a crosssectional study of Emergency Medical Services professionals. Prehosp Disaster Med. 2019;34(3):288–296.

Comparing the Prevalence of Poor Sleep and Stress Metrics in Basic versus Advanced Life Support Emergency Medical Services Personnel

“…Those at the ALS certification level were slightly older (mean age 37.1 years) compared to those at the BLS level (mean age 32.8 years). As seen in past samples of this population (6,7,37), most respondents were men and non-Hispanic white, with some differences between ALS and BLS EMS personnel. There was a higher population proportion of men (78%) and non-Hispanic whites (86%) for ALS compared to BLS (67% men, 74% non-Hispanic white).…”

“…Descriptive statistics with appropriate survey weighting were calculated. Based on prior work demonstrating that some key health outcomes differ between demographic groups within EMS, prevalence estimates were compared across age groups, sex, and EMS certification levels (6,7). For all descriptive statistics, unweighted frequency and population-weighted proportion or weighted mean and standard error are presented.…”

“…Typical response rates to electronic surveys among nationally-certified EMS professionals have been between 10-12% (2,7,8). To adjust for nonresponse and differential response rates, survey weights were created based on variables that are related to response rates in this population, specifically certification level, sex, and minority status (28).…”

“…Chronic diseases are also common, with approximately 24% of EMS personnel reporting a diagnosis of a chronic health condition like diabetes or hypertension (6). Differences in health outcomes between basic life support (BLS) and advanced life support (ALS) EMS personnel have been described, with those at the ALS level reporting increased odds of burnout, lower prevalence of ideal cardiovascular health, and increased odds of chronic health conditions (6)(7)(8).…”

Associations between sleep, stress, and cardiovascular health in emergency medical services personnel

“…Previous work has shown that EMS personnel have a high prevalence of poor health for certain LS7 components such as obesity, poor diet, and inadequate physical activity. 7 , 8 , 9 EMS personnel also have a high prevalence of non‐traditional CVD risk factors, such as poor sleep quality, short or long sleep duration, and high stress, 10 , 11 , 12 , 13 which may further increase the risk of developing CVD. No prior studies have examined the relationship between sleep, stress, and CVH within the occupational group of EMS personnel.…”