Stress and salivary cortisol in emergency medical dispatchers: A randomized shifts control trial

Abstract

Stress at work is a public health concern. Phone operators in emergency medical dispatch centers are particularly at risk. We aimed to demonstrate that the most stressful time for emergency medical dispatchers is the shift when they receive emergency incoming calls, with cortisol as a biomarker of stress. For each emergency medical dispatcher, we measured outcomes over a control day and during three types of shift: Incoming emergency call, Dispatch and Re-assessment. The pattern of shifts was randomized. Saliva was sampled every 15 minutes for 2 hours, i.e. 6 consecutive times, starting 15 minutes after the first life-and-death incoming emergency call between 2 and 5 pm during three types of shift. We measured saliva cortisol every 2 hours over a control day, from 7am to 9pm. Perceived stress was assessed by a visual analog scale. We recruited 22 phone operators aged 36.4+/-10.8 years old (14 women and 8 men). Cortisol values were higher during the Incoming emergency call shift than during the Dispatch (p = .04) and Re-assessment (p = .04) shifts. The increase in cortisol levels was greater in men than in women (p = .009). There were no differences between control values and those of the three shifts. The kinetics of cortisol increased with greater perceived stress overall (p < .001) and for each type of shift (Incoming emergency call, p = .02; Dispatch p = .03; Re-assessment: p < .001). The kinetics of cortisol in response to incoming emergency calls was greater when the call was an absolute emergency (p = .03), and also tended to further increase when a subsequent absolute incoming emergency call was received (p = 0.07). In conclusion, the incoming emergency call shift carries particular risk for dispatchers, who have greater perceived stress and a greater increase in cortisol levels.

A Review of Selected Studies That Determine the Physical and Chemical Properties of Saliva in the Field of Dental Treatment

“…They noted higher levels of cortisol during shift work and in the subgroup of men. Higher cortisol levels are also observed during a serious life-threatening condition [ 78 ].…”

Physiological Stress Markers Following Resuscitations Remain Elevated Throughout Physician Shift Hours

“…This is consistent with data from simulated and real resuscitations, 1,8 but our data note that cortisol levels remain elevated for many hours following the resuscitation. In emergency medical dispatchers, cortisol levels increase with life‐threatening calls, even 2 hours following the call 9 . Disturbances in cortisol levels are associated with posttraumatic stress disorder 10 .…”

A Revised Ecological Model of Occupational Stress: Applications to 9-1-1 Telecommunicators

“…TCs are also exposed indirectly to the vicarious trauma of “first party calls” from victims, family members, or observers who have just witnessed or are experiencing a crime, serious injury, or medical emergency (Golding et al, 2017). Bedini et al (2017) recently reported that levels of salivary cortisol, as a biomarker of stress, were elevated in those emergency medical dispatchers who received an incoming call that required an immediate dispatch of a medical aide unit. To maintain their effectiveness, TCs are also required to learn and master new technical skills as emergency call center systems undergo routine system upgrades.…”