Fit for duty: context and correlates of paramedic health status and job performance

Sandy MacQuarrie

Research output: ThesisDoctoral Thesis

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This thesis is an exploration of paramedic health status and how the demands of their job may influence their health. It begins with an overview of the role of paramedics in the health care system and, importantly, an explanation of the structure of Emergency Medical Services Systems. Their role is explored in settings both nationally and internationally. The first study, as reported in Chapter 3, surveyed the self-reported health status and physical activity (PA) levels of paramedics working for New South Wales Ambulance (NSW Ambulance) in New South Wales, Australia. Data was collected from 747 respondents (507 male, 230 female) and included Body Mass Index (BMI), demographic data, their self-reported Health Related Quality of Life (HRQoL) using the Medical Outcome Survey Short Form 36 (SF-36) and PA levels using the International Physical Abilities Questionnaire (IPAQ). Paramedic health status was explored by gender, posting, level of certification and primary role. Their data were compared with that from the Australian population using data from Household Labour Income Dynamics in Australia (HILDA) Wave 13 survey. There was an exploration of paramedics’ perceived barriers to exercise. There were few significant differences in reporting of HRQoL scores of paramedics by gender and posting. However, there were significantly lower paramedic HRQoL scores compared to the Australian population in six of eight domains and both summary scores. There were small but significant differences in BMI between paramedics by gender and posting (p< 0.001) and between the paramedics and the Australian population (p= 0.01). From paramedics’ survey answers, perceived barriers to exercise most frequently reported were family commitments and lack of time. Regional rostered paramedics reported the barrier of lack of exercise facilities significantly more often than metropolitan rostered paramedics (p<0.001). Physical activity level, reported as median total MET-minutes were 3626 (IQR 1737 – 6537). Males reported significantly higher PA scores than females (p< 0.02) with no significant difference by posting. Median total MET-minutes reported by NSW Ambulance paramedics seem much higher than other studies. High BMI and low SF-36 scores may be related to a perceived inability to engage in regular exercise and the effects of shift work, especially in regional areas. The second study, as reported in Chapter 4, was the validation of the Hexoskin® biometric shirt, specifically its ability to monitor physiological measures of heart rate (HR) and respiratory rate (RR). The Hexoskin® was to be used in an applied research setting, with paramedics wearing it while responding to emergency calls. Heart rate and RR of twenty cyclists wearing the Hexoskin® biometric shirt were compared to standard laboratory devices of ECG and a metabolic cart under four conditions: (1) 85% steady state (rest), (2) 85% steady state (final minute), (3) V̇O2 max (rest) and (4) V̇O2 max (final minute). Measures of HR between the Hexoskin® and the ECG were not significantly different with good Intraclass Correlation Coefficient (ICC). Bland-Altman plots revealed low bias with good agreement. Measures of RR between the Hexoskin® and the metabolic cart were not significantly different with good ICC. Bland-Altman plots revealed low bias with good agreement. Based on this study and the work of others, the Hexoskin® biometric shirt is a reliable and valid method of measuring HR and RR data in conditions including intense physical activity. The validation study allowed a familiarisation process with the Hexoskins in advance of their use in the third and fourth studies. The third study, as reported in Chapter 5, aimed to establish and compare descriptive profiles of two distinct groups of NSW Ambulance paramedics (metropolitan and regional rostered paramedics) and the variables affecting physiological response during emergency calls. It utilised continuous biometric monitoring to measure HR, RR and occupational physical activity (OPA) combined with self-reported measures of non-invasive mean arterial pressure (MAP) and Rate of Perceived Exertion (RPE). Thirty-two paramedics (38.8 ± 8.8 yrs., males 40.6 ± 8.9 yrs., females 35.7 ± 7.4 yrs.) completed a total of 232 shifts (7.3 ± 2.1 shifts/paramedic) establishing a descriptive profile of paramedics. Paramedics completed a total transport to hospital of 3.3 ± 1.7 patients per shift (metropolitan 3.2 ± 1.7, regional 3.4 ± 1.7, p= 0.29). Time (hrs) on all calls for each shift were 4.4 ± 2.4 hrs (metropolitan 5.0 ± 2.6, regional 3.9 ± 2.0 hrs, p< 0.001, d= 0.5). Differences in the physiological parameters were examined from shift start (at rest), during emergency call outs (by call epoch and total call) and shift average. The variables of age, posting, and BMI, also significantly influenced the model. Heart rate and RR increased significantly by seriousness of call priority and by epoch (Assign and On Scene epoch). Mean arterial pressure and RPE were not significantly different by Chief Complaint, but both increased significantly from shift start to shift end (p< 0.01). Occupation physical activity levels were classed as “Low” and steps per shift were below Australian recommended steps per day. Paramedics had significant changes in HR and RR by call priority, epoch, BMI, posting and type of shift. The fourth and final study, as reported in Chapter 6, utilised the Multi-Stage Shuttle Test to estimate the cardiorespiratory fitness (CRF) levels (V̇O2 max and V̇O2 max by category) and established Heart Rate maximum (HRmax) of 14 of the 32 paramedics from Study 3. Differences and associations between the HR, %HRmax, RR, MAP and RPE with CRF were examined. A self-reported measure of HRQoL (SF-36) was employed to examine correlations between those scores with BMI and V̇O2 max. Paramedics who had a higher level of CRF had a lower maximal HR on all calls and by Priority Code and exhibited a lower %HRmax. V̇O2 max values varied from 23-43 mL/kg/min. CRF did not influence HR or %HRmax while performing CPR during cardiac arrest, although results may be affected by sample size. There were few significant correlations between V̇O2 max and HRQoL scores except for general health domain of the SF-36 (r= .571, p= 0.03). Through paramedic self-report and objective measures, it appears that the profession of paramedicine influences health status. This research has provided evidence that paramedic job performance is influenced by aspects of health status and other variables: CRF, BMI, Priority Code response, gender and posting. Not enough is known about the demands of paramedic job performance therefore further study should examine paramedic job demands to better understand the impact or influence of physiological changes on a) clinical performance, b) physical performance and c) resiliency. Paramedic services and the paramedics themselves should recognise, value and promote good health in paramedics.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Charles Sturt University
  • Wickham, James, Principal Supervisor
  • Drinkwater, Eric, Co-Supervisor
  • Crane, James, Co-Supervisor
  • Micalos, Peter, Principal Supervisor
Place of PublicationAustralia
Publication statusPublished - 2019


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