A study assessed the psychobiological functioning of 27 Pre-Hospital Emergency Medical doctors and paramedics over two weeks. Results suggested that the increases in psychological and biological stress responding during periods of emergency are adaptive and essential. However, when professionals frequently face emergencies, the body must respond too often and for too long, which can impact well-being and may lead to burnout. The research highlights the importance of recovery periods to maintain the health and well-being of medical professionals.

Situations, where the perceived demands of an event exceed our perceived ability to cope, are interpreted as challenging or threatening and can lead to stress. To cope with these challenging events or stressors, biological mechanisms are activated, which through the secretion of the hormones adrenaline and cortisol, facilitate the liberation and mobilisation of energy resources to deal with threats.

The experience of acutely challenging events is a ubiquitous feature of those who provide critical emergency care and adapt by mounting rapid physiological responses to provide the resources needed to deal with the emerging situation. The nature of this professional occupation, however, means that these responses are likely to be frequent with limited opportunity for recovery. Given that the repeated activation of physiological stress responses often leads to burnout, these professionals are particularly at risk in terms of their health and well-being.

Monitoring individuals in real emergencies would provide an understanding of the stress responses during critical care, but it presents logistical challenges. A viable alternative is to assess individuals during high-fidelity training scenarios, i.e. highly realistic representations of equivalent real-world scenarios. It was in this context that Mark A. Wetherell and collaborators carried out the first and most comprehensive assessment of psychobiological response during high-fidelity training in pre-hospital emergency medicine.

With the support of the BIAL Foundation, researchers from Northumbria University and James Cook University Hospital (UK) used a sample of doctors and paramedics (N = 27) and assessed their psychobiological functioning over ten days of training and a weekend with no activities. The training was high-fidelity and based on real-life scenarios (i.e. road traffic accidents, firearms incidents, and swift water rescue operations) so that professionals developed the skills and knowledge to work in complex and stressful pre-hospital environments.

Different psychobiological response patterns were identified between training days and weekends, with higher levels of anxiety, stress, worry, heart rate, and cortisol on training days, and lower levels on the weekend. In addition, it was observed that on training days with a greater physical and psychological workload, the professionals reported lower levels of coping resources and control and showed higher levels of psychobiological responding.

The results were presented in the article “Assessing the psychobiological demands of high-fidelity training in pre-hospital emergency medicine”, published in October in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, where the authors explore how emergency situations (with different loads) and recovery affect the emotional, behavioural and physiological responses of medical professionals. Although the study was carried out in a training situation, it was high-fidelity and based on real situations, and therefore representative of the day-to-day experiences of those who provide critical emergency care.

Considering recent reports showing that “more than 50% of those who provide emergency medical care are experiencing moderate to high levels of burnout, this study reinforces the importance of the opportunity for recovery to avoid the negative consequences of repeated and sustained physiological activation of biological mechanisms to deal with challenging events on the health and well-being of these professionals”, emphasises Mark A. Wetherell.

Learn more about the project “26/20 - Anticipation and experience of stressful situations and their psychobiological impact on providing pre-hospital emergency medicine care” here. Watch Mark A. Wetherell's video here.