EMS Study Links Stress with Sleeping, Drinking Habits of Medics

June 15--A survey of 256 paramedics at Austin-Travis County EMS has shown a connection between their mental health and off-duty sleep and drinking habits, including that medics with clinically significant symptoms of depression or post-traumatic stress disorder were more likely to endorse getting drunk at least once in the previous three months.

The anonymous, voluntary survey is an early foray for the agency to explore the behavioral health of paramedics, a population that EMS psychologist Marc Kruse said is virtually unstudied. The effort is aimed at studying the prevalence of behavioral health problems among medics, as well as figuring out ways the agency can help improve their health.

Kruse, who conducted the survey during the spring of 2012, plans to present some of the results at a Research Society on Alcoholism meeting in Orlando, Fla., this month. In the fall, he plans to replicate the survey with medics at the Wake County Department of Emergency Medical Services in North Carolina to gauge whether his findings in Austin are comparable.

Kruse declined to provide the survey questions but said some were designed to screen for symptoms of depression and PTSD, and some examined strategies medics use to cope with stress, such as food and substances. The survey also asked about off-duty sleep patterns and alcohol use during the previous three months.

Of 320 eligible paramedics, about 80 percent participated in the survey. The average age of participants was 37, and about two-thirds reported having more than five years of experience working for the agency. Nineteen percent were women.

One study looked at drinking, and a presentation of the research that Kruse provided reports finding "relatively modest" alcohol use among paramedics but a strong relationship between signs of heavy drinking and using substances to cope with distress. Medics experiencing clinically significant symptoms of depression or PTSD were more likely to endorse getting drunk once in the previous three months, according to the study.

About 1 in 5 of the paramedics who completed the survey said he or she did not drink alcohol during the previous three months. According to the survey, 81 percent of paramedics who reported drinking consumed 3.2 drinks twice a week, on average.

About 53 percent of drinkers reported getting drunk an average of once a month in the three months before the survey, according to the study. Meanwhile, 65 percent of drinkers reported binge drinking -- more than five drinks in a sitting for men and more than four drinks for women -- a little less than twice a month, on average.

Drinking to the point of getting drunk and binge drinking were significantly correlated with symptoms of depression and PTSD, using substances to cope with distress and reduced off-duty sleep.

Kruse also has used the survey to research how the amount of sleep medics get off-duty affects their mental health. While medics reported an average of 6.3 hours of sleep while off-duty, medics who said they got less sleep, 5.5 hours, also reported severe depression symptoms.

The study found that reduced off-duty sleep is significantly associated with higher PTSD symptoms, lower life satisfaction, lower psychological resilience, higher occupational stress, higher burnout, getting drunk more often, and using substances and food to deal with stress.

Medics work a variety of schedules in a 48-hour workweek, EMS Director Ernie Rodriguez said. Some cover four 12-hour shifts in a row, and within that workweek medics could rotate between stations with varying call volumes.

"Our field staff and our commanders get exposed to, really, some stressful and very traumatic experiences," Kruse said. "Every time the tone goes off, they have an opportunity to interact with somebody as they're dying or their life is being forever transformed."

Asked whether he found any of the results of this study surprising, Kruse said he and others involved in research based on the survey, including researchers at the University of Texas and Paul Hinchey, the agency's medical director, weren't sure what to expect.

Kruse said there are no outside studies with which to compare the results of the survey, though anecdotally he said they seem to be similar to what medics at other agencies experience.

Rodriguez said that's why it will be important to extend the study beyond the city's system.

"What kinds of best practices can we glean from each other?" he said.

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