Page 58 - JSOM Spring 2021

such, this study sought to create a comprehensive personal post-9/11, which ostensibly includes Operation Iraqi Freedom
trauma profile for EMS personnel with prior military service (OIF), Operation Enduring Freedom (OEF), and Operation
and to evaluate the impact of military service on the likelihood New Dawn (OND). 25
of VT. This holistic trauma profile included sociodemographic,
childhood trauma, military, and occupational characteristics, Prior to the collection of any individual or agency informa-
as well as life events experienced by the population of pri- tion questionnaires, written informed consent was obtained
or-service EMS professionals. from all participants and EMS agency leaders. A total of 764
EMS personnel participated in this study with an overall sur-
vey completion rate of 98.3%. Of those, 89 (11.6%) were
Methods
veterans.
Study Design
Institutional review board approval was obtained from Rush Life Events
University, Chicago, Illinois. This was a prospective cross-sec- The Life Events Checklist DSM-5 (LEC-5) was used to quan-
tional survey study. Twelve EMS agencies were selected based tify the proportions of stressful material experienced by EMS
on human settlement area (HSA), geographic location, and size. personnel with prior military service and evaluated 17 poten-
Of those, nine agreed to participate in this study. An agency tially traumatic events (PTEs) stratified by how the respondent
information questionnaire (AIQ) was sent to each agency to had experienced the event: directly, witnessed, learned about,
identify the types of prehospital service provided as well as the or part of job duties. The instrument had good internal consis-
annual number and types of critical stress events that affected tency, yielding a Cronbach’s α of .854. Previous studies have
the agency. HSA was defined as rural, suburban, or urban reported a range for Cronbach’s alpha of 0.67–0.93 for this
based on 2013 US Census criteria, of which four, three, and instrument. 27–29 Each respondent could select any way an event
two EMS agencies were recruited, respectively. Geographic applied to them individually, which yielded a comprehensive
21
location was based on data from the North Carolina Depart- profile of not just what events had been experienced by EMS
ment of Commerce and all regions were represented except for personnel (with and without veteran status), but in what man-
the southeast, western, and northwest. EMS personnel were ner those events had been experienced.
22
recruited during monthly training evolutions offered by each
participating EMS agency. Each respondent was provided a Statistical Analysis
105-item paper survey designed to quantify stress syndromes IBM SPSS Statistics (IBM; www.ibm.com/analytics/spss-sta-
®
®
in EMS professionals. For this project, sociodemographic and tistics-software) was used to collect and analyze data with sta-
personal trauma profiles were extrapolated from the overall tistical significance established with an α ≤ .05. Descriptive
survey using both the 10-item Adverse Childhood Experiences statistics were utilized to compare proportions of EMS person-
(ACEs) questionnaire and the 17-item Life Events Checklist nel with and without prior military service to various demo-
DSM-5 (LEC-5). The Impact of Events Scale-Revised (IESR) graphic, socioeconomic, childhood, and occupational factors.
was used to determine the presence of VT. Civilian EMS and military subgroups were further stratified
by whether the likelihood of any stress syndrome existed.
The aims of this study were to create an individualized per-
sonal trauma profile for EMS clinicians with prior military Hierarchical linear regression was conducted using total scores
service and to determine the impact of prior service on the on the IESR to ascertain the predictive utility of prior military
prevalence of VT while controlling for potential confounders. service. It was also used to understand the unique contribution
of prior service to the EMS clinician affected by VT. Squared
Study Setting and Population semipartial correlations for significant variables determined
The 415 EMS agencies in North Carolina answer over one unique criterion validity.
million calls for service annually and provide primary 911
response to the state’s 100 counties and some 9.5 million Results
residents. 23,24 A total of 25,344 individuals hold an EMS cre-
dential in the state, of which 6,952 were paramedics, 1,707 Sociodemographic Profile
were advanced EMTs (AEMTs), and 14,005 were emergency A total of 764 individuals participated in the survey. Overall,
medical technicians (EMTs), accounting for 89.42% of the 89 (11.6%) had prior military service. In total, 496 (64.4%)
credentialed emergency services personnel in the state. Emer- civilian EMS personnel were identified as experiencing any of
24
gency medical responders (EMRs) and emergency medical dis- three evaluated stress syndromes (burnout [BO], compassion
patchers (EMDs) make up the remaining 10.58% of personnel fatigue [CF], or VT), while 61 (71.8%) of veterans were af-
and were not included in this study. Using this data, a standard fected by one or more of these syndromes. The proportion of
sample size calculator was used to determine the needed sam- males was 20.0% higher in the veteran population compared
ple for this project, using a confidence level of 95% and a mar- to civilian EMS personnel. A full sociodemographic profile is
gin of error of 4%. The sample size needed was determined located in Table 1.
to be 587 respondents, which was then multiplied by 25% to
account for the potential of attrition bias and yielded a final, Military Profile
needed sample of 734 respondents. In this sample, 89 EMS personnel indicated prior military ser-
vice. A total of 49 (57.6%) were male, and 15 (16.9%) were
At any given time, there are roughly 736,000 military veter- minorities. Of those, 61 (71.8%) were affected by a stress syn-
ans living in North Carolina and an additional 129,000 ac- drome. A total of 56 (62.9%) veterans had prior Army service,
tive-duty military personnel. 25,26 Veterans represent 9.8% of while 8 (8.9%), 11 (12.4%), and 9 (10.1%) veterans served in
North Carolina’s total population. Of those, 21% served the Navy, Marine Corps, and Air Force, respectively. A single
25
in the Gulf War, while 14% served in military operations (1.1%) veteran served in the US Coast Guard.

56 | JSOM Volume 21, Edition 1 / Spring 2021