• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of oenvmedOccupational and Environmental MedicineCurrent TOCInstructions for authors
Occup Environ Med. Jun 2003; 60(Suppl 1): i40–i46.
PMCID: PMC1765729

Acute and chronic job stressors among ambulance personnel: predictors of health symptoms


Objectives: To predict symptomatology (post-traumatic distress, fatigue, and burnout) due to acute and chronic work related stressors among ambulance personnel.

Methods: Data were gathered from 123 ambulance workers in The Netherlands in a longitudinal design. At two measurements they completed standardised questionnaires to assess health symptoms, such as the Impact of Event Scale, the Maslach Burnout Inventory, and the Checklist Individual Strength. Acute stressors were assessed with specific questions, and chronic work related stressors were measured with the Questionnaire on the Experience and Assessment of Work.

Results: Most of the ambulance workers had been confronted with acute stressors in their work. They also reported more chronic work related stressors than a reference group. Of the participants, more than a tenth suffered from a clinical level of post-traumatic distress, a tenth reported a fatigue level that put them at high risk for sick leave and work disability and nearly a tenth of the personnel suffered from burnout. Best predictors of symptomatology at time 2 were lack of social support at work and poor communication, such as not being informed about important decisions within the organisation.

Conclusions: Ambulance personnel are at risk to develop health symptoms due to work related stressors. Although, acute stressors are related to health symptoms, such as fatigue, burnout, and post-traumatic symptoms, it was not found to predict health symptoms in the long term. Main risk factors have to do with social aspects of the work environment, in particular lack of support from the supervisor as well as colleagues and poor communication. When implementing workplace interventions these social aspects need to be taken into account.

Full Text

The Full Text of this article is available as a PDF (146K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Tennant C. Work-related stress and depressive disorders. J Psychosom Res. 2001 Nov;51(5):697–704. [PubMed]
  • Beaton R, Murphy S, Johnson C, Pike K, Corneil W. Exposure to duty-related incident stressors in urban firefighters and paramedics. J Trauma Stress. 1998 Oct;11(4):821–828. [PubMed]
  • McFarlane AC, Papay P. Multiple diagnoses in posttraumatic stress disorder in the victims of a natural disaster. J Nerv Ment Dis. 1992 Aug;180(8):498–504. [PubMed]
  • Ursano RJ, Fullerton CS, Kao TC, Bhartiya VR. Longitudinal assessment of posttraumatic stress disorder and depression after exposure to traumatic death. J Nerv Ment Dis. 1995 Jan;183(1):36–42. [PubMed]
  • Marmar CR, Weiss DS, Metzler TJ, Ronfeldt HM, Foreman C. Stress responses of emergency services personnel to the Loma Prieta earthquake Interstate 880 freeway collapse and control traumatic incidents. J Trauma Stress. 1996 Jan;9(1):63–85. [PubMed]
  • Clohessy S, Ehlers A. PTSD symptoms, response to intrusive memories and coping in ambulance service workers. Br J Clin Psychol. 1999 Sep;38(Pt 3):251–265. [PubMed]
  • Day AL, Livingstone HA. Chronic and acute stressors among military personnel: do coping styles buffer their negative impact on health? J Occup Health Psychol. 2001 Oct;6(4):348–360. [PubMed]
  • Alexander DA, Klein S. Ambulance personnel and critical incidents: impact of accident and emergency work on mental health and emotional well-being. Br J Psychiatry. 2001 Jan;178(1):76–81. [PubMed]
  • Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979 May;41(3):209–218. [PubMed]
  • Chemtob CM, Tomas S, Law W, Cremniter D. Postdisaster psychosocial intervention: a field study of the impact of debriefing on psychological distress. Am J Psychiatry. 1997 Mar;154(3):415–417. [PubMed]
  • Raphael B, Lundin T, Weisaeth L. A research method for the study of psychological and psychiatric aspects of disaster. Acta Psychiatr Scand Suppl. 1989;353:1–75. [PubMed]
  • Vercoulen JH, Swanink CM, Fennis JF, Galama JM, van der Meer JW, Bleijenberg G. Dimensional assessment of chronic fatigue syndrome. J Psychosom Res. 1994 Jul;38(5):383–392. [PubMed]
  • Vercoulen JH, Hommes OR, Swanink CM, Jongen PJ, Fennis JF, Galama JM, van der Meer JW, Bleijenberg G. The measurement of fatigue in patients with multiple sclerosis. A multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects. Arch Neurol. 1996 Jul;53(7):642–649. [PubMed]
  • Bültmann U, de Vries M, Beurskens AJ, Bleijenberg G, Vercoulen JH, Kant I. Measurement of prolonged fatigue in the working population: determination of a cutoff point for the checklist individual strength. J Occup Health Psychol. 2000 Oct;5(4):411–416. [PubMed]
  • James AE, Wright PL. Occupational stress in the ambulance service. Health Manpow Manage. 1991;17(4):4–11. [PubMed]
  • Weisaeth L. Importance of high response rates in traumatic stress research. Acta Psychiatr Scand Suppl. 1989;355:131–137. [PubMed]
  • Alexander DA, Wells A. Reactions of police officers to body-handling after a major disaster. A before-and-after comparison. Br J Psychiatry. 1991 Oct;159:547–555. [PubMed]
  • Brom D, Kleber RJ, Defares PB. Brief psychotherapy for posttraumatic stress disorders. J Consult Clin Psychol. 1989 Oct;57(5):607–612. [PubMed]

Articles from Occupational and Environmental Medicine are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...