Association of post-traumatic stress disorder and work performance: A survey from an emergency medical service, Karachi, Pakistan

doi:10.5847/wjem.j.1920-8642.2017.03.009

Abstract

Abstract:

BACKGROUND: The purpose of the study was to explore the association between post-traumatic stress disorder (PTSD) and work performance of emergency medical services personnel in Karachi, Pakistan.

METHODS: Emergency medical service personnel were screened for potential PTSD using Impact of Event Scale-Revised (IES-R). Work performance was assessed on the basis of five variables: number of late arrivals to work, number of days absent, number of days sick, adherence to protocol, and patient satisfaction over a period of 3 months. In order to model outcomes like the number of late arrivals to work, days absent and days late, negative binomial regression was applied, whereas logistic regression was applied for adherence to protocol and linear for patient satisfaction scores.

RESULTS: Mean scores of PTSD were 24.0±12.2. No association was found between PTSD and work performance measures: number of late arrivals to work (RRadj 0.99; 0.98-1.00), days absent (RRadj 0.98; 0.96-0.99), days sick (RRadj 0.99; 0.98-1.00), adherence to protocol (ORadj 1.01; 0.99-1.04) and patient satisfaction (β 0.001%-0.03%) after adjusting for years of formal schooling, living status, coping mechanism, social support, working hours, years of experience and anxiety or depression.

CONCLUSION: No statistically significant association was found between PTSD and work performance amongst EMS personnel in Karachi, Pakistan.

Key words: Emergency medical service, Karachi, Pakistan, Post-traumatic stress disorder, Stress, Work performance

Salima Kerai, Omrana Pasha, Uzma Khan, Muhammad Islam, Nargis Asad, Junaid Razzak. Association of post-traumatic stress disorder and work performance: A survey from an emergency medical service, Karachi, Pakistan[J]. World Journal of Emergency Medicine, 2017, 8(3): 214-222.

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Variables	Staff	Operational definition	Analysis
Number of late comings	All staff	Late is marked when a staff reports 40 minutes after the actual reporting time	Numerator: number of late arrivals Denominator: total working days (72 days)
Number of days absent	All staff	Absent is not coming to work for whole day OR 3 lates are marked as one absent	Numerator: number of days absent Denominator: total working days (72 days)
Number of sick days	All staff	Those who do not come to work due to being ill or sick	Numerator: number of sick calls Denominator: total working days (72 days)
Adherence to protocol	Doctors and nurses	Performed according to pre-defined algorithms/protocol	Numerator: number of times adhered to protocol Denominator: total emergencies in 72 days
Adherence to protocol	Drivers	Number of vehicle crashes
Patient satisfaction	All staff	Patient satisfaction refers to contentment with the treatment provided and with the skills and attitude of paramedics. Score ranges from 0-24, 0 being lowest, 24 being highest	Numerator: score obtained Denominator: total score

S. NO	Indicators for adherence to protocol for doctor and nurse
1	With complaint of chest pain
	a) Aspirin was received
2	With complaint of shortness of breath/respiratory distress
	a) Oxygen saturation was checked
	b) Oxygen was given
3	With complaint of one sided weakness/stroke
	a) Blood pressure was checked
	b) Blood sugar was checked
4	With complaint of road traffic crash
	a) Analgesia given
5	With complaint of cardiac arrest
	a) CPR was initiated
6	With complaint of altered or loss of consciousness or in case of seizures
	a) Blood sugar was checked

Variables	Results (n=507)
Job type
Doctors	37 (7.3)
Nurses	202 (39.8)
Drivers	211 (42.6)
Paramedics	57 (11.2)
Age groups in years	32.4±5.8
≤25	52 (10.3)
26-35	336 (66.2)
36-45	105 (20.7)
≥55	14 (2.8)
Marital status
Single	139 (27.4)
Married	368 (72.6)
Living status
Family	426 (84.0)
Alone	81 (15.8)
Years of experience^*	4±1.0
Working hours in a week^*	47.2±6.5
Years of formal schooling^*	13.8±2.9
Household monthly income in PKR per month
10 000-25 000	195 (38.5)
25 000-50 000	208 (41.0)
50 000-100 000	88 (17.4)
100 000-300 000	16 (3.2)
Substance abuse (addiction)	174 (34.3)
Coping^*
Dysfunctional	17.5±3.3
Emotion focused	24.5±3.9
Problem focused	25.3±3.2
Social support^*
Family	22.6±4.8
Friends	19.9±5.1
Significant others	19.7±7.3
Family history of psychiatric illness	82 (16.1)
Use of medicine to relive stress	27 (5.3)
Anxiety and depression^* (AKUADS)	15.6±8.2
Above cut-off^?	146 (28.8)
Post-traumatic stress disorder^* (IES-R)	24.0±12.2
Above cut-off^?	111 (22.0)

Variables	Unadjusted rate ratios	95%CI	Adjusted rate ratios	95%CI
PTSD	1.00	0.99-1.01	0.99	0.98-1.00
Years of formal schooling	1.03	0.99-1.07	1.04	1.00-1.08
Years of experience	1.17	1.04-1.33	1.17	1.04-1.32
Working hours per week	1.02	1.01-1.04	1.02	1.01-1.04
Social support of family	0.97	0.94-0.99	0.97	0.94-0.99

Variables	Unadjusted rate ratios	95%CI	Adjusted rate ratios	95%CI
PTSD	0.99	0.97 to 1.00	0.98	0.96-0.99
Living status (Alone)	1.70	1.02 to 2.81	1.78	1.09-2.93
Dysfunctional coping	1.06	0.99 to 1.13	1.08	0.99-1.05