Identifying Modifiable Momentary Predictors of Substance Use in High Risk Emergency Medical Services Clinicians

Emergency Medical Services (EMS) clinicians, including EMTs and Paramedics, are first responders who deliver life-saving care to patients before arrival to the hospital. EMS clinicians play a pivotal role in improving patient outcomes, but in doing so are repeatedly placed in unpredictable situations and exposed to frequent work-related stressors. Among all types of first responders, including police officers and firefighters, EMS clinicians have the highest risk for developing chronic stress, mental health problems, and substance use.

While higher stress levels are related to health risk behaviors in EMS clinicians, stress responses can be effectively managed through self-regulatory strategies. These strategies include controlling motivation, cognition, and emotion to avoid immediate gratification and achieve long term goals. However, limited mental health resources and challenging work environments make it difficult for EMS clinicians to effectively use these strategies. Since EMS clinicians experience unavoidable stress, studying self-regulation is relevant to improve health risk behaviors. Our prior national survey study of EMS clinician members of national organizations found that self-regulation likely plays a role in determining how stress may impact substance use in EMS clinicians. These results were very promising but need to be examined over time across multiple EMS shifts.

This pilot study will examine how EMS clinicians cope with work-related stress in daily real life environments. In the proposed study, we will recruit EMS clinicians from across the United States to answer brief surveys several times each day about their stress, self-regulation, and substance use. This study will allow us to identify if changes in self-regulation throughout the day influence how higher stress levels might impact health risk behaviors. If the study findings support the key role of self-regulation in coping with stress, this will lead to the development of a future digital health intervention that will offer resources to improve self-regulation strategies based on real-time changes in stress and self-regulation. The overall goal is to design a future just-in-time digital health application for this high-risk population.