Association of post-traumatic stress disorder with work performance amongst emergency medical service personnel

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Pre-hospital care providers are exposed to various kinds of stressors. Their repeated day to day exposure to various types of critical and traumatic incidents can lead to stress reactions like post-traumatic stress disorder. These reactions can significantly impair their psycho-social and occupational functioning. Purpose: The purpose of this study is to quantify the burden of PTSD in Emergency Medical Service (EMS) in Karachi and to identify the association between post-traumatic stress disorder (PTSD) and work performance amongst EMS. Methods: This cross-sectional study was conducted on EMS personnel of a private institution (AMAN ambulance service) in Karachi, Pakistan. EMS personnel were screened for potential PTSD using impact of event scalerevised (IES-R). Mean score and cutoff score (i.e. 33) of IES-R was used to compare characteristics of participants. Work performance was assessed on basis of five variables; number of late arrivals to work, number of days absent, number of days sick, adherence to protocol and patient satisfaction survey over the period of 3 months. In order to explore the association of PTSD with work performance variables; linear regression was applied for number of late arrivals, number of days absent, number of sick days and patient satisfaction survey whereas logistic regression was applied for adherence to protocol. Results: Out of 536 EMS personnel, 529 were approached; of which 518 were included as study participants. The mean score of PTSD was found to be 23.9 ± 12.1 with 21.6% of people were above cut off on IES-R. In multivariable analysis; PTSD was not found to be significantly associated with number of late arrivals (0.0004; 95% Cl -0.006 to 0.006), number of days absent (V-0.003; 95% CI -0.01 to 0.002), number of days sick ((3=-0.003; 95% CI -0.007 to -0.003), patient satisfaction (13=0.00009; 95% Cl -0.0002 to 0.0003) and adherence to protocol (AOR = 1.01, 95% CI 0.98 to 1.03) in our EMS population. While, years of experience, working hours per week and years of formal schooling found to have positive relationship whereas perceived social support by family found to have negative relationship with number of late arrivals. Anxiety and depression on screening, living alone and average working hours was found to be significantly associated with number of absents. However, number of sick days increases with increase in age and for those who live alone in Karachi. It was also found out that employee with problem focused coping found to have increase patient satisfaction. Additionally, it was found out that adherence to protocol decrease by age and increase by years of experience. Conclusion: On average, one in five people found to have PTSD on screening tool in our EMS population of Karachi, Pakistan. No significant association was found between post-traumatic stress and work performance as measured by number of late comings, number of days absents, number of sick days, adherence to protocol and patient satisfaction in this EMS population.

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