Due to time-critical decision-making, physical strain and the uncontrolled environment, prehospital emergency management is frequently associated with high levels of stress in medical personnel. Stress has been known to cause ischemia like changes in electrocardiograms (ECGs), including arrhythmias and deviations in ST-T segments. There is a lack of knowledge regarding the occurrence of changes in ST-T segments in prehospital emergency physicians. We hypothesized that ST-T segment deviations occur in prehospital emergency physicians in the field. In this prospective observational trial, ST-T segments of emergency physicians were recorded using 12-lead Holter ECGs. The primary outcome parameter was defined as the incidence of ST-T segment changes greater than 0.1 mV in two corresponding leads for more than 30 s per 100 rescue missions. The secondary outcomes included T-wave inversions and ST-segment changes shorter than 30 s or smaller than 0.1 mV. Surrogate parameters of stress were measured using the NASA-Task Load Index and cognitive appraisal, and their correlation with ST-T segment changes were also assessed. Data from 20 physicians in 36 shifts (18 days, 18 nights) including 208 missions were analysed. Seventy percent of previously healthy emergency physicians had at least one ECG abnormality; the mean duration of these changes was 30 s. Significantly more missions with ECG changes were found during night than day shifts (39 vs. 17%, p < 0.001). Forty-nine ECG changes occurred between missions. No ST-T segment changes > 30 s and > 0.1 mV were found. Two ST-T segment changes < 30 s or < 0.1 mV (each during missions) and 122 episodes of T-wave inversions (74 during missions) were identified. ECG changes were found to be associated with alarms when asleep and NASA task load index. ECG changes are frequent and occur in most healthy prehospital emergency physicians. Even when occurring for less than 30 s, such changes are important signs for high levels of stress. The long-term impact of these changes needs further investigation. Trial registration The trial was registered at ClinicalTrials.gov (NCT04003883) on 1.7.2019: https://clinicaltrials.gov/ct2/show/NCT04003883?term=emergency+physician&rank=2

中文翻译：

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该领域院前急诊医师的 ST-T 段变化：一项前瞻性观察试验

由于时间紧迫的决策、身体压力和不受控制的环境，院前应急管理经常与医务人员的高压力有关。众所周知，压力会导致缺血，如心电图 (ECG) 的变化，包括心律失常和 ST-T 段的偏差。院前急诊医师对 ST-T 段发生变化缺乏了解。我们假设 ST-T 段偏差发生在该领域的院前急诊医师中。在这项前瞻性观察试验中，使用 12 导联动态心电图记录急诊医师的 ST-T 段。主要结果参数定义为每 100 次救援任务超过 30 秒，两个相应导联中 ST-T 段变化大于 0.1 mV 的发生率。次要结局包括 T 波倒置和短于 30 秒或短于 0.1 mV 的 ST 段变化。使用 NASA 任务负荷指数和认知评估来测量压力的替代参数，并评估它们与 ST-T 段变化的相关性。分析了 36 个轮班（18 天 18 夜）的 20 位医生的数据，包括 208 次任务。70% 以前健康的急诊医师至少有一次心电图异常；这些变化的平均持续时间为 30 秒。夜间发生心电图变化的任务明显多于白班（39% vs. 17%，p < 0.001）。任务之间发生了 49 次 ECG 变化。没有发现 > 30 s 和 > 0.1 mV 的 ST-T 段变化。两个 ST-T 段变化 < 30 s 或 < 0。确定了 1 mV（每次在任务期间）和 122 次 T 波反转（在任务期间 74 次）。发现心电图变化与睡眠时的警报和 NASA 任务负荷指数有关。心电图变化频繁发生在大多数健康的院前急诊医师身上。即使发生时间少于 30 秒，这种变化也是高压力水平的重要标志。这些变化的长期影响需要进一步调查。试验注册 该试验于 2019 年 7 月 1 日在 ClinicalTrials.gov (NCT04003883) 注册：https://clinicaltrials.gov/ct2/show/NCT04003883?term=emergency+physician&rank=2 即使发生时间少于 30 秒，这种变化也是高压力水平的重要标志。这些变化的长期影响需要进一步调查。试验注册 该试验于 2019 年 7 月 1 日在 ClinicalTrials.gov (NCT04003883) 注册：https://clinicaltrials.gov/ct2/show/NCT04003883?term=emergency+physician&rank=2 即使发生时间少于 30 秒，这种变化也是高压力水平的重要标志。这些变化的长期影响需要进一步调查。试验注册 该试验于 2019 年 7 月 1 日在 ClinicalTrials.gov (NCT04003883) 注册：https://clinicaltrials.gov/ct2/show/NCT04003883?term=emergency+physician&rank=2