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This dissertation examines cardiovascular health (CVH) among Emergency Medical Service (EMS) providers. CVH is defined by the American Heart Association (AHA) as the simultaneous presence of seven ideal factors; smoking status, body mass index, physical activity, healthy diet score, total cholesterol, blood pressure and fasting plasma glucose. Cardiovascular diseases comprise the top causes of death in the United States, and because of this, the AHA has set forth a 2020 Impact Goal to improve the CVH of those in the United States by 20% while reducing mortality from cardiovascular events by 20%.The first aim of this dissertation was to compare overall CVH, and its individual components, between nationally-certified EMS professionals and the general population. Overall ideal CVH and ideal component CVH was found to be higher in EMS when compared to the general population. Specifically, EMS professionals were more likely to have ideal levels of physical activity, diet, cholesterol and fasting blood glucose.The second aim of this dissertation was to identify associations between work-life characteristics and CVH among EMS professionals. Some work-life characteristics were identified to be associated with ideal CVH. It was noted that as the number of EMS organizations at which the provider performed EMS work increased, overall CVH iidecreased. Those providers working in aeromedical services and those who reported conducting patient care had higher prevalence of ideal CVH when compared to other types of agency types and services. Lastly, those providers who were more highly satisfied with their main EMS job had a higher prevalence of ideal CVH when compared to those that were dissatisfied.The third aim of this dissertation was to identify associations between CVH and absenteeism among EMS professionals. A higher prevalence of workplace absenteeism was observed among first responders when compared to estimates from the general working population. Females self-reported a higher number of missed workdays when compared to males and as age increased, an increase in number of missed workdays and a decrease in ideal CVH was observed. Those individuals who were married reported fewer missed workdays and higher ideal CVH then those of other types of marital status. With respect to work-life characteristics, those EMS professionals practicing in an advanced life support setting (Advanced Emergency Medical Technicians and paramedics) reported greater average missed workdays than those working in a basic life support setting (Emergency Medical Responders and Emergency Medical Technicians). Lastly, as typical weekly call volume increased to did the reported absenteeism. Specific characteristics that were found to be associated with both absenteeism and CVH included sex, age, marital status, certification level and typical weekly call volume.This dissertation highlights the necessity for several areas of future research in both cardiovascular disease and occupational epidemiology. First, a longitudinal assessmentof CVH and research into tailored public health interventions to increase the proportion of EMS providers with all seven ideal CVH components is needed. Second, an understanding of the causal relationship between CVH and health outcomes and job performance among EMS professionals is warranted. Since stressful work conditions are thought to exacerbate cardiovascular disease risk, additional workplace interventions to mitigate the negative consequences of providing prehospital emergency care may be needed. Lastly, a detailed assessment of the causal mechanisms linking CVH with workplace absenteeism is required to expand the understanding of the relationship between the EMS profession and overall health.

Among EMS professionals, occupational exposures in mental illness literature are not well-represented. Currently, no literature exists examining the prevalence of mental illness in a large national cohort of EMS professionals. As such, the purpose of this study is to address the lack of scientific knowledge and evidence in the field of mental illness among EMS professionals. The objectives of this master’s thesis are three fold. The first objective is to estimate the prevalence and severity of depression, anxiety, and stress among a cohort of nationally certified EMS professionals. Because other healthcare professions may have similar occupational exposures related to mental illness, the second objective of this study is a comparison of nationally certified EMS professionals’ depression, anxiety, and stress prevalence to other healthcare professions. The third objective of this master’s thesis is the determination of differences between cases and controls (defined by the 21- question Depression, Anxiety, and Stress Scale (DASS-21)) from the same cohort with respect to clinical depression, anxiety, stress, and demographic and work-life characteristics.n accordance with previous methodologies, a questionnaire was included as part of the 2009 biennial recertification paperwork mailed to all nationally certified EMS professionals prior to their 2009 expiration date. This questionnaire contained demographic and work-life characteristic items as well as the DASS-21. Three outcome variables of interest were derived from the DASS-21: clinical depression, clinical anxiety, and clinical stress. Any scores above “normal” for each of the outcomes were determined to be a case and controls were defined as those whose scores fell below the case cutpoint. A complete case-control analysis was performed for each of the three outcome variables. Independent variables were chosen based on previous methodologies and plausibility. A total of 15 independent variables were assessed.The prevalence of depression among the cohort was found to be 6.8%, the prevalence of anxiety was found to be 6.0%, and the prevalence of stress was 5.9%. In the final logistic regression models, certification level, service type, general health, exercise, smoking status, and age were found to be statistically significant in each of the depression, anxiety, and stress models. Further, years of experience, race, and education level was found to be unique only to the depression and stress models. Marital status was found to be statistically significant in only the depression and anxiety models. Lastly, gender was unique to the depression logistic model. This study was able to identify statistically significant demographic and work-life characteristic variables that predicted depression, anxiety, and stress. Future research should attempt to follow EMS professionals prospectively to determine specific characteristics associated with occupational traumatic exposure and the development of clinical depression, anxiety, and stress. Likewise, specific research efforts should be undertaken to establish early recognition criteria in EMS professionals to ensure adequate and quick treatment of mental disorders.