Enzo Plaitano, a fourth-year PhD candidate in the Center for Technology and Behavioral Health at Geisel who has worked as an emergency medical technician and paramedic for 10 years. Dartmouth photo.
by Timothy Dean, Dartmouth College
Innovative research led by a team of investigators from Dartmouth’s Geisel School of Medine—in collaboration with national and local organizations across the U.S.—is showing promise for the development of a digital health app designed to help emergency medical services (EMS) clinicians manage job stress.
EMS clinicians are repeatedly placed in isolated and unpredictable situations with only an ambulance and limited equipment, personnel, and medical oversight to care for patients. These work-related factors put them at higher risk for chronic stress, mental health problem, and substance use.
“We have a lot of stigma surrounding mental health in EMS,” says Enzo Plaitano, a fourth-year PhD candidate in the Center for Technology and Behavioral Health (CTBH) at Geisel who has worked as an emergency medical technician (EMT) and paramedic for 10 years. “It’s hard to admit that you’re not okay when you’re always supposed to be the one helping other people. This app might be one solution to help support my peers.”
The app being developed by Plaitano and others at Dartmouth will be designed to adapt to near real-time changes in clinicians’ stress and physical environment, prompting them to do self-assessments on their mobile devices to monitor their stress levels.
“In future studies, we can pair these self-assessments with passive sensing data from a smartphone or smart watch,” he explains. “These devices collect information on heart rate variability, an indicator of stress responses, as well as general location. We can determine when an EMS clinician has experienced a spike in stress but is back at the station and ready to receive a brief, evidence-based intervention.”
Such interventions might include brief mindfulness exercises, cognitive reappraisal prompts, or even a Therabot-style conversational agent designed for in-the-moment coaching.
“These immediate and easily accessible resources may be better than waiting until we get home after our shifts to try to cope with the extreme difficulties of the job,” says Plaitano. “That can hopefully help them manage their stressors in a more adaptive and healthy way.”
Plaitano is now the principal investigator of a federal grant from the National Institute on Drug Abuse (grant number 1F31DA062393), providing funding for up to two more years, and the CTBH Pilot Grant Program to build upon this work and start informing the development of his health app. He has established core collaborations and support from mentors across Dartmouth and other prominent organizations such as the National Registry of EMTs, the National Center for PTSD, and the National Association of EMTs.
“I came to Dartmouth to work with the world-class experts at the CTBH,” says Plaitano. “I knew they could teach me how to develop tools to better support our vulnerable but essential EMS clinicians—86 percent of whom have indicated in our surveys that they would try using a digital health tool designed for stress management if it were available.”
Earlier this year, Plaitano and his team launched an intensive longitudinal study to understand the relationships between stress, emotion regulation, and health risk behaviors in the daily lives of EMS clinicians nationally.
For this study, they screened more than 2,000 EMS clinicians from across the U.S. for eligibility. In just a few months, Plaitano enrolled their target number of 110 full-time EMS clinicians across 33 states. Using a personalized text message system, participants completed multiple short surveys each day for a month. The surveys were sent to their smartphones, providing real-time data on changes in their stress levels, emotion regulation, and substance use risks.
The team has finished collecting all of their data, including more than 12,200 individual surveys from the 110 EMS clinicians. “I’m excited that we’re in the data analysis phase where we can start to uncover what to include in our future intervention. It’s truly an app designed for EMS clinicians, by EMS clinicians,” says Plaitano, whose ultimate goal is to develop an app for better stress management that is easy to use, confidential, and broadly accessible.