title: Cortisol and alpha-amylase as stress response indicators during pre-hospital emergency medicine training with repetitive high-fidelity simulation and scenarios with standardized patients.
abstract: BACKGROUND
  In emergency medicine, the benefits of high-fidelity simulation (SIM) are widely accepted and standardized patients (SP) are known to mimic real patients accurately. However, only limited data are available concerning physicians' stress markers within these training environments. The aim of this pilot study was to investigate repetitive stress among healthcare professionals in simulated pre-hospital emergency scenarios using either SIM or SPs.
  
  
  METHODS
  Teams with one emergency medical services (EMS) physician and two paramedics completed three SIM scenarios and two SP scenarios consecutively. To evaluate stress, salivary cortisol and alpha-amylase were measured in saliva samples taken before, during and after the scenarios.
  
  
  RESULTS
  A total of 14 EMS physicians (29% female; mean age: 36.8 ± 5.0 years; mean duration of EMS-experience: 9.1 ± 5.8 years) and 27 paramedics (11% female; age: 30.9 ± 6.9 years; EMS experience: 8.1 ± 6.0 years) completed the study. Alpha-amylase and cortisol levels did not differ significantly between the two professions. Cortisol values showed a gradual and statistically significant reduction over time but little change was observed in response to each scenario. In contrast, alpha-amylase activity increased significantly in response to every SIM and SP scenario, but there was no clear trend towards an overall increase or decrease over time.
  
  
  CONCLUSIONS
  Increases in salivary alpha-amylase activity suggest that both SIM and SP training produce stress among emergency healthcare professionals. Corresponding increases in salivary cortisol levels were not observed. Among physicians in the emergency setting, it appears that alpha-amylase provides a more sensitive measure of stress levels than cortisol.
authors.affiliation: Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany. bvalentin@ukaachen.de.|AIXSIM - Simulation Centre for Anesthesiology, Intensive Care and Emergency Medicine, RWTH Aachen University Hospital, Aachen, Germany. bvalentin@ukaachen.de.
authors.forename: Bernd
authors.initials: B
authors.lastname: Valentin
authors.affiliation: Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany. ogrottke@ukaachen.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Grottke
authors.affiliation: Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany. Max@skorning.de.
authors.forename: Max
authors.initials: M
authors.lastname: Skorning
authors.affiliation: Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany. sbergrath@ukaachen.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bergrath
authors.affiliation: Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany. hfischermann@ukaachen.de.
authors.forename: Harold
authors.initials: H
authors.lastname: Fischermann
authors.affiliation: Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany. droertgen@ukaachen.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rörtgen
authors.affiliation: Centre for Learning and Knowledge Management and Information Management in Mechanical Engineering RWTH Aachen University, Aachen, Germany. Marie.Mennig@p3-group.com.
authors.forename: Marie-Therese
authors.initials: MT
authors.lastname: Mennig
authors.affiliation: Department of Medical Statistics, RWTH Aachen University Hospital, Aachen, Germany. cfitzner@ukaachen.de.
authors.forename: Christina
authors.initials: C
authors.lastname: Fitzner
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden, Dresden, Germany. Michael.Mueller@uniklinikum-dresden.de.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Müller
authors.affiliation: Institute of Psychology I, University of Technology, Dresden, Germany. clemens.kirschbaum@tu-dresden.de.
authors.forename: Clemens
authors.initials: C
authors.lastname: Kirschbaum
authors.affiliation: Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany. rrossaint@ukaachen.de.
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.affiliation: Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany. sbeckers@ukaachen.de.|AIXTRA - Interdisciplinary Centre for Medical Education, RWTH Aachen University Hospital, Aachen, Germany. sbeckers@ukaachen.de.
authors.forename: Stefan K
authors.initials: SK
authors.lastname: Beckers
mesh_terms: D000328:Adult; D000488:Allied Health Personnel; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D005858:Germany; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D008297:Male; D008348:Manikins; D016544:Patient Simulation; D010820:Physicians; D010865:Pilot Projects; D012463:Saliva / Q000737:chemistry*; D013315:Stress, Psychological / Q000175:diagnosis*; D000516:alpha-Amylases / Q000032:analysis*
chemical_list: D000516:alpha-Amylases; D006854:Hydrocortisone