title: Using Shoulder Straps Decreases Heart Rate Variability and Salivary Cortisol Concentration in Swedish Ambulance Personnel.
abstract: BACKGROUND
  Previous research has shown that paramedics are exposed to risks in the form of injuries to the musculoskeletal system. In addition, there are studies showing that they are also at increased risk of cardiovascular disease, cancer, and psychiatric diseases, which can partly be explained by their constant exposure to stress. The aim of this study is to evaluate whether the use of shoulder straps decreases physical effort in the form of decreased heart rate and cortisol concentration.
  
  
  METHODS
  A stretcher with a dummy was carried by 20 participants for 400 m on two occasions, one with and one without the shoulder straps. Heart rate was monitored continuously and cortisol samples were taken at intervals of 0 minutes, 15 minutes, 30 minutes, 45 minutes, and 60 minutes. Each participant was her or his own control.
  
  
  RESULTS
  A significant decrease in heart rate and cortisol concentration was seen when shoulder straps were used. The median values for men (with shoulder straps) at 0 minutes was 78 bpm/21.1 nmol/L (heart rate/cortisol concentration), at 15 minutes was 85 bpm/16.9 nmol/L, and at 60 minutes was 76 bpm/15.7 nmol/L; for men without shoulder straps, these values were 78 bpm/21.9 nmol/L, 93 bpm/21.9 nmol/L, and 73 bpm/20.5 nmol/L. For women, the values were 85 bpm/23.3 nmol/L, 92 bpm/20.8 nmol/L, and 70 bpm/18.4 nmol/L and 84 bpm/32.4 nmol/L, 100 bpm/32.5 nmol/L, and 75 bpm/25.2 nmol/L, respectively.
  
  
  CONCLUSIONS
  The use of shoulder straps decreases measurable physical stress and should therefore be implemented when heavy equipment or a stretcher needs to be carried. An easy way to ensure that staff use these or similar lifting aids is to provide them with personalized, well-adapted shoulder straps. Another better option would be to routinely sewn these straps into the staff's personal alarm jackets so they are always in place and ready to be used.
authors.affiliation: Ambulance Service, Skaraborg Hospital, Skövde, Sweden; Skaraborg Hospital, Skövde, Sweden.
authors.forename: Kåre J
authors.initials: KJ
authors.lastname: Karlsson
authors.affiliation: Ambulance Service, Skaraborg Hospital, Skövde, Sweden; Skaraborg Hospital, Skövde, Sweden.
authors.forename: Patrik H
authors.initials: PH
authors.lastname: Niemelä
authors.affiliation: School of Health Sciences, Borås University, Borås, Sweden; Swedish Armed Forces, Centre for Defence Medicine, Västra Frölunda, Sweden.
authors.forename: Anders R
authors.initials: AR
authors.lastname: Jonsson
authors.affiliation: Department of Paediatrics, Skaraborg Hospital, Skövde, Sweden.
authors.forename: Carl-Johan A
authors.initials: CJ
authors.lastname: Törnhage
keywords: ambulance personnel; heart rate; saliva cortisol; shoulder straps; stretcher