Fit for duty: The health status of New South Wales Paramedics

Alex James MacQuarrie, Caroline Robertson, Peter Micalos, James Crane, Richard High, Eric Drinkwater, James Wickham




Paramedics are health care workers who respond to medical emergencies. Paramedics exhibit high rates of injury and illness with markers of poor health. The aims of this study were to explore the self-reported health status of paramedics in New South Wales, Australia, and to compare it with that of the Australian general population and to examine paramedics’ attitudes towards exercise.


In 2015, paramedics employed by NSW Ambulance were invited to complete a web-based survey composed of the Medical Outcomes Survey Short Form 36 (SF-36), measures of attitudes towards exercise and demographic information. Normative comparator data for the Australian general population (BMI and SF-36 scores) were sourced from the Household Income Labour Dynamics in Australia 2015 survey.


Of the approximately 3,300 paramedics invited to participate, 747 completed the survey (507 male, 240 female).  Mean age and mean years of service were 41.5 ± 9.5 (SD) and 13.6 ± 9.0 respectively. Male paramedics scored higher than females (p<0.001) in the Vitality domain of the SF-36, and regional paramedics had a higher General Health domain score than metropolitan paramedics (p<0.05). Regional male paramedics had higher BMIs than their metropolitan counterparts (28.04 kg/m2 ± 3.99 vs. 26.81 kg/m2 ± 4.67, p = 0.001). Compared to the Australian population, paramedics scored higher in the Physical Function domain (p<0.001) but lower in summary scores for mental and physical health (p<0.001). Paramedics’ BMIs were slightly higher than the general population (27.10 ± 4.30 kg/m2 vs. 26.47 ±5.42, p<0.001). Paramedics reported lack of time, family commitments, and lack of motivation and in regional postings: distance to fitness facilities and shift patterns as barriers to exercise.


Paramedics scored lower on the SF-36 than the general population, which can indicate a lower health-related quality of life.  High BMI and low SF-36 scores may be related to a perceived inability to engage in regular exercise. Increasing BMI can be associated with the development of markers of poor health. Attention is needed to ensure that paramedics are “fit for duty”.  Ambulance management should foster innovative health promotion programs and paramedics need to recognise and value good health.


Illness, Fitness, Wellness, Injury, Ambulance, Exercise

Full Text:



Lavender SA, Conrad KM, Reichelt PA, Johnson PW, Meyer F. Biomechanical analyses of paramedics simulating frequently performed strenuous work tasks. Appl Ergonomics. 2000;31(2):167-77.

Leyk D, Rohde U, Erley O, Gorges W, Essfeld D, Erren TC. Maximal manual stretcher carriage: performance and recovery of male and female ambulance workers. Ergonomics. 2007;50(5):752-62.

Barnekow-Bergkvist M, Aasa U, Ängquist KA, Johansson H. Prediction of development of fatigue during a simulated ambulance work task from physical performance tests. Ergonomics. 2004;47(11):1238-50.

Fischer S. Canadian Safety and Security Program - Physical Demands Analysis. Ottawa, Ontario: Center for Security Science; 2014.

Ashton A, McCluskey A, Gwinnutt CL, Keenan AM. Effect of rescuer fatigue on performance of continuous external chest compressions over 3 min. Resuscitation. 2002;55(2):151-5.

Havel C, Herkner H, Haugk M, Richling N, Riedmuller E, Trimmel H, et al. Physical strain on advanced life support providers in different out of hospital environments. Resuscitation. 2008;77(1):81-6.

Ko PC, Wang HC, Chiang WC, Yang CW, Ma MH. Comprehensive evaluation for quality of prehospital CPR. Resuscitation. 2008;78(1):98-9.

Courtney JA, Francis AJP, Paxton SJ. Caring for the Carers: Fatigue, Sleep, and Mental Health in Australian Paramedic Shiftworkers. Australian & New Zealand Journal of Organisational Psychology. 2010;3(1):32-41.

Campeau AG. The space-control theory of paramedic scene-management. Symb Interact. 2008;31(3):285-302.

Huxley R, Mendis S, Zheleznyakov E, Reddy S, Chan J. Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk - a review of the literature. Eur J Clin Nutr. 2010;64:4.

Clark S, Rene A, Theurer WM, Marshall M. Association of Body Mass Index and Health Status in Firefighters. J Occup Environ Med. 2002;44(10).

Nuttall FQ. Body Mass Index: Obesity, BMI, and Health: A Critical Review. Nutrition Today. 2015;50(3).

Sterud T, Oivind E, Hem E. Health Status in the ambulance services: a systematic review. BMS Health Services Research. 2006;6(82):10.

Dominick KL, Ahern M, Gold C, Heller DA. Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging Clinical Experimental Research. 2002;14(6).

Kales, Tsismenakis AJ, Zhang C, Soteriades ES. Blood Pressure in Firefighters, Police Officers, and Other Emergency Responders. Am J Hypertens. 2009;22(1):11-20.

Tsismenakis AJ, Christophi CA, Burress JW, Kinney AM, Min K, Kales SN. The Obesity Epidemic and Future Emergency Responders. Obesity 2009;17(8):1648-50.

Maguire BJ, O'Meara P, Brightwell R, O'Neill B, Fitzgerald G. Occupational injury risk among Australian paramedics: an analysis of national data. Med J Aust. 2014;200(8):4.

Maguire BJ, Smith S. Injuries and Fatalities among Emergency Medical Technicians and Paramedics in the United States. Prehosp Disaster Med. 2013;FirstView:1-7.

Broniecki M, Esterman A, May E, Grantham H. Musculoskeletal disorder prevalence and risk factors in ambulance officers. J Back Musculoskeletal Rehab. 2010;23:165-74.

Betlehem J, Horvath A, Jeges S, Gondocs Z, Nemeth T, Kukla A, et al. How Healthy are Ambulance Personnel in Central Europe? Eval Health Prof. 2013;00(0):13.

Dixon J, Welch N. Researching the Rural–Metropolitan Health Differential Using the ‘Social Determinants of Health’. Aust J Rural Health. 2000;8(5):254-60.

Boreham CA, Gamble RP, Wallace W, Cran G, Stevens AB. The health status of an ambulance service. Occup Med. 1994;44(3):3.

Bennett P, Williams Y, Page N, Hood K, Woolard M. Levels of mental health problems among UK emergency ambulance workers. Emerg Med J. 2004;21:235-6.

Gamble RP, Stevens AB, McBrien H, Black A, Cran GW, Boreham C. Physical fitness and occupational demands of the Belfast Ambulance Service. Br J Ind Med. 1991;49(9):4.

Buzga M, Jirak Z, Buzgova R. State of Physical Health and Fitness of Paramedics in the Czech Republic. Wulfenia Journal. 2015;22(3):8.

Berrington de Gonzalez A, Hartge P, Cerhan J, Flint A, Hannan L, MacInnis R, et al. Body-mass index and mortality among 1.46 million white adults. New Engl J Med. 2010;363(23):8.

Di Angelantonio E, Bhupathiraju S, Wormser D, Gao P, Kaptoge S, Berrington de Gonzalez A, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388(10046):10.

Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126-31.

Diepetro L. Physical Activity in Aging: Changes in Patterns and Their Relationship to Health and Function. J Gerontol A Biol Sci Med Sci. 2001;56A(Special Issue II):9.

Australian Government Department of Health. Australia's Physical Activity and Sedentary Behaviour Guidelines. In: Health Do, editor. Canberra, Australia: Australian Government; 2017. p. 8.

Lindsay D, Devine S, Sealey R, Leicht A. Time kinetics of physical activity, sitting and quality of life measures within a regional workplace: a cross-sectional analysis. BMC Public Health. 2016;16(786):9.

Gandek B, Sinclair S, Kosinski M, Ware J. Psychometric Evaluation of the SF-36 Health Survey in Medicare Managed Care. Health Care Financ Rev. 2004;25(4):20.

Ware J, Kosinski M, Keller SD. SF-36 physical and mental health summary scales: a user's manual. Boston: The Health Institute; 1994.

Trewin D. 1995 National Health Survey SF36 Population Norms. In: Statistics ABo, editor. Canberra: Australian Bureau of Statistics; 1995. p. 40.

Trewin D. 2001 National Health Survey Summary of Results. Canberra: Australian Bureau of Statistics; 2001.

Wilkins R. Families, Incomes and Jobs, Volume 9. Melbourne: Melbourne Institute of Applied Economic and Social Research; 2014.

Butterworth P, Crosier T. The validity of the SF-36 in an Australian National Household Survey: demonstrating the applicability of the Household Income and Labour Dynamics in Australia (HILDA) Survey to examination of health inequalities. BMC Public Health. 2004;4(1):1-11.

Ware J, Snow K, Kosinski M, Gandek B. SF-36 health survey manual and interpretation guide. The Health Institute, Boston; 1993.

Wold H. Causal Flows with Latent Variables: Parting of the ways in the light of NIPALS modelling. European Economic Review. 1974;5(1):18.

Wasito I, Mirkin B. Nearest neighbours in least-squares data imputation algorithms with different missing patterns. Comput Stat Data Anal. 2006;50:23.

Pek E, Fuge K, Marton J, Banfai B, Csaszarne Gombos G, Betlehem J. Cross-sectional survey on self reported health of ambulance personnel. Scandanavian Journal of Trauma, Resuscitation and Emergency Medicine. 2015;23(14):12.

Betlehem J, Gondocs Z, Jeges S. Major contributing factors of self percieved health in Hungarian ambulance personnel. Magyar Mentesugy. 2013;1(4):12.

Studnek JR, Bentley M, MacCrawford J, Fernandez AR. An Assessment of Key Health Indicators among Emergency Medical Services Professionals. Prehosp Emerg Care. 2010;14(1):14-20.

Simmons D, McKenzie A, Eaton S, Cox H, Khan MA, Shaw J, et al. Choice and availability of takeaway and restaurant food is not related to the prevalence of adult obesity in rural communities in Australia. Int J Obesity. 2005;29:7.

James P, Troped P, Hart J, Joshu C, Colditz G, Brownson R, et al. Urban Sprawl, Physical Activity, and Body Mass Index: Nurses’ Health Study and Nurses’ Health Study II. Am J Public Health. 2013;103(2):369-75.

Almajwal AM. Correlations of Physical Activity, Body Mass Index, Shift Duty, and Selected Eating Habits among Nurses in Riyadh, Saudi Arabia. Ecol Food Nutr. 2015;54(4):397-417.

Kuehl KS, Kisbu-Sakarya Y, Elliot DL, Moe EL, DeFrancesco CA, MacKinnon DP, et al. Body Mass Index is a Predictor of Fire Fighter Injury and Worker Compensation Claims. J Occup Environ Med. 2012;54(5):579-82.

Hegg-Deloye S, Brassard P, Prairie J, Larouche D, Jauvin N, Poirer P, et al. Prevalence of risk factors for cardiovascular diseases in paramedics. Int Arch Occup Environ Health. 2015.

Merrill S. Task Performance and Health Improvement Recommendations for Emergency Medical Service Practitioners. United States: American Council on Exercise; 2013.

Fitness Passport. Fitness Passport 2018 [cited 2018 September 16]. Available from:

McAdams MA, Van Dam R, Hu FB. Comparison of self-reported and measured BMI as correlates of disease markers in US adults. Obesity. 2007;15(1):188-196



  • There are currently no refbacks.

Copyright (c) 2018 Alex James MacQuarrie, Caroline Robertson, Peter Micalos, James Crane, Richard High, Eric Drinkwater, James Wickham

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

IJP is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) licence. Article copyright remains with individual authors. Authors grant unrestricted copyright license to the IJP. Readers may copy, distribute, build upon, reproduce, and display the work with the proper citation of the original work in this publication.

DPLA Rights statement: The IJP supports the National Principles for Open Access Policy Statement.