Work-related stress among emergency medical services healthcare workers in İstanbul: A cross-sectional analysis

Emergency medical services healthcare workers (EMS-HCWs) are frequently exposed to high occupational stress due to demanding work environments, which may adversely affect their psychological well-being and job performance. Limited data are available for Türkiye, particularly for İstanbul, which is a densely populated metropolitan city with a large EMS workforce. This cross-sectional analytical study was conducted between September and December of 2014 in İstanbul. Data were collected using the Perceived Stress Scale (PSS-14) and Organizational Stress Questionnaire-Doetinchem (VOS-D). Of the 1100 EMS-HCWs invited to participate, 1000 returned the completed questionnaires (response rate: 90.9%). After excluding incomplete forms, 574 responses were included in the final analysis (inclusion rate: 52.2%). Descriptive statistics, nonparametric group comparisons, effect size estimation, correlation analyses, and multiple linear regression were performed. Overall, 78.6% of EMS-HCWs demonstrated moderate levels of perceived stress. Female EMS-HCWs reported significantly higher Perceived Stress Scale and Organizational Stress Questionnaire-Doetinchem scores compared with males (all P < .001). Command and Control Center (CCC) staff had higher scores for psychological complaints, health problems, and social variables than the station staff (all P < .05). Workplace and behavioral factors, including inadequate training, limited social support, perceived staffing shortages, low job satisfaction, unsafe working conditions, smoking, and alcohol use, were significantly associated with higher stress scores. Regression analysis revealed that the VOS-D subdomains (stressors, psychological complaints, and social variables) significantly predicted the Perceived Stress Scale total scores, explaining 23.4% of the variance (P < .001). Emergency medical services healthcare workers in İstanbul experienced substantial occupational stress, with female EMS-HCWs and Command and Control Center staff being particularly vulnerable. These findings highlight the urgent need for targeted and multifaceted interventions to improve workplace safety, staffing adequacy, and psychosocial support, thereby promoting the health and effectiveness of EMS-HCWs in high-density urban settings.