# Secondary Traumatic Stress Among Emergency Medical Personnel: A Cross-Sectional Study in Romania

## TL;DR

This study in Romania finds that most emergency medical workers have low levels of secondary traumatic stress, but some groups like women and nurses experience higher symptoms.

## Contribution

The study provides new evidence on secondary traumatic stress among emergency medical personnel in Romania, highlighting gender and role-specific differences.

## Key findings

- Most participants (77.2%) reported little or no secondary traumatic stress.
- Women and nurses had significantly higher STS scores compared to men and ambulance drivers/attendants.
- Years of experience and age were weakly correlated with higher intrusion symptoms.

## Abstract

Background/Objectives: Secondary traumatic stress (STS) affects healthcare professionals indirectly exposed to patients’ trauma, and emergency personnel may be particularly vulnerable. Evidence from Romania is limited. Methods: We conducted a cross-sectional survey (July–August 2025) among emergency medical professionals working across the integrated emergency care system in Timisoara, Romania (prehospital ambulance/SMURD services and hospital Emergency Department). Secondary Traumatic Stress (STS) symptoms were measured using the 17-item Secondary Traumatic Stress Scale (STSS; item coding 1–5). We summarized STSS total/subscale scores and reliability, classified total scores into severity categories (0–68 metric), compared scores by workplace, sex, and professional role, and examined associations with age and years of experience. Results: The analytic sample included 145 participants (49.0% women), with a median age of 44 years [33–50] and median professional experience of 10 years [5–15]. Mean total STSS was 36.4 (SD 11.9; range 17–66) and internal consistency was high (Cronbach’s alpha = 0.92). Most participants were classified as little/no STS (77.2%), followed by mild (12.4%), moderate (5.5%), high (4.1%), and severe (0.7%). STSS scores did not differ significantly between ambulance service and ED/UPU staff. Women reported higher total STSS than men (39.0 vs. 33.9; p = 0.010), with significant differences for intrusion (p = 0.035) and arousal (p = 0.004). Role differences were significant for total STSS, intrusion, and arousal (p ≤ 0.031), with nurses scoring higher than ambulance drivers/attendants in post hoc comparisons. Years of experience showed small positive correlations with total STSS (r = 0.18, p = 0.032) and intrusion (r = 0.21, p = 0.010); age was associated with intrusion only (r = 0.22, p = 0.008). Conclusions: In this Romanian emergency care cohort, most participants reported low STS severity, but a clinically relevant minority had moderate-to-severe symptoms. Higher symptom burden among women and nurses suggests groups that may benefit from targeted monitoring and support within the integrated emergency system.