Document Type : Original Article


1 Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

2 DPFA Academy of Work and Health, Leipzig, Germany

3 Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran, Nursing Management, Nursing Management, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran

4 Institute of Psychology, University of Gdansk, Gdańsk, Poland

5 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden


BACKGROUND: Health is a complex structure and has physical, psychological, and social 
approaches. The importance and impact of health assessment have caused considerable attention to 
be paid to the employees of the health system and the determining factors of this relationship. Hence, 
the main purpose of this study was to find out the bio‑psycho‑social health situation in prehospital 
emergency technicians as the research question staff.
MATERIALS AND METHODS: The present study is a systematic review and data have retrieved 
through extensive search in Scopus, Web of Science, PubMed (including Medline), Cochrane 
Library, Irandoc, Magiran, MedLib, and SID databases with a combination of keywords of “Health, 
” “Assessment, ” “Social,” “Psychological,” “Biological,” “Emergency,” and “prehospital,” according 
to the search strategy, between 2000 and 202111 studies were reviewed; then, they were entered 
based on the objectives of the study and narrative analysis was performed by the researcher.
RESULTS: After analyzing the articles, a total of 4 factors affecting bio‑psycho‑social health in 
prehospital emergency technicians have been extracted and identified, which included health 
management, bio‑psycho‑social factors, occupational factors, and behavioral factors.
CONCLUSION: This research showed four factors, namely health management, bio‑psycho‑social 
factors, occupational factors, and behavioral factors which could be effective in Bio‑Psycho‑Social 
health. Since prehospital emergency services have an important role in maintaining the health of the 
community, which requires attention to the bio‑psycho‑social health of emergency personnel, more 
studies have focused on health management among the four mentioned factors, but the need to 
examine the other three factors for a more accurate assessment of the health of emergency personnel 
seems necessary. Therefore, prevention and response strategies based on bio‑psycho‑social health 
assessment models are proposed to promote the health of prehospital emergency technician staff.


1. Ramezankhani A, Jahani H, Hatami H, Sharifzadeh G, Hosseini S. 
Determine the effect of intervention on the adoption of preventive 
behaviours of the brucellosis was based on the health belief model. 
2. Sulmasy DP. A biopsychosocial‑spiritual model for the care of 
patients at the end of life. The gerontologist. 2002;42(suppl_3):24‑33.
3. Bolton D, Gillett G. The biopsychosocial model of health and 
disease: New philosophical and scientific developments: Springer 
Nature; 2019.
4. Kusnanto H, Agustian D, Hilmanto D. Biopsychosocial model 
of illnesses in primary care: A hermeneutic literature review. 
J Family Med Prim Care. 2018;7 (3):497‑500.
5. Walker JG, Jackson HJ, Littlejohn GO. Models of adjustment to 
chronic illness: Using the example of rheumatoid arthritis. Clinical 
psychology review. 2004;24 (4):461‑88.
6. Kaplan D, Coogan SL. The next advancement in counseling: The 
bio‑psycho‑social model. Vistas: Compelling perspectives on 
counseling. 2005:17‑25.
7. Pace B. Renaissance of sickle cell disease research in the Genome 
Era: World Scientific; 2007.
8. Frazier LD. The past, present, and future of the biopsychosocial 
model: A review of The Biopsychosocial Model of Health and 
Disease: New philosophical and scientific developments by 
Derek Bolton and Grant Gillett. New Ideas in Psychology. 
9. Engert V, Grant JA, Strauss B. Psychosocial Factors in Disease 
and Treatment—A Call for the Biopsychosocial Model. JAMA 
Psychiatry. 2020;77 (10):996‑7.
10. Rodgers J, Cuevas AG, Williams DR, Kawachi I, Subramanian S. 
The relative contributions of behavioral, biological, and 
psychological risk factors in the association between psychosocial 
stress and all‑cause mortality among middle‑and older‑aged 
adults in the USA. GeroScience. 2021:1‑18.
11. Clompus S, Albarran J. Exploring the nature of resilience 
in paramedic practice: A psycho‑social study. International 
Emergency Nursing. 2016;28:1‑7.
12. Hugelius K, Berg S, Westerberg E, Gifford M, Adolfsson A. 
Swedish ambulance managers’ descriptions of crisis support for 
ambulance staff after potentially traumatic events. Prehospital 
and disaster medicine. 2014;29 (6):589.
13. Lebares CC, Coaston TN, Delucchi KL, Guvva EV, Shen WT, 
Staffaroni AM, et al. Enhanced Stress Resilience Training in 
Surgeons: Iterative Adaptation and Biopsychosocial Effects in 2 
Small Randomized Trials. Ann Surg. 2021;273 (3):424‑32.
14. Usul E, Şan İ, Bekgoz B. The Effect of the COVID‑19 Pandemic on 
the Anxiety Level of Emergency Medical Services Professionals. 
Psychiatria Danubina. 2020;32:563‑9.
15. Klimley KE, Van Hasselt VB, Stripling AM. Posttraumatic stress 
disorder in police, firefighters, and emergency dispatchers. 
Aggression and violent behavior. 2018;43:33‑44.
16. Mazhin SA, Khankeh H, Farrokhi M, Aminizadeh M, 
Poursadeqiyan M. Migration health crisis associated with climate 
change: A systematic review. Journal of education and health 
promotion. 2020;9.
17. Purssell E. Can the Critical Appraisal Skills Programme check-lists 
be used alongside Grading of Recommendations Assessment, 
Development and Evaluation to improve transparency and 
decision-making? Journal of advanced nursing. 2020;76 (4):1082‑9.
18. Bazazan A, Dianat I, Bahrampour S, Talebian A, Zandi H, 
Sharafkhaneh A, et al. Association of musculoskeletal disorders 
and workload with work schedule and job satisfaction among 
emergency nurses. International emergency nursing. 2019;44:8‑13.
19. Farre A, Rapley T, editors. The new old (and old new) medical 
model: four decades navigating the biomedical and psychosocial understandings of health and illness. Healthcare; 2017: 
Multidisciplinary Digital Publishing Institute.
20. Erving CL, Satcher LA, Chen Y. Psychologically resilient, but 
physically vulnerable? Exploring the psychosocial determinants 
of African American women’s mental and physical health. 
Sociology of Race and Ethnicity. 2021;7 (1):116‑33.
21. Rentscher KE, Carroll JE, Mitchell C. Psychosocial stressors and 
telomere length: a current review of the science. Annual review 
of public health. 2020;41:223‑45.
22. Wade DT, Halligan PW. The biopsychosocial model of illness: 
a model whose time has come. SAGE Publications Sage UK: 
London, England; 2017.
23. Nino L, Marchak F, Claudio D. Physical and mental workload 
interactions in a sterile processing department. International 
Journal of Industrial Ergonomics. 2020;76:102902.
24. Maake CS. Individual and collective exposure to workplace 
violence of pre‑hospital Emergency Care providers in urban Cape 
Town: Cape Peninsula University of Technology; 2020.
25. Kim ES, Delaney SW, Tay L, Chen Y, Diener ED, Vanderweele TJ. 
Life Satisfaction and Subsequent Physical, Behavioral, and 
Psychosocial Health in Older Adults. The Milbank Quarterly. 
2021;99 (1):209‑39.
26. Delshad V, Khankeh H, Ebadi A, Bidzan M, Harouni G, Stueck M. 
Psychobiological risk assessment in emergency medical service 
drivers: study protocol for structural equation modeling. Health 
Psychology Report. 2020;8 (1).
27. Copeland D, Henry M. The relationship between workplace 
violence, perceptions of safety, and Professional Quality of Life 
among emergency department staff members in a Level 1 Trauma 
Centre. International Emergency Nursing. 2018;39:26‑32.
28. Afshari D, Jafarzadeh Z, Nakhaei M, Sahraneshin Samani A, 
Nourollahi‑Darabad M. Mental Workload and Job Satisfaction 
in Pre‑Hospital Emergency Technicians. Jundishapur Journal of 
Health Sciences. 2020;12 (3).
29. Hames AM. African American Women with Type 2 Diabetes: 
A Biopsychosocial‑Spiritual Approach. 2010.
30. Shields G, Slavich G. Lifetime stress exposure and health: a review 
of contemporary assessment methods and biological mechanisms. 
Soc. Personal. Psychol. Compass 11, e12335. 2017.
31. Rice V, Glass N, Ogle K, Parsian N. Exploring physical health 
perceptions, fatigue and stress among health care professionals. 
Journal of multidisciplinary healthcare. 2014;7:155.
32. Benatti B, Albert U, Maina G, Fiorillo A, Celebre L, Girone N,
et al. What happened to patients with obsessive compulsive 
disorder during the COVID‑19 pandemic? A multicentre report 
from tertiary clinics in northern Italy. Frontiers in Psychiatry. 
33. Avraham N, Goldblatt H, Yafe E. Paramedics’ experiences and 
coping strategies when encountering critical incidents. Qualitative 
Health Research. 2014;24 (2):194‑208.
34. Hemsworth D, Baregheh A, Aoun S, Kazanjian A. A critical 
enquiry into the psychometric properties of the professional 
quality of life scale (ProQol‑5) instrument. Applied Nursing 
Research. 2018;39:81‑8.