• Math Mj Smeets, Piet Vandenbossche, Wilma Ljm Duijst, MookWalther Nka vanWNVDepartment of Intensive Care Medicine, Academisch Ziekenhuis Maastricht, Maastricht, The Netherlands.School of Health Professions Education, Maastricht University, Maastricht, The Netherlands., and LeersMathie P GMPGhttp://orcid.org/0000-0001-5186-5600Clinical Chemistry & Hematology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands mat.leers@zuyderland.nl..
• Clinical Chemistry & Hematology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands.
• Emerg Med J. 2021 Apr 1; 38 (4): 297-302.

BackgroundAcute or chronic stress can lead to physical and mental disorders. Measuring cortisol can objectify the degree of stress. Cortisol is traditionally measured in serum, but recently the relevant fraction of free cortisol can be reliably measured in saliva, using the very sensitive liquid chromatography tandem mass spectrometry (LC-MS/MS) method. The use of saliva is non-invasive and allows easy serial testing around stressful events. The main objective of this study is to investigate whether serial saliva cortisol determinations using the LC-MS/MS method can be used to assess the stress response that first responders may experience during moments of acute professional deployment in their daily work.MethodsHealthy first responders (police officers, firefighters, rapid response team, ambulance personnel, first aid and emergency medical personnel) were recruited to participate in a Euregional high-reliability simulation training ('Be Aware'-scenario training, 19 April 2018). At three time points, simultaneous venous blood samples and saliva samples were obtained. These time points were 1 hour before, immediately after and 10 hours after the simulation training. The correlation between changes in saliva cortisol measured by LC-MS/MS and serum cortisol at all three time points was determined. Results were compared with spectators not directly participating in the simulation.Results70 subjects participated in the simulation. There was a strong correlation between the changes in saliva and blood cortisol at the three time points. A significant increase in blood and saliva cortisol was shown 1 hour after the experienced stress moments. The levels had almost completely returned to baseline in all healthy volunteers 10 hours later. Cortisol in spectators was unaffected.ConclusionSerial saliva cortisol measurements using LC-MS/MS is a reliable and fast non-invasive functional stress assay, which can be easily collected in daily practice and used for investigation and monitoring of stress response in front line responders.© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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