Cortisol Levels in AcUte Stress moments

Physiological stress is characterized by a steep increase of ACTH and cortisol
in peripheral blood. An increase in cortisol levels leads to an increased
gluconeogenesis and degradation of lipids. Also, an increased glucose level is
seen in peripheral blood. It is known from earlier studies that extreme acute
stress situations can lead to very high levels of cortisol. This in turn can
lead to psychological blockade but also physiological complaints and even
damage. It is reasonable that continuous training of certain possible
stressfull situations can lead to a better handling of the stress feelings for
that moment. At this moment a so-called "terroristic exercise" is planned for
all caregivers involved in the Southwest part of Limburg (The Netherlands):
ambulance-nurses, emergencyroom-nurses, police, fire department, but also a
specialized military group (rapid response team) will take part in this
exercise moment. Because the training level how to cope with certain stressfull
situations differ between these group of caregivers, it is hypothesized that
there will be a difference in cortisol levels before and after the exercise.

The major objective of this study is to investigate the level and response in
cortisol before and after a stressfull situations in different groups of
care-givers. It is hypothesized that the best trained group will show the
lowest increase in cortisol during and after stressfull situations. For our
case, this will be the military rapid-response team.
Next to this, questionnares will be used to investigate possible responses in
cortisol levels and correlate them with possible coincidences.
Finally, this exercise will be used to validate our new cortisol-assay in
saliva to the golden standard 'cortisol levels in plasma'. The new assay in
saliva have certain benefits to the blood test (it is faster, high sensitivity
and less invasive).

It will be an observational study which will be performed during the "disaster
exercise" of the LVIZ (Limburgse Vereniging voor Intensieve Zorg; 19 april
2018). Before, just after, and 10 hrs after the exercise blood- and saliva
samples will be collected in the different groups of care-givers
(ambulance-nurses, emergencyroom-nurses, police, fire department, but also a
specialized military group (rapid response team)).

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- correlation between cortisol in saliva and in peripheral blood