Perceived stress and risky driving among emergency medical services personnel: parallel mediation effects of cognitive failures and emotional exhaustion

Background: Risky driving behavior (RDB) while ambulances are engaged in medical emergency services comprises a critical occupational risk as well as a public-safety threat, but the mechanisms underlying such behaviors influenced by perceived stress among emergency medical services (EMS) personnel remain poorly articulated. Based on transactional stress appraisal theory and conservation of resources theory, this study investigated the mediating role of cognitive failures and emotional exhaustion between perceived stress and risky driving. Methods: A cross-sectional survey was carried out among 400 frontline emergency medical services personnel, including ambulance drivers, emergency medical technicians, and paramedics with recent experience in driving ambulances on duty in Saudi Arabia. Partial least squares structural equation modeling was used to analyze data. Results: Perceived stress directly did not significantly affect risky driving. But perceived stress positively affected cognitive failures and emotional exhaustion. Cognitive failures and emotional exhaustion, in consequence, had strong positive effects on risky driving. Mediation analysis also indicated specific indirect effects of perceived stress on risky driving through cognitive failures and emotional exhaustion, with both counting as full mediations. The control variables listed were not significant. Conclusion: Perceived stress affects risky driving behavior among emergency medical services personnel not directly but through both cognitive and affective pathways that are parallel to each other. Stress may also promote risky driving in particular through attention lapses, action and memory failures, stressful task conditions leading to emotional depletion, etc. These findings are an expansion of the understanding of driving safety in emergency medical services and emphasize that to enhance safe driving during ambulance operations, it is vital to address not just stress itself but also the cognitive and emotional fallout from stress.