The Competencies of Emergency Medical Technicians in Iranian Emergency Services for Critical Situations

The Relationship Between Ski Patrols and Emergency Medical Services Systems

Objectives: This was a study to evaluate the utilization of emergency medical services (EMS) systems during the outbreak of severe acute respiratory syndrome (SARS), and to assess the incidence of infection among emergency medical technicians (EMTs). Methods:This was a prospective, observational study conducted in the EMS system of Taipei, Taiwan. Probable/suspect cases of SARS were defined by World Health Organization criteria. SARS-related transports were categorized into 1) requests from hospitals for probable/suspect cases of SARS, 2) quarantined individuals, and 3) febrile persons. City ambulances were organized into teams A, B, and C for transports of different perceived risks. Data on the EMS volume, the transport category, the final SARS status of patients, and the EMT responsible for the transports were collected. The EMS projected volume was computed by previous years' data and compared with that collected. The SARS incidence among EMTs was assessed by investigating probable SARS (P-SARS) and by surveying the seroprevalence of SARS-associated coronavirus (SARS-CoV) antibody. Results: From March 18 to June 19, 2003, there were 7,961 EMS transports, similar to the volume projected from previous years (7,506) (95% CI = 6,688 to 8,324). Of these, 1,760 (22.1%) were SARS-related. When SARS-related transports were excluded, there was a 12.2% decrease (95% CI = 11.4% to 12.9%) in EMS activities. Requests from hospitals, quarantined individuals, and febrile citizens accounted for 23%, 18%, and 59% of SARS-related transports. Among the 397 P-SARS cases in the city of 2.65 million people (incidence 0.01%, 95% CI = 0.01% to 0.02%), 138 (35%) required EMS transports. Two EMTs working in team C, the team with the lowest risk, developed P-SARS. One of them died soon thereafter. The incidence of P-SARS was 0.6% (95% CI = 0.2% to 2.2%), or 0.1% (95% CI = 0.03% to 0.4%) per transport. SARS-CoV serology was available in 74.1% of EMTs who were alive. In addition to the surviving P-SARS EMT, one EMT from team A, the team with the highest risk, was seropositive. Combining P-SARS and the seropositive case, three EMTs were infected (incidence 1.3%, 95% CI = 0.4% to 3.6%). No patient transported by the infected EMTs developed SARS. The hospitals serving EMS by the infected EMTs had been involved in a clustered outbreak prior to the EMTs' infections. Conclusions: During the outbreak of SARS, the overall EMS volume did not change significantly, but the non-SARS EMS activities decreased. Compared with the general population, EMS providers are at higher risk of contracting the SARS virus regardless of different perceived levels of risk. Standard protections and procedures for infection control should be strictly followed during transport and within the hospital environment.

Objectives: This was a study to evaluate the utilization of emergency medical services (EMS) systems during the outbreak of severe acute respiratory syndrome (SARS), and to assess the incidence of infection among emergency medical technicians (EMTs). Methods:This was a prospective, observational study conducted in the EMS system of Taipei, Taiwan. Probable/suspect cases of SARS were defined by World Health Organization criteria. SARS‐related transports were categorized into 1) requests from hospitals for probable/suspect cases of SARS, 2) quarantined individuals, and 3) febrile persons. City ambulances were organized into teams A, B, and C for transports of different perceived risks. Data on the EMS volume, the transport category, the final SARS status of patients, and the EMT responsible for the transports were collected. The EMS projected volume was computed by previous years' data and compared with that collected. The SARS incidence among EMTs was assessed by investigating probable SARS (P‐SARS) and by surveying the seroprevalence of SARS‐associated coronavirus (SARS‐CoV) antibody. Results: From March 18 to June 19, 2003, there were 7,961 EMS transports, similar to the volume projected from previous years (7,506) (95% CI = 6,688 to 8,324). Of these, 1,760 (22.1%) were SARS‐related. When SARS‐related transports were excluded, there was a 12.2% decrease (95% CI = 11.4% to 12.9%) in EMS activities. Requests from hospitals, quarantined individuals, and febrile citizens accounted for 23%, 18%, and 59% of SARS‐related transports. Among the 397 P‐SARS cases in the city of 2.65 million people (incidence 0.01%, 95% CI = 0.01% to 0.02%), 138 (35%) required EMS transports. Two EMTs working in team C, the team with the lowest risk, developed P‐SARS. One of them died soon thereafter. The incidence of P‐SARS was 0.6% (95% CI = 0.2% to 2.2%), or 0.1% (95% CI = 0.03% to 0.4%) per transport. SARS‐CoV serology was available in 74.1% of EMTs who were alive. In addition to the surviving P‐SARS EMT, one EMT from team A, the team with the highest risk, was seropositive. Combining P‐SARS and the seropositive case, three EMTs were infected (incidence 1.3%, 95% CI = 0.4% to 3.6%). No patient transported by the infected EMTs developed SARS. The hospitals serving EMS by the infected EMTs had been involved in a clustered outbreak prior to the EMTs' infections. Conclusions: During the outbreak of SARS, the overall EMS volume did not change significantly, but the non‐SARS EMS activities decreased. Compared with the general population, EMS providers are at higher risk of contracting the SARS virus regardless of different perceived levels of risk. Standard protections and procedures for infection control should be strictly followed during transport and within the hospital environment.

Terrorism response training for emergency medical technicians since september 11, 2001: A nation unprepared

Objectives Many United States (U.S.) communities face challenges with Emergency Medical Services (EMS) workforce turnover. The demands created by the pandemic have worsened the stressors EMS clinicians face, possibly changing the drivers of workforce turnover. Our study aims to understand the factors associated with Emergency Medical Technicians (EMTs) and paramedics’ likelihood of leaving EMS. Methods We conducted a cross-sectional analysis of nationally registered civilian EMTs and paramedics ages 18–85 from October 2021 to April 2022. After recertifying their National EMS certification, respondents were invited to complete a survey regarding their primary role, additional jobs, and the likelihood of leaving EMS in the next 12 months. If likely to leave, reasons for leaving were collected and evaluated for the top reasons. Multivariable logistic regression modeling (OR, 95% CI) was used to describe the odds of being likely to leave in 12 months, adjusted for age, agency type, education level, primary role, and job satisfaction. Results A total of 29,671 (response rate-25.9%) EMTs and paramedics were included in the analysis, with 7.1% and 7.9%, respectively, reporting they were likely to leave EMS in 12 months. The EMTs likely to leave were younger (median age 32 vs. 37) and had fewer years with main EMS job (median 3 vs. 4) than paramedics. A lower proportion of EMTs were male (68.8% vs. 78.6%) and non-Hispanic White (79.8% vs. 87.6%). The EMTs were less likely full-time (65.6% vs. 87.5%) and held fewer EMS jobs (23.4% vs. 32.3%). The EMTs and paramedics reported stress as the most significant reason for leaving (27.9% and 38.8%, respectively), followed by COVID-19 (12.9% and 19.3%) and education (18.3% and 6.4%). Those dissatisfied had significantly higher odds of leaving (11.91 and 13.46, respectively). The EMTs and paramedics in hospitals (OR = 2.32, OR = 2.37), private (OR = 2.72, OR = 2.38), and government non-fire (OR = 2.22, OR = 1.98) agencies were likelier to leave than fire agencies. Conclusion Although increased stress and pandemic-related factors are most common reasons reported for being likely to leave EMS, job dissatisfaction was the most impactful factor. A better understanding of factors that drive job satisfaction needs evaluation to develop strategies to enhance retention.

108 Knowledge, Attitudes and Practices Regarding Vital Signs Amongst EMTs of the Ghana Ambulance Service

There is reason to believe that traumatic events experienced on the job make emergency medical services (EMS) workers more skeptical about their spiritual beliefs. Little is known about the spiritual lives and experiences of emergency medical technicians (EMTs). No studies have measured the responses of EMTs to the spiritual needs of their patients. This study investigates whether EMS workers are less spiritual than the average U.S. citizen, and what effect this has on prayer for patients and perceived happiness. Data were collected in a major metropolitan EMS system from 125 EMTs and paramedics through a questionnaire about their beliefs and behaviors regarding their spirituality. Pearson product-moment correlation coefficients (r) were used to analyze variables. The religious attitudes of EMTs were compared with those of the general population as defined in the Gallup studies. Ninety-one percent of the EMS workers interviewed and 94% of Gallup's sample of the general population said they believe in God. The findings on other measures in the EMT sample also were very similar to those defined in the general population. Of the EMTs, 60% said they never have doubted the existence of God. Eighty-four percent believe God still works miracles, and 80% of the EMTs believe in life after death. Eighty-seven percent of EMS workers pray; 62% pray for their patients, and 54% pray for their coworkers. Frequency of church or synagogue attendance is positively and significantly correlated with the degree of perceived life happiness (r = 0.226, p < 0.025 > 0.005). Frequency of prayer also is correlated positively to perceived life happiness (r = 0.182, p < 0.025 > 0.005). Emergency medical services workers are interested and willing to talk about their spiritual lives. They do have more doubts about the existence of God than does the average civilian, but are just as spiritual. Those EMTs with more active spiritual lives perceive themselves as happier. The majority of EMS workers pray for their patients.

Utilization of Emergency Medical Transports and Hospital Admissions Among Persons With Behavioral Health Conditions

HighlightsWhat are the main findings?High burnout was observed in both EMT students and practising EMT professionals, based on instrument-specific thresholds, with no statistically significant between-group difference detected.In the exploratory adjusted model, age was associated with high burnout, whereas professional status and sex were not significant correlates.What are the implications of the main findings?The findings may support the inclusion of early psychosocial risk assessment and support strategies during EMT training, particularly before and during clinical placements.EMS organisations and educational institutions could use these exploratory findings to inform coordinated approaches to workforce well-being, occupational health, and healthcare workforce sustainability.Background: Burnout is a relevant occupational health concern in Emergency Medical Services (EMSs), with potential implications for workforce well-being, occupational health, and the sustainability of prehospital care. Although burnout has been widely studied among healthcare professionals, evidence concerning Emergency Medical Technician (EMT) students remains limited. This exploratory study aimed to estimate high burnout prevalence among EMT students and practising EMT professionals in Madrid, Spain, describe burnout dimensions in both groups, and examine sociodemographic correlates of high burnout status. Methods: A cross-sectional comparative study was conducted between March and June 2024 using a convenience sample of 85 participants: 43 EMT students and 42 practising EMT professionals. Burnout was assessed using validated Spanish versions of the Maslach Burnout Inventory: the MBI-SS for students and the MBI-HSS for professionals. Because these instruments are population-specific and rely on different norms and thresholds, between-group comparisons of raw scores were interpreted as exploratory. Descriptive analyses, between-group comparisons with effect sizes, correlation analyses, and an exploratory binary logistic regression model were performed. Results: High burnout was identified in 22 EMT students (51.2%) and 23 practising EMT professionals (54.8%), with no statistically significant between-group difference detected (p = 0.73; Cramer’s V = 0.04). Between-group comparisons of burnout dimensions showed small effect sizes for Emotional Exhaustion (Cohen’s d = 0.17), Depersonalisation (Cohen’s d = 0.24), and Personal Accomplishment (Cohen’s d = −0.26). Age was positively associated with Emotional Exhaustion (r = 0.29, p = 0.008) and Depersonalisation (r = 0.24, p = 0.028), and negatively associated with Personal Accomplishment (r = −0.26, p = 0.019). In the exploratory adjusted logistic regression model, age was associated with high burnout status (OR = 1.05; 95% CI 1.01–1.10; p = 0.017), whereas group and sex were not significant correlates. Conclusions: High burnout levels were observed in both EMT students and practising EMT professionals in this regional exploratory sample. However, the findings should be interpreted cautiously due to the cross-sectional design, convenience sampling, modest sample size, limited statistical power, and use of population-specific burnout instruments. These results suggest that burnout-related distress may be relevant across the EMT training-to-practice pathway and support the need for larger longitudinal and multicentre studies incorporating occupational, educational, and organisational variables.

Background Alternative emergency medical services (EMS) disposition programs have been developed for adults with low-acuity complaints. One barrier to including children in such programs is a lack of evidence regarding whether paramedics and emergency medical technicians (EMTs) can accurately identify children with low-acuity complaints. Our primary objective was to compare the accuracy of EMTs to that of paramedics in identifying low-acuity pediatric encounters. Our secondary objective was to determine whether support for alternative EMS dispositions differed between paramedics and EMTs. Methods This was a planned secondary analysis of a cross-sectional study of children transported by EMS to an emergency department (ED). Acuity was defined using a composite measure that included physiological patient assessments, resources used (including laboratory tests and radiographs), and patient disposition. EMS clinicians rated on a Likert scale their level of agreement that a patient had a low-acuity problem and could have been transported by private vehicle, seen in clinic, or not transported. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for paramedic and EMT acuity assessments were calculated. Results EMS surveys were completed for 84.0% of 996 participants (76.4% by EMTs, 22.6% by paramedics). 35.1% of participants were classified as having a low-acuity complaint. The sensitivity for identifying a child as low-acuity was 24% (95% CI 20%, 38%) for paramedics and 50% (46%, 54%) for EMTs. The PPV for identifying a child as low-acuity was 0.44 (0.28, 0.60) for paramedics and 0.62 (0.55, 0.68) for EMTs. Only 20.5% of paramedics and 22.5% of EMTs supported non-transport for children with low-acuity complaints. Conclusions Relying on EMS assessments of pediatric patient acuity may lead to under-triage, regardless of whether a paramedic or EMT makes this determination. Additional training and triage tools may be required before children can be safely included in alternative EMS disposition programs.

Background: Workforce diversity can reduce communication barriers and inequalities in healthcare delivery, especially in settings where time pressure and incomplete information may exacerbate the effects of implicit biases. Emergency medical services (EMS) professionals represent a critical entry point into the healthcare system for diverse populations, yet little is known regarding changes in the demographic composition of this workforce. Our primary objective was to describe the gender and racial/ethnic composition of emergency medical technicians (EMTs) and paramedics who earned initial National EMS Certification from 2008 to 2017. Secondarily, we compared demographic characteristics of the 2017 EMT and paramedic cohorts to the U.S. population. Methods: As a proxy for recent graduates likely to enter the workforce, we conducted a serial cross-sectional analysis of all EMTs and paramedics earning initial National EMS Certification from January 1, 2008 to December 31, 2017. Cuzick’s non-parametric test of trend was used to assess for changes in the gender and racial/ethnic composition of the EMS cohorts over time. For 2017, we calculated differences the gender and racial/ethnic composition of the EMT and paramedic cohorts to the U.S population, stratifying by Census region. Results: The study population included 588,337 EMTs and 105,356 paramedics. The proportion of females earning initial EMT certification rose from 28% in 2008 to 35% in 2017. Throughout the study period, less than one-fourth of newly certified paramedics were female (range: 20–23%). The proportion of EMS professionals identifying as black remained near 5% among EMTs and 3% among paramedics. The proportion of newly-certified Hispanic EMS professionals rose from 10% to 13% among EMTs and from 6% to 10% among paramedics. Compared to the U.S. population, females and racial/ethnic minorities were underrepresented among EMTs and paramedics earning initial certification and these representation differences varied across geographic regions. Conclusions: The underrepresentation of females and minority racial/ethnic groups observed during this 10-year investigation of EMTs and paramedics earning initial certification suggests that EMS workforce diversity is unlikely to undergo substantial change in the near future. The representation gaps were larger and more stable among paramedics compared to EMTs and suggest an area where concerted efforts are needed to encourage students of diverse backgrounds to pursue EMS.

Background. Rapid glucose testing is a valuable tool for emergency medical services (EMS) patient evaluation andtreatment. In most EMS systems, paramedics, but not emergency medical technicians (EMTs), are authorized to use glucometry. Objectives. To evaluate the influence of EMT glucometry on paramedic involvement in a two-tiered EMS response system. Methods. King County, Washington, EMTs underwent training in glucometry to determine blood sugar levels for specific patient presentations. The authors conducted a prospective cohort study of the first 500 EMT uses of glucometry, from October 2003 through March 2004, during which time EMTs recorded their subjective assessments of this additional information on their decisions to involve paramedics. Results. Overall, glucometry results appeared to influence EMT decisions to involve paramedics. Glucometry prompted EMTs to upgrade the triage level andrequest paramedic evaluation for 5% of patients (n = 22); glucometry caused EMTs to downgrade the triage level, canceling already dispatched paramedics for 5% of patients (n = 23); andglucometry allowed EMTs to function without paramedics when they otherwise would have called for assistance for 11% of patients (n = 52). In an additional 12% of patients (n = 54), paramedic involvement was not actually influenced, but EMTs still indicated that glucometry would have had an effect on triage had paramedics not been present. Conclusion. Use of glucometry by EMTs appears to influence the decision to involve paramedics, potentially enabling more efficient andappropriate triage.

Administering oxygen therapy (OT) has an essential role in preventing/managing hypoxemia in both acute and chronic conditions. It should be adjusted to achieve the normal oxygen saturation of 94%-98% in most cases. This study aims to evaluate knowledge, attitude and practice (KAP) of nurses, paramedics, emergency medical technicians (EMTs) and Emergency Medical Services (EMS) physicians working at emergency departments (ED) in Riyadh, Saudi Arabia. In this cross-sectional study, a structured questionnaire was used to assess KAP related to OT of nurses, paramedics, EMTs and EMS physicians currently working at an ED of a tertiary care hospital. Knowledge and attitude were assessed using a Likert scale from 1-5, whereas practice was assessed as a yes/no categorical variable. A total of 444 emergency health-care workers (EHCWs) participated, of which 225 (50.7%) were male, with the majority (77%) in the age group of 20-35 years. Over half of the sample were nurses (266; 59.9%). The mean score for knowledge about OT was 5.51±1.45, attitude was 26.31±3.17 and for practices 4.55±1.76. The main factors which were associated with poor KAP were workload and lack of local guidelines. The distribution of overall practice score was significantly better among paramedics - nurses group and EMT - nurses group. This study demonstrates that there is a gap in EHCWs' KAP, particularly regarding when to provide OT to a patient. This gap can affect patients' safety. Extensive educational and training programs about OT are needed to raise awareness among health-care providers.

Emergency Medical Services System (EMSS), including pre-hospital emergency medical services and in-hospital emergency medical care, offers people Emergency Medical Services (EMS) in daily lives or disasters. For the medical system, pre-hospital emergency medical services extend the emergency room to out of the hospital. Emergency Medical Technician (EMT), the performer of pre-hospital emergency medical services and trained by professional emergency medical courses, can offer emergency medical treatments to emergency patients and take them to hospitals for more medical care when accidents happened. EMT now is the professional symbol of pre-hospital emergency medical services. Concerning about their job stress, social support and professional commitment and confirming the relationships among them could help us understand EMT more and improve the quality of the EMSS. The purpose of this study was to explore the relationships among the Emergency Medical Technicians’ job stress, social support and professional commitment. This study employed the structured questionnaire to collect the related data. Finally, total 353 Emergency Medical Technicians of Designated Ambulance Crews in Taipei City completed and returned the questionnaires, and the response rate was 94.1%. The result of this study indicated that the major work type of EMT was lower job control and higher psychological demands. The social support of EMT was at the middle-high level, and the professional commitment was at the moderate level. EMT with more working experiences perceived higher social support, and the higher social support related to the higher job control, lower psychological demands and higher professional commitment. There were significant differences on job control and professional commitment across different emergency medical education levels (equal to the working units in this study). EMT-P (Paramedic) had higher job control and professional commitment than EMT-II. As the study proposed, working experiences and emergency medical education levels of EMT were both important factors to influence the social support. Emergency medical education levels and social support of EMT also significantly influence the job stress (including job control and psychological demands). In Summary, the emergency medical education levels, social support, and job stress all had strongly impact on the factors significantly influence the professional commitment.

342 A Brief Survey of Karachis Emergency Medical Services