Emergency Medical Services Workers Research Articles

Psychosocial working conditions, perceived patient safety and their association in emergency medical services workers in Germany - a cross-sectional study.

Emergency medical service (EMS) workers face challenging working conditions that are characterized by high stress and a susceptibility to making errors. The objectives of the present study were (a) to characterize the psychosocial working conditions of EMS workers, (b) to describe the perceived quality of patient care they provide and patient safety, and (c) to investigate for the first time among EMS workers associations of psychosocial working conditions with the quality of patient care and patient safety. For this cross-sectional study, we carried out an online survey among 393 EMS workers who were members of a professional organization. Working conditions were measured by the Demand-Control-SupportQuestionnaire (DCSQ) and seven self-devised items covering key stressors. Participants reported how often they perceived work stress to affect the patient care they provided and we inquired to what extent they are concerned to have made a major medical error in the last three months. Additionally, we used parts of the Emergency Medical Services - Safety Inventory (EMS-SI) to assess various specific errors and adverse events. We ran descriptive analyses (objective a and b) and multivariable logistic regression (objective c). The most common stressors identified were communication problems (reported by 76.3%), legal insecurity (69.5%), and switching of colleagues (48.9%) or workplaces (44.5%). Overall, 74.0% reported at least one negative safety outcome based on the EMS-SI. Concerns to have made an important error and the perception that patient care is impaired by work stress and were also frequent (17.8% and 12.7%, respectively). Most psychosocial working conditions were associated with the perception that patient care is impaired due to work stress. Work stress in EMS staff is pronounced and negative safety outcomes or potential errors are perceived to occur frequently. Poor psychosocial working conditions were only consistently associated with perceived impairment of patient care due to work stress. It seems necessary to reduce communication problems and to optimize working processes especially at interfaces between emergency services and other institutions. Legal insecurity could be reduced by clarifying and defining responsibilities. Communication and familiarity between team colleagues could be fostered by more consistent composition of squads.

Associations between paramedics' salutogenic health experience and the intention to stay in the profession: A cross-sectional survey.

To investigate the association between paramedics' salutogenic health and their intentions to stay in their profession. A cross-sectional survey. Paramedics from eight purposively selected organizations participated in this study (n = 433). The data were collected in 2022 with the Salutogenic Health Indicator Scale and validated single questions that assessed work ability, recovery and self-rated stress. Intention to stay was measured using two questions about the intention to leave prehospital emergency medical service work and leave the nursing sector completely during the next 2 years. Data were analysed using logistic regression and statistical significance tests. Men had higher mean salutogenic health scores than women. No significant differences in salutogenic health were observed across work experience or occupational groups. Paramedics intending to stay in their profession exhibited higher salutogenic health scores than those intending to leave. In the logistic regression models, increasing levels of salutogenic health and work ability were associated with intention to stay in the profession.

Sleep Safety in Emergency Medical Services Workers

Sleep Safety in Emergency Medical Services Workers

The Polk COVID-19 and Flu Response clinical trial: COVID-19 antibody positivity higher in Black EMS workers

This study reports on a countywide assessment of COVID-19 positivity among emergency medical services workers. Participants completed a short survey of demographic factors and co-morbidities prior to obtaining COVID-19 and influenza testing to analyze the prevalence of these two respiratory viruses that EMS workers, being the first on the scene, are at special risk for, especially in the early days of the pandemic. A total of 7% had a positive COVID-19 antibody test. Although Black EMS personnel only comprised 9% of the cohort, they were significantly more likely to test positive for COVID-19 (P=0.0012). Black race remained a statistically significant predictor in a multivariate model that included the age, sex, BMI, number of hours of direct patient contact, whether the medic was symptomatic, presence of co-morbidities and whether or not the medic had received a flu shot prior (P=0.0008, 95% CI 0.0621-0.2354). This clinical trial (NCT04682132) ) was registered at clinicaltrials.gov, a resource provided by the U.S. National Library of Medicine.

5. KNOWLEDGE, ATTITUDE AND PRACTICE OF PREHOSPITAL EMERGENCY IN VIETNAM, 2023

Objective: Assessing the knowledge, attitude and practice of prehospital emergency in Vietnam in 2023. 
 Subjects and methods: A survey on 10,800 people was implemented to assess the status of prehospital emergency and the capacity of the local health system. 
 Results: Only 33.65% of people knew about emergency calls and 33.20% of people did not know or sure about emergency calls. 49.48% of people believed that ambulances are useful, medical staff are useful in emergency care (50.04%). All residents estimated the ambulance’s time of arrival after calls around 5 - 60 minutes. The majority of people chose to transport emergency patients by taxi, personal car or carrying patients to the hospital, only 32.63% of people chose to call an ambulance when at home and 33.80% when outside. Most people reported to trust emergency medical service workers when the ambulance arrived at the scene or when the patient was hospitalized. 
 Conclusion: Although people’s knowledge and attitude towards prehospital emergency were inadequate, most people trusted medical staff when they arrived at the emergency scene or when taking patients to the hospital.

Cancer Risks among Emergency Medical Services Workers in Ontario, Canada

Objectives Emergency medical services workers, such as paramedics, provide important emergency care and may be exposed to potential carcinogens while working. Few studies have examined the risk of cancer among paramedics demonstrating an important knowledge gap in existing literature. This study aimed to investigate cancer risks among paramedics in a large cohort of Ontario workers. Methods Paramedics were identified in the Occupational Disease Surveillance System (ODSS) from 1996 to 2019. The ODSS was established by linking lost-time worker’s compensation claims to administrative health data, including the Ontario Cancer Registry to identify incident cases of cancer. Cox-proportional hazard models were used to calculate age and sex-adjusted hazard ratios and 95% confidence intervals to estimate the risk of cancer among paramedics compared to all other workers in the ODSS. Results A total of 7240 paramedics were identified, with just over half of the paramedics identifying as male similar to the overall ODSS cohort. Paramedics had a statistically significant elevated risk of any cancer (HR 1.19, 95% CI 1.06–1.34), and elevated risks for melanoma (HR 2.18, 95% CI 1.46–3.26) and prostate cancer (HR 1.73, 95% CI 1.34–2.22). Paramedics had a statistically significant reduced risk for lung cancer (HR 0.48, 95% CI 0.28–0.83). Findings were similar to cancer risks identified in firefighters and police in the same cohort. Conclusions This study contributes valuable findings to understanding cancer risks among paramedics and further supports the existing evidence on the increased risk of cancer among emergency medical services workers. We have observed some similar results for firefighters and police, which may be explained by similar exposures, including vehicle exhaust, shiftwork, and intermittent solar radiation. This can lead to a better understanding of carcinogens and other exposures among paramedics and inform cancer prevention strategies.

Comparing the effect of foot reflexology with olive oil and peppermint inhalation on job stress and fatigue severity among emergency medical services workers

Comparing the effect of foot reflexology with olive oil and peppermint inhalation on job stress and fatigue severity among emergency medical services workers

An Elucidation on the Challenges of Pre-hospital Emergency Technicians: A Study on Emergency Medical Technicians in Shiraz, Iran

Background: The identification of the strengths and weaknesses of pre-hospital emergency technicians, as the first providers of treatment services to critically ill patients, is of utmost importance. Objectives: This study was conducted to explain the challenges faced by emergency medical technicians in Shiraz, Iran, within 2021 - 2022. Methods: The present study was a qualitative study that was conducted using the traditional qualitative content analysis (Graneheim and Lundman, 2004). Sampling in this study was purposeful. A semi-structured interview was conducted with 17 emergency technicians in Shiraz. Lincoln and Guba’s standards were used to validate the data. Results: This study identified 3 categories and 12 subcategories. These three categories include management challenges, professional problems, and cultural barriers. Subcategories were “insufficient emergency medical services (EMS) stations”, “lack of human resources”, “role ambiguity”, “lack of organizational support”, lack of job prestige”, “high job stress”, “crowded missions”, “lack of psychotherapy and counseling”, “high-risk profession, “public’s false perception of EMS job”, “abuse of emergency call center services”, and “disrespectful behavior”. Conclusions: Considering that the provision of EMS is an inherently stressful and highly anxious job, some measures can be taken to reduce the mental effects of such pressure on the technicians. In addition, they should run public awareness campaigns to improve the cultural level of society to better understand the duties and activities of EMS workers at the community level.

Effect of Work-Related Behavior and Experience Patterns on Sleep Quality in Emergency Medical Service Personnel.

The aim of this study was to examine the influence of work-related behavior and experience patterns on sleep quality in emergency medical service personnel. From the total sample of 508 emergency medical service workers who took part in the Germany-wide online survey, 368 respondents completed the questionnaires on sleep characteristics (Pittsburgh Sleep Quality Index [PSQI]) and work-related behavior and experience pattern. Three hundred sixty-seven of the 368 participants also finished the Regensburg Insomnia Scale. Based on their work-related behavior and experience pattern results, individuals were categorized into one of the four following patterns: two risk patterns (A, B) and two healthy behavior and experience patterns (G, S). Participants that were classified into risk-pattern A and B (33.85%) scored significantly higher in both PSQI and Regensburg Insomnia Scale overall score and all PSQI components implicating a poorer sleep quality. A total of 78.5% of the individuals with pattern A and B were considered bad sleepers whereas only 43.4% of individuals with pattern G and S were scored as bad sleepers. Work-related behavior and experience patterns showed a strong association to sleep characteristics and may therefore be used to identify appropriate preventative measures.

No frequency change of prehospital treatments by emergency medical services workers for traumatic cardiac arrest patients before and after the COVID-19 pandemic in Korea: a case series

Purpose: Out-of-hospital traumatic cardiac arrest (TCA) often has a poor prognosis despite rescue efforts. Although the incidence and mortality of out-of-hospital cardiac arrest have increased, bystander cardiopulmonary resuscitation (CPR) has decreased in some countries during the COVID-19 pandemic. In the prehospital setting, immediate treatment of cardiac arrest is required without knowing the patient’s COVID-19 status. Because COVID-19 is usually transmitted through the respiratory tract, airway management can put medical personnel at risk for infection. This study explored whether on-scene treatments involving CPR for TCA patients changed during the COVID-19 pandemic in Korea. Methods: This retrospective study used data from emergency medical services (EMS) run sheets in Gangwon Province from January 2019 to December 2021. Patients whose initial problem was cardiac arrest and who received CPR were included. Data in 2019 were classified as pre–COVID-19 and all subsequent data (from 2020 and 2021) as post–COVID-19. Age, sex, possible cause of cardiac arrest, and treatments including airway maneuvers, oropharyngeal airway (OPA) or i-gel insertion, endotracheal intubation (ETI), bag-valve mask (BVM) ventilation, intravenous (IV) line establishment, neck collar application, and wound dressing with hemostasis were investigated. Results: During the study period, 2,007 patients received CPR, of whom 596 patients had TCA and 367 had disease-origin cardiac arrest (DCA). Among the patients with TCA, 192 (32.2%) were pre–COVID-19 and 404 (67.8%) were post–COVID-19. In the TCA group, prehospital treatments did not decrease. The average frequencies were 59.7% for airway maneuvers, 47.5% for OPA, 57.4% for BVM, and 51.3% for neck collar application. The rates of ETI, i-gel insertion, and IV-line establishment increased. The treatment rate for TCA was significantly higher than that for DCA. Conclusions: Prehospital treatments by EMS workers for patients with TCA did not decrease during the COVID-19 pandemic. Instead, the rates of ETI, i-gel insertion, and IV-line establishment increased.

Different words for stroke: the same concept? an analysis of associated symptoms and intended reaction in Brazil

BackgroundDifferent names for stroke might mislead physicians and emergency medical service workers. This study aimed to assess the different words for stroke in Brazil and both intended response and related symptoms associated with those names.MethodsCross-sectional study enrolling healthy individuals from urban areas in Northeast of Brazil for an open-ended survey. We presented a typical clinical case of a stroke (an elderly who had sudden onset of hemiparalysis and slurred speech) and asked “what is happening?”, “what would you do?” and “which other symptoms could happen in this condition?”.ResutsFrom 1,475 interviewed individuals, 1,220 (82,7%) recognized the scenario as a stroke. There were 3 words to correctly identify (based on correct intended response and spontaneously evoked associated symptoms) the stroke, which were “AVC” (acronym for cerebrovascular accident, in Portuguese), “derrame” (spillage) and “trombose” (thrombosis). There were significant differences among them concerning demographic, economic, educational and geographical aspects, but there was no difference according to the intended reaction among them. The most cited associated symptoms (excluding those present in the case) were impaired consciousness (10.6%), headache (8.9%) and dysesthesia (7.7%). “Aneurisma” (aneurism) was also cited, by 3 individuals.ConclusionThere are at least three words for stroke in Portuguese (“AVC”, “derrame” and “trombose”); they were similar in terms of correct intended responses and spontaneously cited accompanying symptoms. Stroke campaigns should apply different names to reach a broader audience and to improve stroke recognition.

Impact of the COVID-19 pandemic response on the Emergency Medical Services workforce, Texas, USA

Introduction: The physical and mental health impacts of the coronavirus disease 2019 (COVID-19) response on healthcare workers has been extensively studied; less is known about impacts specific to the prehospital Emergency Medical Service’s (EMS) workforce. However, given data about the physical and psychological impacts to EMS workers participating in prior emergencies and disasters, the response to the COVID-19 pandemic likely increased risk among the EMS workforce.
 Methods: EMS agencies in the State of Texas were stratified according to agency structure, eg, fire-based, nonfire-based governmental, hospital-based private, nonhospital-based private, and other. A systematic sample of 10 agencies was selected from each of the five strata. An interview guide was developed to collect information about prior experience with disaster or emergency response, professional roles since the start of the COVID-19 pandemic, and alternations to professional roles and EMS systems during both prior responses and the COVID-19 response. Interviews were transcribed and inductively coded to identify themes.
 Results: Five themes were identified in qualitative interviews. These included 1) early pandemic lessons, 2) protocol changes, 3) personal stressors, 4) professional stressors, and 5) lessons learned. Increased workloads, operational changes, fear of transmission to friends and family, and fatigue from working conditions were emphasized by participants. However, adaptations are being identified that could help EMS agencies and their workforces maintain resilience, even during an ongoing emergency response.
 Discussion: The COVID-19 response created unique professional and personal stressors to the EMS workforce and limited access to coping mechanisms previously used to reduce stress. Targeted studies are needed to guide the implementation of evidence-based interventions to protect the well-being of EMS personnel now and during future public health emergency and disaster responses.

Firearm ownership and storage practices among United States firefighters and emergency medical services personnel.

Compared with the general U.S. population, firefighters (FF) and emergency medical services (EMS) workers (FF + EMS personnel) are at increased risk for firearm suicide. Although secure firearm storage is associated with reduced risk of firearm suicide, no study has examined the prevalence and sociodemographic correlates of firearm ownership and storage practices among U.S. FF + EMS personnel. A total of 141 U.S. FF + EMS personnel completed a structured, web-based self-report questionnaire. Overall, 76.6% (n = 108) of FF + EMS personnel in our sample reported owning a personal firearm, among whom 85.2% (n = 92) reported owning more than one firearm. Among firearm owners, 42.6% (n = 46) reported secure firearm storage (i.e., unloaded and locked) and 57.4% (n = 62) reported nonsecure firearm storage (i.e., loaded and/or unlocked). FF + EMS personnel who cited personal safety as the only reason for firearm ownership, as opposed to reporting other or multiple reasons for ownership (e.g., hunting), were at increased odds of reporting nonsecure storage practices (69.4% vs. 47.5%; OR = 2.51, 95% CI [1.14, 5.55], p = .023). Most FF + EMS personnel in our sample reported firearm ownership, and approximately half of the firearm owners reported nonsecure firearm storage practices. Promoting secure firearm storage practices among FF + EMS personnel might decrease risk of firearm suicide and other forms of firearm-related injuries. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

EMS workers on the frontline of the opioid epidemic: effects of sleep and social support on depression

PurposeThis study focuses on Emergency Medical Service (EMS) personnel and examines the impact of overdose calls for opioids and attitudes of EMS workers towards individuals with substance use disorders on EMS workers' mental well-being while accounting for self-reported sleep and social support.Design/methodology/approachThis cross-sectional study surveyed EMS workers (N = 608) across Pennsylvania on demographic variables, frequency of overdose calls, attitudes towards opioid use and naloxone administration on measures of mental health. Multiple logistic regression models were estimated to examine the relationship of perception of opioid use and treatment and likelihood that EMS workers might experience depression.FindingsAuthors found two main findings: (1) There was a significant relationship between more negative perceptions about opioid use/naloxone and the likelihood that EMS workers might experience depression. (2) There was a significant relationship between number of overdose calls EMS workers responded to and likelihood of depression, which appeared to be alleviated by improvements in sleep and social support.Research limitations/implicationsThere is potential opportunity for EMS employers to minimize the impact of the opioid epidemic on EMS worker mental health. Trainings to highlight effectiveness of treatment should be further explored, along with ways to enhance social support and improve sleep for EMS workers to protect against the stress associated with responding to this public health crisis.Originality/valueThis study adds to the literature on the impact of the opioid epidemic as it relates to mental health outcomes for EMS professionals providing frontline care to those experiencing opioid use disorders.

Disaster Knowledge, Skills, and Preparedness among Emergency Medical Services in Saudi Arabia.

Introduction:Emergency Medical Service (EMS) workers are critical to effective disaster response in Saudi Arabia. The World Health Organization requires countries and governments to have prepared emergency health workers and disaster action plans. Therefore, it is important to understand the disaster knowledge, skills, and preparedness of Saudi Arabian EMS workers. This study investigated factors influencing EMS workers’ disaster knowledge, skills, and preparedness in the Saudi Arabian context.Method:A descriptive cross-sectional survey using The Disaster Preparedness Evaluation Tool was distributed to EMS workers in military and government hospitals across three Saudi Arabian cities. Responses were recorded on a 6-point Likert scale where higher scores indicated higher knowledge, skills, or preparedness. The results were analyzed using descriptive and inferential statistical analysis.Results:272 EMS workers participated in this study. EMS workers reported a moderate level of knowledge (3.56), skills (3.44), and preparedness (3.73) for disasters. Despite the moderate level, EMS workers reported a high level of involvement in regular disaster drills (M=4.24, SD=1.274) and a strong interest in further disaster education opportunities (M=5.43, SD=1.121). Participants also reported a high skill level with the triage principles used in their workplace during a disaster (M=4.06, SD=1.218). The study findings revealed a significant positive correlation between disaster preparedness levels and age, years of experience, education level, and the facility worked in.Conclusion:EMS workers have moderate disaster knowledge, skills, and preparedness levels. Knowledge, skill, and preparedness have a significant relationship with the EMS workers’ demographics. These findings demonstrate the need to invest in preparing Saudi Arabian EMS workers to effectively respond to bioterrorism disasters.

The Rookie: Observations and Musings of a Recently Retired Military Pilot in His First Year of Helicopter Emergency Medical Services Work

The Rookie: Observations and Musings of a Recently Retired Military Pilot in His First Year of Helicopter Emergency Medical Services Work

Transition from College to Professional Workplace: Lived Experiences of Mid-Level Emergency Care Graduates Working in a Provincial Department of Health in South Africa

This study aimed to obtain empirical data on the lived experiences of emergency care technicians (ECT) during their transition into the emergency medical service work environment. This qualitative (phenomenological) study used focus group discussions with 26 ECT graduates to obtain verbal statements describing their lived experiences when transiting from college to pre-hospital workplace environments. The three dominant emerging themes were workplace readiness and reception, professional confidence, and resistance in the workplace. The experiences reported regarding workplace readiness and reception were largely negative. The majority of the participants shared that the EMS station they were deployed to had not been ready to receive and optimally utilise their skills. In addition, participants stated that their integration into the workplace had been unpleasant, as they experienced a great deal of exclusion and resistance from colleagues. Furthermore, participants described how peer support, positive feedback from patients and co-workers, and the new skills and knowledge acquired during training enhanced their professional confidence. These findings suggest that more needs to be done by stakeholders in emergency care education and practice in South Africa to ensure that the transition of graduate paramedics to the workplace environment is a positive and less stressful experience. The recommendations made in this article could be beneficial in achieving this.

Occupational exposure to blood and body fluids among prehospital emergency medical services workers in Mashhad, Northeast of Iran

This study aimed to assess occupational exposure to blood and body fluids (BBFs) and the use of protective equipment among prehospital emergency medical services (EMS) workers in Mashhad, Iran. This cross-sectional questionnaire survey-based study was conducted from July 2020 to March 2021 in Mashhad. All prehospital EMS workers of Mashhad were invited to participate in the study using the census technique. The questionnaire was about occupational exposure to BBFs, infection control, protective measures, health program, and demographic information. In total, 442 participants answered the questionnaire (response rate: 82.77%). Based on the findings, 420 (95.2%) and 402 (91.2%) participants had been exposed to BBFs as prehospital EMS workers. Moreover, 31.5% and 38.5% of these exposures were caused by contaminated needles and lancets, respectively. The BBFs incidents have occurred despite 98% of the EMS workers reporting there is a needle safety disposable box in the ambulance. The relationship between awareness of precaution measures after exposure to BBFs and training course completion was significant (P < .0001). This study demonstrated the high prevalence of occupational exposures to BBFs among prehospital EMS workers. Considering the significant relationship between the completion of standard precautions courses and awareness of BBFs' postexposure measures, it is recommended to consider multi-faceted strategies for continuous monitoring, training, and follow-up of prehospital EMS workers.

Mastering the Patient Handoff

Mastering the Patient Handoff

Exploring Disparities in Self-Reported Mental Health Symptoms Across Professional Categories in Spain's Emergency Medical Services: A Nationwide Cross-Sectional Study.

This study aimed to analyze stress, anxiety, depression, and self-efficacy levels among Spanish out-of-hospital emergency medical professionals from February 1, 2021, to April 30, 2021. A nationwide survey was completed by 1666 Emergency Medical Services (EMS) workers. The Depression, Anxiety, and Stress Scale (DASS-21) and the General Self-Efficacy Scale (GSE) were used. Data analysis used chi-squared, análisis of variance (ANOVA), and logistic regressions. The sample comprised 833 (50%) men, with an average age of 44.3 ± 9.9 y (range: 19-67 y). Occupational distribution included 453 (27.2%) physicians, 474 (28.4%) nurses, and 739 (44.4%) emergency medical technicians (EMTs). EMTs exhibited higher odds of severe or extremely severe depression compared with physicians (odds ratio [OR]: 1.569; 95% confidenceinterval [95% CI]: 1.213-2.030) and nurses (OR: 1.561; 95% CI: 1.211-2.012). EMTs also displayed higher probabilities of severe or extremely severe anxiety compared with nurses (OR: 1.944; 95% CI: 1.529-2.701). Furthermore, EMTs demonstrated elevated probabilities of severe or extremely severe stress compared with physicians (OR: 1.387; 95% CI: 1.088-1.770). However, no significant differences were found in self-efficacy, with a median value of 73 [20]. Out-of-hospital EMS workers experienced mental health challenges, showing varying levels of depression, stress, and anxiety across different occupational groups. EMTs were particularly affected.