Emergency Medical Services Professionals Research Articles

Technology commitment of emergency medical service practitioners and dispatchers

Background Digitalization and artificial intelligence (AI) have entered the emergency medical service (EMS). Successful use of them depends on employees’ personal attitudes towards modern technology and its use. Aims This study explored the technology commitment of EMS professionals, dispatchers and emergency physicians, including towards AI systems. Methods To assess attitudes in the context of AI systems in EMS, employees were asked to answer an online questionnaire between October 2021 and March 2022. Findings A total of 510 participants, including 184 EMS professionals, 199 dispatchers and 68 emergency physicians, participated. These professionals had moderate to high technology commitment values with minor differences. Technology commitment correlated negatively with age. Gender had no effect. Conclusion The EMS provides fertile ground for AI systems. It is important to keep in mind that people with uncertainties and reservations need support. The scales in the questionnaire proved to be reliable and valid.

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.

Dynamic deployment models for high-performance Emergency Medical Services

While the emergency medical services profession has evolved substantially, the way that paramedic resources respond to these incidents has stayed relatively the same, mostly mirroring deployment models utilized by fire departments. The problem is that fire and paramedic services require two very different types of staffing. Fire departments are mainly tasked with protecting property, and therefore follow a static 24/7 deployment model due to predictable demand (PRPS, 2020a). This is not the case however with paramedic services. While fire departments focus on property, paramedics requires a greater focus on protecting people and health. Over the past decade, there has been a staggering increase in medical calls, which has overwhelmed paramedic services across Canada. During the COVID-19 pandemic, most of the world saw ambulance call volumes and response times increase by up to 50% (Amiry & Maguire, 2021), especially for life-threatening emergencies (Prezant et al, 2020). It proves the importance of keeping staffing and deployment planning current to adequately deal with these surges. With regular instances of little to no ambulances available, even on regular days, there need to be improved methods identified for better resource management. For the purposes of this study, the deployment plans at two of Ontario’s largest and busiest paramedic services (referred to as Service A and Service B) were examined, to determine how different deployment models help paramedic services adapt to their call volume and remain prepared for larger-scale emergency responses.

Prediction of Out-of-Hospital Cardiac Arrest Survival Outcomes Using a Hybrid Agnostic Explanation TabNet Model

Survival after out-of-hospital cardiac arrest (OHCA) is contingent on time-sensitive interventions taken by onlookers, emergency call operators, first responders, emergency medical services (EMS) personnel, and hospital healthcare staff. By building integrated cardiac resuscitation systems of care, measurement systems, and techniques for assuring the correct execution of evidence-based treatments by bystanders, EMS professionals, and hospital employees, survival results can be improved. To aid in OHCA prognosis and treatment, we develop a hybrid agnostic explanation TabNet (HAE-TabNet) model to predict OHCA patient survival. According to the results, the HAE-TabNet model has an “Area under the receiver operating characteristic curve value” (ROC AUC) score of 0.9934 (95% confidence interval 0.9933–0.9935), which outperformed other machine learning models in the previous study, such as XGBoost, k-nearest neighbors, random forest, decision trees, and logistic regression. In order to achieve model prediction explainability for a non-expert in the artificial intelligence field, we combined the HAE-TabNet model with a LIME-based explainable model. This HAE-TabNet model may assist medical professionals in the prognosis and treatment of OHCA patients effectively.

Types and effects of feedback for emergency ambulance staff: a systematic mixed studies review and meta-analysis

BackgroundExtensive research has been conducted into the effects of feedback interventions within many areas of healthcare, but prehospital emergency care has been relatively neglected. Exploratory work suggests that enhancing feedback...

Psychosocial Work Stress and Occupational Stressors in Emergency Medical Services

Emergency medical service (EMS) professionals often experience work stress, which escalated during COVID-19. High job demand in the EMS profession may lead to progressive decline in physical and mental health. We investigated the prevalence of psychosocial job stress in the three levels of EMS: basic, advanced, and paramedic, before and during the COVID-19 pandemic. EMS professionals (n = 36) were recruited from EMS agencies following the Institutional Review Board approval. Participants took surveys on demographics, personal characteristics, chronic diseases, and work schedules. Job stress indicators, namely the effort-reward ratio (ERR) and overcommitment (OC), were evaluated from survey questionnaires using the effort-reward imbalance model. Associations of job stress indicators with age, sex, body mass index, and working conditions were measured by logistic regression. Psychosocial work stress was prevalent with effort reward ratio > 1 in 83% of participants and overcommitment scores > 13 in 89% of participants. Age, body mass index, and work hours showed strong associations with ERR and OC scores. The investigation findings suggested that a psychosocial work environment is prevalent among EMS, as revealed by high ERR, OC, and their correlation with sleep apnea in rotating shift employees. Appropriate interventions may be helpful in reducing psychosocial work stress in EMS professionals.

Ensuring Optimal Mental Health Programs and Policies for First Responders: Opportunities and Challenges in One U.S. State

This study examined opportunities and challenges faced by individuals working to advance mental health policy and programming for first responders. We utilized qualitative content analysis and interviews with 16 firefighters, emergency medical services professionals, law enforcement officers, and others involved in programming or policy in the U.S. state of Ohio. Six themes characterized opportunities and challenges encountered: (1) variations in programming and policy exist across jurisdictions; (2) opportunities exist to enhance mental health awareness and self-care training for first responders; (3) need exists for specialized mental health clinicians accustomed to and capable of effectively working with first responders; (4) confidentiality protections are lacking for peer supporters not trained in critical incident stress management; (5) having an internal champion and broader support is key to program and policy advancement; and (6) interdepartmental collaboration provides opportunities for sharing resources and best practices. Results illustrate continued need for strategic policymaking, program development, and coordination.

Secondary trauma response in emergency services systems (STRESS) project: quantifying and predicting vicarious trauma in emergency medical services personnel.

There is a lack of literature exploring vicarious trauma (VT) in emergency medical services (EMS) personnel. VT is emotional countertransference that occurs between the clinician and patient. The presence of trauma- or stressor-related disorders could be a factor in the rising suicide rate in these clinicians. This was a cross-sectional statewide study of American EMS personnel, using one-stage area sampling. Nine EMS agencies were selected to participate based on geographic area, who then provided data about annual call volume and mix. The Impact of Event Scale-Revised was used to quantify VT. Univariate analyses used chi-square and ANOVA to evaluate the relationship between VT and various psychosocial and demographic characteristics. Factors significant in the univariate analyses were included in a logistic regression to determine predictors of VT while controlling for potential confounders. A total of 691 respondents participated in the study, of which 44.4% were female and 12.3% were minorities. Overall, 40.9% had VT. Of those, 52.5% scored high enough to potentially illicit immune system modulation. Compared to those without VT, more than four times as many EMS professionals with VT self-reported as currently in counselling (9.2% v. 2.2%; p < 0.01). Approximately one in four EMS professionals (24.0%) had considered suicide, while nearly half (45.0%) knew an EMS provider who had died by suicide. There were multiple predictors of VT, including female sex (odds ratio [OR] 1.55; p = 0.02) and childhood exposure to emotional neglect (OR 2.28; p < 0.01) or domestic violence (OR 1.91; p = 0.05). Those with other stress syndromes, such as burnout or compassion fatigue, were 2.1 and 4.3 times more likely to have VT, respectively. Among study participants, 41% suffered from VT, and 24% had considered suicide. As a largely understudied phenomenon in EMS professionals, additional research on VT should focus on causality and the mitigation of sentinel events experienced in the workplace.

Modernizing payment to critical access hospitals: A proposal for the next iteration of the Flex Program.

Modernizing payment to critical access hospitals: A proposal for the next iteration of the Flex Program.

Evaluating the influence of alcohol intoxication on the pre-hospital identification of severe head injury: a multi-center, cohort study

ABSTRACT Objective To determine the influence of intoxication on the pre-hospital recognition of severely head-injured patients by Emergency Medical Services (EMS) professionals and to investigate the relationship between suspected alcohol intoxication and severe head injury. Methods This multi-center, retrospective, cohort study included trauma patients, aged ≥ 16 years, transported by an ambulance of the Regional Ambulance Facility Utrecht to any emergency department in the participating trauma regions. Results Between January 1, 2015 and December 31, 2017, 19,206 patients were included, of whom 1167 (6.0%) were suspected to have a severe head injury in the field, and 623 (3.2%) were diagnosed with such an injury at the hospital. These injuries were less frequently recognized in patients with a GCS ≥ 13 than in patients with a GCS < 13 (25.0% vs. 76.2%). Patients suspected to be intoxicated had a higher chance to suffer from severe head injury (OR 1.42, 95%-CI 1.22–1.65) and were recognized slightly more often (45.3% vs. 40.2%). Conclusion Severe head injuries are difficult to recognize in the field, especially in patients without a decreased GCS. Suspicion of alcohol intoxication did not seem to influence pre-hospital injury recognition, as it possibly makes a severe head injury harder to recognize and simultaneously raises caution for a severe injury.

Defining priorities for emergency medical services education research: A modified Delphi study.

As out-of-hospital medicine evolves, emergency medical services (EMS) education practices must also be updated to ensure that EMS professionals acquire and maintain the skills needed to best serve patients. We aimed to identify and rank the top 10 research priorities related to EMS education in the United States. We conducted a convenience survey of EMS educators to identify challenges facing EMS education before leveraging a purposefully selected panel of EMS educators to prioritize research gaps through a modified Delphi approach. Data were collected electronically (March 2021-June 2021) over 4 survey rounds consisting of idea generation (Rounds 1 and 2), importance scoring (Round 3), and consensus ranking (Round 4). At the end of Round 4, composite scores were used to generate a list of 10 prioritized research gaps related to EMS education. In the pre-Delphi survey, 463 EMS educators identified 2055 challenges facing EMS education. We recruited 32 EMS education experts as Delphi panelists and 28 completed all 4 rounds. Panelists submitted 77 knowledge gaps. The top 10 knowledge gaps included defining competency of EMS learners and educators, association of curricula and accreditation requirements with real-world practice, the effects of diversity and cultural humility among educators and learners on equitable patient care, evidence-based teaching methods, and public perception of the EMS profession and education system. Although 10 gaps were prioritized, panelists deemed all 77 gaps as having considerable importance for EMS education. This suite of knowledge gaps is intended to guide researchers and research-funding bodies for future resource allocation.

Factors associated with job satisfaction of emergency medical services professionals – a cross-sectional study

Relevance. Shortage of skilled emergency medical services (EMS) employees is an alarming global problem. EMS missions have increased by fifty percent in many communities. The high EMS demand, low recruitment rate and loss of skilled employees forced EMS organization to explore ways to improve EMS employees work ability and satisfaction. To date there are no data available on EMS employees’ job satisfaction levels in Kuwait. Intention – To establish the national EMS job satisfaction level, identify factors associated with job satisfaction and explore the relationship between job satisfaction, physical wellbeing and depressive disorder. Methodology. A cross-sectional survey was conducted in 80 Kuwait EMS employees online (15 January –15 March 2020). Job satisfaction and depressive disorders were assessed via a questionnaire based on Minnesota Satisfaction Questionnaire (MSQ) that included 21 items. Descriptive and regression analysis were performed. Results and Discussion. The overall mean of job satisfaction was closer to moderate, 3.9 ± 1.4. The participants described the EMS profession to have moderate levels of intrinsic factors except for achievement 1.8 ± 1.5. And to have moderate levels of extrinsic factors except for pay and social factors: overall mean 2.7 ± 1 and 2.2. ± 1.5, respectively. There were three factors associated with job satisfaction: gender (p = < 0.001), career advancement (p = 0.003) and responsibilities (p = 0.005). This analysis also showed significant association between job satisfaction and EMS employees’ well-being (p = 0.001) and absence of depressive disorder (p = < 0.001). Conclusion. There is a moderate level of job satisfaction among EMS workforce in Kuwait. Gender, career advancement and responsibilities were the main factors associated with job satisfaction. Having satisfied EMS employees with their job can eliminate depressive disorder and enhance physical well-being. Future efforts to improve EMS employee’s recruitment, work ability and work quality should reflect on these findings.

Maladaptive Cognitions in EMS Professionals as a Function of the COVID-19 Pandemic.

The coronavirus disease pandemic has pro-foundly affected emergency medical services (EMS) profes-sionals, but the emotional impact is unknown. This was a cross-sectional survey of North Carolina EMS profes-sionals from April to May 2021. EMS professionals on an ac-tive roster were included. With pandemic-related perceptions, the 15-item Posttraumatic Maladaptive Beliefs Scale (PMBS) was used to quantify the severity of maladaptive cognition. Significant univariate variables were used to create a hier-archical linear regression to assess the potential impact of pandemic-related factors on maladaptive cognition scores. Overall, 811 respondents were included; of those, 33.3% were female, 6.7% were minorities, and 3.2% were Latinx; the mean age was 41.11 ± 12.42 years. Mean scores on the PMBS were 37.12 ± 13.06 and ranged from 15 to 93. PMBS scores were 4.62, 3.57, and 3.99 points higher, respec-tively, in those with increased anxiety, those who trusted their sources of information, and those who reported to work de-spite being symptomatic. Pandemic-specific factors accounted for 10.6% of the variance in PMBS total scores (ΔR2 = 0.106, ΔF[9, 792]; p < .001). Psychopathological factors accounted for an additional 4.7% of the variance in PMBS total scores (ΔR2 = 0.047, ΔF[3, 789]; p < .001). Given that 10.6% of the difference in PMBS scores can be explained by pandemic- related factors, maladaptive cognitions in EMS are a considerable concern and could lead to the development of significant psychopathology post-trauma.

Child Maltreatment Education: Utilizing an Escape Room Activity to Engage Learners on a Sensitive Topic.

Child Maltreatment Education: Utilizing an Escape Room Activity to Engage Learners on a Sensitive Topic.

140 Factors Influencing Emergency Medical Services Burnout

140 Factors Influencing Emergency Medical Services Burnout

Monkeypox 2022: A Primer and Identify-Isolate-Inform (3I) Tool for Emergency Medical Services Professionals.

Monkeypox 2022 exhibits unprecedented human-to-human transmission and presents with different clinical features than those observed in prior outbreaks. Previously endemic only to West and Central Africa, the monkeypox virus spread rapidly world-wide following confirmation of a case in the United Kingdom on May 7, 2022 of an individual that had traveled to Nigeria. Detection of cases with no travel history confirms on-going community spread. Emergency Medical Services (EMS) professionals will likely encounter patients suspected or confirmed to have monkeypox, previously a rare disease and therefore unfamiliar to most clinicians. Consequently, it is critical for EMS medical directors to immediately implement policies and procedures for EMS teams - including emergency medical dispatchers - to identify potential monkeypox cases. These must include direction on actions EMS professionals should take to protect themselves and others from virus transmission. Monkeypox 2022 may manifest more subtly than it has historically. Presentations include a subclinical prodrome and less dramatic skin lesions - potentially limited to genital or anal body regions - which can be easily confused with dermatologic manifestations of common sexually transmitted infections (STIs). While most readily spread by close contact with infectious skin lesions on a patient, it is also transmissible from fomites, such as bed sheets. Additionally, droplet transmission can occur, and the virus can be spread by aerosolization under certain conditions. The long incubation period could have profound negative consequences on EMS staffing if clinicians are exposed to monkeypox. This report summarizes crucial information needed for EMS professionals to understand and manage the monkeypox 2022 outbreak. It presents an innovative Identify-Isolate-Inform (3I) Tool for use by EMS policymakers, educators, and clinicians on the frontlines who may encounter monkeypox patients. Patients are identified as potentially exposed or infected after an initial assessment of risk factors with associated signs and symptoms. Prehospital workers must immediately don personal protective equipment (PPE) and isolate infectious patients. Also, EMS professionals must report exposures to their agency infection control officer and alert health authorities for non-transported patients. Prehospital professionals play a crucial role in emerging and re-emerging infectious disease mitigation. The monkeypox 2022 3I Tool includes knowledge essential for all clinicians, plus specific information to guide critical actions in the prehospital environment.

Predictors of COVID-19 Vaccination Among EMS Personnel.

IntroductionUnvaccinated emergency medical services (EMS) personnel are at increased risk of contracting coronavirus disease 2019 (COVID-19) and potentially transmitting the virus to their families, coworkers, and patients. Effective vaccines for the severe acute respiratory syndrome coronavirus 2 virus exist; however, vaccination rates among EMS professionals remain largely unknown. Consequently, we sought to document vaccination rates of EMS professionals and identify predictors of vaccination uptake.MethodsWe conducted a cross-sectional survey of North Carolina EMS professionals after the COVID-19 vaccines were widely available. The survey assessed vaccination status as well as beliefs regarding COVID-19 illness and vaccine effectiveness. Prediction of vaccine uptake was modeled using logistic regression.ResultsA total of 860 EMS professionals completed the survey, of whom 74.7% reported receiving the COVID-19 vaccination. Most respondents believed that COVID-19 is a serious threat to the population, that they are personally at higher risk of infection, that vaccine side effects are outweighed by illness prevention, and the vaccine is safe and effective. Despite this, only 18.7% supported mandatory vaccination for EMS professionals. Statistically significant differences were observed between the vaccinated and unvaccinated groups regarding vaccine safety and effectiveness, recall of employer vaccine recommendation, perceived risk of infection, degree of threat to the population, and trust in government to take actions to limit the spread of disease. Unvaccinated respondents cited reasons such as belief in personal health and natural immunity as protectors against infection, concerns about vaccine safety and effectiveness, inadequate vaccine knowledge, and lack of an employer mandate for declining the vaccine. Predictors of vaccination included belief in vaccine safety (odds ratio [OR] 5.5, P=<0.001) and effectiveness (OR 4.6, P=<0.001); importance of vaccination to protect patients (OR 15.5, P=<0.001); perceived personal risk of infection (OR 1.8, P=0.04); previous receipt of influenza vaccine (OR 2.5, P=0.003); and sufficient knowledge to make an informed decision about vaccination (OR 2.4, P=0.024).ConclusionIn this survey of EMS professionals, over a quarter remained unvaccinated for COVID-19. Given the identified predictors of vaccine acceptance, EMS systems should focus on countering misinformation through employee educational campaigns as well as on developing policies regarding workforce immunization requirements.

COVID-19 Booster Uptake among First Responders and Their Household Members May Be Lower than Anticipated.

(1) Background: COVID-19 vaccination status varies widely among law enforcement and emergency medical services professionals. Though at high risk of exposure, these first responders have demonstrated significant vaccine hesitancy, with only 70% reportedly vaccinated. We sought to understand whether similar vaccine hesitancy exists for first responders and their household contacts around COVID-19 boosters. (2) Methods: In a prospective longitudinal cohort of first responders and their household contacts, survey data was collected, including demographics, medical history, COVID-19 exposure risks, and vaccination and/or booster status. The statistical analysis focused on primary vaccination and booster rates of both the first responders and their household contacts. (3) Results: Across 119 study participants, 73% reported having received some combination of vaccine and/or booster, and 26% were unvaccinated. Vaccinated individuals were older, reported less prior exposure to COVID-19 and had more comorbidities. Only 23% reported having received a COVID-19 booster. Pairing of the data for household contacts demonstrated a 60% agreement to receive primary vaccination but only a 20% agreement for boosters within households. (4) Conclusions: This study provides insight into the vaccination and booster rates of first responders and household contacts. Focused efforts to enhance vaccinations is essential for the protection and maintenance of this critical workforce.

Differences in Attachment, Resilience, and Negative Affect in Non-Treatment-Seeking and Treatment-Seeking EMS Professionals

Emergency medical service (EMS) professionals have a stressful vocation, inarguably worsened by the COVID-19 pandemic, which affects their mental health and makes them a vulnerable population warranting further study. However, to date, no published research has compared non-treatment and treatment-seeking EMS professionals in the same greater metropolitan area. In this study, we examined differences and similarities among the non-treatment-seeking EMS professionals (&lt;em&gt;n &lt;/em&gt;= 57) from a local EMS agency and treatment-seeking EMS personnel (&lt;em&gt;n &lt;/em&gt;= 53) from a non-profit community treatment center on six assessment instruments that measure attachment avoidance, attachment anxiety, resilience, depression, generalized anxiety, posttraumatic stress disorder (PTSD), and suicidality. The Mann-Whitney U test revealed attachment avoidance, attachment anxiety, depression, generalized anxiety, and posttraumatic stress disorder (PTSD) were significantly higher in the treatment-seeking sample compared to the non-treatment-seeking group. Resilience and suicide did not significantly differ. Correlational analyses revealed that the most consistent findings for both samples were PTSD, depression, and generalized anxiety. Findings suggest that negative affect may underlie these three constructs, regardless of whether the individual is treatment-seeking or not. These findings are conceptualized through three different theoretical frameworks: attachment, resilience, and negative affect. We also make recommendations for EMS agencies and suggest future scholarship based on these preliminary findings.

Secondary Traumatic Stress in Emergency Services Systems Project: Quantifying the Effect of Personal Trauma Profiles on Lifetime Prevalence of Suicidality in Emergency Medical Services Personnel

ObjectiveWithin the last 20 years, there has been a 500% increase in public safety suicides, the exact cause of which is unknown. MethodsThis was a cross-sectional survey of emergency medical services (EMS) personnel. Nine EMS agencies were selected to participate based on geography and population. The survey assessed sociodemographic, occupational, and military factors. Childhood adversity and traumatic experiences were evaluated using the Adverse Childhood Experiences Questionnaire and the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, respectively. Using factors significant in univariate analyses, a logistic regression was conducted to determine predictors of suicidality while controlling for potential confounders. ResultsA total of 681 EMS providers participated; 56.1% were male, 12.6% were minorities, and 72.8% were paramedics. Nearly a quarter (24.4%) had considered suicide. Approximately twice as many had received counseling for a stress-related event, and 1.5 times as many identified as currently in counseling. Indigenous populations were 4.76 times more likely to have suicidality (odds ratio [OR] = 4.76; 95% confidence interval [CI], 1.22-18.62). Suicidality was 97% more likely in EMS professionals with prior military service (OR = 1.97; 95% CI, 1.08-3.57) and 2.22 times more likely in sexual minorities (OR = 2.22; 95% CI, 1.16-4.25). Emotional abuse (OR = 1.86; 95% CI, 1.08-3.21) and burnout (OR = 2.88; 95% CI, 1.78-4.66) were also predictive. ConclusionsSuicidality is an indisputable concern for the EMS profession and represents a multifaceted issue that must be addressed.