Verbal and visual information exchange in EMS-to-ED patient handovers: An observational and attitudinal study.

The activities of emergency medical workers are closely related to high psycho- emotional and physical stress. Such a connection has a direct impact on professional activities: the effectiveness of medical services, success in achieving professional heights, including the quality of life. It is worth noting that the productivity of professional activities exponentially depends on the adequacy of the individual›s mental states. Purpose . Psychological analysis of the dependence of the level of personal and situational anxiety of medical workers of general- purpose mobile emergency medical teams on the work experience in the emergency care system and the level of education, in order to assess the productivity and effectiveness of medical services. Materials and methods . The material for the study was the results of a survey (according to the author›s questionnaire) of 121 emergency medical workers of the city of Ufa in substations located in different areas of the city. Anxiety analysis was carried out using the standard Spielberger–Khanin method. Results. Analysis of the level of personal anxiety showed a sharp increase in this indicator (p<0.05) for paramedics with work experience from 4 to 10 years (41.4±3.89 Spielberger–Khanin scale) and doctors with work experience over 10 years (41.0±2.02 Spielberger–Khanin scale). The level of situational anxiety is most pronounced (p<0.05) for doctors with more than four years of work experience (20.0±0.02 vs 19.4±3.70 (paramedics & nurses) [comparison from 4 to 10 years] and 23.4±2.82 vs 18.4±1.99 (paramedics); 19.5±2.71 (nurses) [comparison over 10 years] Spielberger–Khanin scale). For paramedics, there is an insignificant increase (9.4%) in the reactive anxiety indicator in comparison with up to 3 years of work and the period of work from 4 to 10 years, with a subsequent decrease (9.5%) with work more than 10 years. Conclusions: Research of personal and situational anxiety in close connection with the most important parameters of education and work experience for emergency medical workers allows to individualize and unify the approach to stabilizing the anxiety indicators of medical workers of general mobile teams. In addition, to more accurately identify the necessary methods for correcting emerging risks and, as a result, to improve the productivity and efficiency of medical services provided by emergency medical workers in the Russian Federation and abroad.

The study examines how employees of the emergency medical service in the Czech Republic come to terms with death and crisis situations. It is based on oral history research and focuses on the everyday practice and experience of emergency medical service staff – physicians, nurses, drivers, and paramedics. It presents an actor’s perspective on death and deals with the early period of the modern emergency medical service, from the 1970s to the early twenty-first century. The article provides an overview of the attitudes towards death held by paramedics, but it primarily focuses on the strategies they have adopted to be able to cope psychologically with extreme situations and with patients’ deaths. The article also explores which cases emergency medical service employees consider the most difficult, as well as what they think and do in relation to their own psychological hygiene.

BackgroundPeripheral intravenous (IV) access is a fundamental pre-hospital procedure performed by emergency medical services (EMS) personnel and remains the primary route for drug administration. Pediatric IV cannulation is often challenging in out-of-hospital settings. The aim of this study was to evaluate the frequency of peripheral intravenous access being established in pre-hospital settings by EMS staff in pediatric patients.Material/MethodsThis retrospective study analyzed 6331 records of emergency medical services (EMS) dispatches involving patients under 18 years of age between 2020 and 2022. The study protocol included an assessment of cannulation rate depending on the patient’s age, case characteristics, ICD 10 (International Classification of Diseases, Tenth Revision) diagnosis and whether the patient required transport to a hospital.ResultsPeripheral intravenous access was established in 1073 of 6331 pediatric patients (16.94%). The cannulation rate increased significantly with age, from 1.03% in infants (<1 year) to 75.12% in adolescents (12–18 years) (p<0.001). Logistic regression analysis identified age, trauma (OR=1.96), poisoning (OR=3.88), and transfer by Helicopter Emergency Medical Services (HEMS) (OR=5.86) as predictors of IV cannulation (p<0.001).ConclusionsThe overall rate of peripheral intravenous access establishment in pediatric patients in pre-hospital settings is relatively low, with the lowest rates observed in children under 1 year of age. Age, trauma, poisoning, and referral to HEMS teams significantly increased the likelihood of cannulation. It is essential to develop evidence-based algorithms and targeted training to support EMS personnel in managing vascular access in critically ill children.

Background: Lifestyle affects health, and health-promoting behaviour is pivotal to preventing chronic illnesses and to improving wellbeing. However, limited data exist on the health behaviours of German emergency medical services (EMS) staff. Aim. This research aimed to investigate and characterise the health behaviours of German EMS staff. Methods: Data from the EMS Health Study 2023 a nationwide survey of German EMS staff (n=1171) were analysed in the light of adherence to World Health Organization (WHO) recommendations on physical activity, tobacco and alcohol consumption and compliance with German Nutrition Society guidelines. Findings. German prehospital EMS staff ate inadequate amounts of fruits and vegetables, and consumed more high-energy foods and foods with unfavourable nutrient profiles – such as sugar-sweetened beverages, fast food, sweets and snacks – than recommended. Only 40.0% of men and 40.2% of women met the WHO recommendations for physical activity, 15.8% of men and 17.7% of women reported abstaining from alcohol and approximately one in three were current smokers. Conclusion: Health behaviour among German prehospital EMS staff is suboptimal, and there is an urgent need for targeted preventive interventions to promote healthier lifestyles.

Background: Emergency Medical Services (EMS) personnel in Chobe, Botswana, operate in a remote region with limited infrastructure. They face challenges such as geographical isolation, wildlife risks, like encounters with elephants or lions during emergency calls and shortages of equipment and staff. These stressors can impact the effectiveness of emergency care provision and the well-being of EMS staff. Objectives: To explore lived experiences of EMS staff in Chobe, on the delivery of emergency medical services in Chobe District of Botswana. Methods: A qualitative case study design was employed to explore the lived experiences of EMS staff. This design enabled an in-depth understanding of participants' perspectives within their real-life context. Data were collected through in-depth, semi-structured interviews with eight EMS staff members selected using purposive sampling, ensuring the inclusion of participants with relevant knowledge and experience. Thematic analysis was used to analyze the data, following Braun and Clarke’s updated reflexive approach [1]. This involved six iterative steps: familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the final report. This method allowed for the systematic identification and interpretation of key themes that emerged from the data. Results: Four key themes emerged from the data, reflecting the lived experiences of Emergency Medical Services (EMS) staff in the Chobe region: (1) operational challenges, (2) Psychosocial stain and coping, (3) professional identity and team dynamics , and (4) environmental and safety risks. 1. Operational Challenges: Participants reported persistent shortages of essential resources, including ambulances, medical equipment, and staff. These constraints often resulted in delayed response times and hindered the delivery of effective emergency care. 2. Psychosocial strain and Coping: EMS personnel described experiencing significant physical exhaustion and emotional strain. Exposure to traumatic scenes, extended shifts, and lack of psychosocial support contributed to burnout. Coping strategies were mainly informal—such as peer debriefing and emotional withdrawal— and were perceived as inadequate. 3. Professional Identity and team dynamics: Respondents expressed frustration over limited training opportunities, unclear career progression, and a perceived lack of appreciation for their work. These factors negatively impacted morale and professional development. 4. Environmental and Safety Risks: The Chobe environment presented unique hazards, including encounters with wild animals, poor road infrastructure, and vast distances between emergency sites and healthcare facilities. These risks compromised both the safety of EMS staff and the quality of emergency response. Discussion: This study highlights that the delivery of Emergency Medical Services (EMS) in the Chobe region is significantly affected by a combination of operational limitations, professional challenges, staff well-being concerns, and environmental risks. These interconnected issues compromise the effectiveness and safety of EMS delivery. To address these challenges, it is essential to implement clear policies, allocate adequate resources, provide structured mental health support, and offer ongoing professional training. Such measures would improve both service delivery and the overall well-being of EMS personnel in remote and high-risk settings like Chobe. Keywords: Emergency Medical Services, pre-hospital care, psychological distress, staffing shortages, qualitative research.

Background: In low and middle-income countries like Pakistan, road traffic accidents (RTAs) continue to be a major cause of morbidity and mortality in the worldwide. One of the most dangerous outcomes of such accidents is cardiac and respiratory complications, and the Patient outcomes are significantly influenced by the effectiveness of emergency transport systems. The availability, promptness, and caliber of pre-hospital emergency care are still poorly understood in rural areas like District Karak in Khyber Pakhtunkhwa. The purpose of this study is to evaluate how emergency transport systems contribute to fewer cardiac and respiratory issues in RTA cases in the district Karak, Khyber Pakhtunkhwa. Objective: The role of emergency transport systems in improving cardiac and respiratory complication in road traffic accident cases. Methodology: A cross-sectional, observational study was conducted involving 105 participants, including patients (31%), family members (33%), and emergency medical services (EMS) staff (36%). Data were collected through structured questionnaires and interviews to evaluate emergency response time, equipment readiness, pre-hospital interventions, and stakeholder satisfaction. Demographic analysis revealed a mean patient age of 30.92 years, with a range spanning from 1 to over 60 years. Males comprised 86% of the cases, while females accounted for 14%. The majority of respondents were from rural areas (65%), with 35% residing in urban settings. Types of emergencies included respiratory (39%), cardiac (17%), and a patient having a both complication (44%). Results: Results specified that emergency transport services played a crucial role in stabilizing patients before hospital arrival. However, gaps were observed in equipment availability, timely response within the "golden hour," and the level of clinical training among EMS personnel. These challenges were more pronounced in rural settings compared to urban areas. The study highlights how effective pre-hospital treatment significantly improves patient survival and recovery, but it also highlights how urgently underserved areas need to invest in EMS infrastructure, training, and resource allocation. Conclusion: The emergency transport systems, mostly in resource-limited districts like Karak, can greatly improve the outcomes of cardiac and respiratory emergencies following RTAs. Representatives and health administrators must prioritize improvements in EMS delivery to reduce preventable deaths and complications during the critical pre-hospital phase.

Musculoskeletal Disorders in Emergency Medical Services Staff: Predictors and Relationship With Occupational Stress

Births in the prehospital setting are infrequent yet associated with increased odds of maternal and neonatal morbidity and mortality. There is limited understanding of the experiences of emergency medical services staff in handling these potentially high-risk situations. We explored the perspectives of ambulance personnel in Aotearoa New Zealand when responding to out-of-hospital births. Hato Hone St John Ambulance is the largest emergency medical services provider in Aotearoa New Zealand. Between October and November 2023, all Hato Hone St John frontline staff were invited to complete an online survey, including open text questions about their experiences and challenges attending unplanned births. Data was coded and organised into themes using NVivo software and the inductive approach to thematic analysis. One hundred and forty-seven responses were received and included in the survey. Participants encountered a range of challenges in providing intrapartum care in the prehospital setting. Two key themes were identified: (1) navigating complexity and uncertainty in unplanned births, and (2) practical challenges and unsuitable environments; with several subthemes demonstrating that the ambulance personnel responded to obstetric emergencies in diverse circumstances, diligently working to deliver optimal care for both mothers and neonates. This study describes novel challenges faced by ambulance personnel attending unplanned births in Aotearoa New Zealand alongside obstacles previously reported by emergency medical services in other jurisdictions. These findings may be invaluable in guiding further research, curriculum and resource development to better prepare ambulance personnel for the challenging and uncertain situations that characterise prehospital birth events.

Although survival for out-of-hospital cardiac arrest (OHCA) is lower at emergency medical service (EMS) agencies serving Black/Hispanic communities, it is unknown whether this is due to practice differences. Within the Cardiac Arrest Registry to Enhance Survival (CARES) registry in the United States, we conducted a survey from 2022 to 2023 of resuscitation practices at EMS agencies with ≥10 OHCAs annually between 2015 and 2019. We examined differences in dispatch, first responder, and EMS practices between agencies with majority Black/Hispanic catchment areas (>50% residents Black or Hispanic) and majority White catchment areas using χ2 tests. We estimated each agency's risk-standardized rate of survival to hospital admission for OHCA using multivariable hierarchical logistic regression and evaluated whether survival differences between the 2 agency groups were attenuated after adjusting for resuscitation practice differences. Among 470 EMS agencies (181 707 OHCAs), 47 (10.0%) served a majority Black/Hispanic catchment area. At EMS agencies with Black/Hispanic catchment areas, dispatchers and police first responders were less likely to always recognize a cardiac arrest (29.8% versus 43.0%); police first responders were less likely to respond to OHCA (46.8% versus 68.9%), initiate CPR (59.6% versus 83.2%), or apply an automated external defibrillator (29.8% versus 60.0%); and EMS staff were less likely to assess CPR competency annually (46.5% versus 65.0%) and use waveform capnography (91.5% versus 99.5%), as compared with agencies with White catchment areas. EMS agencies serving majority Black/Hispanic catchment areas had 2% (95% CI, 0.9-3.1%; P<0.001) lower risk-standardized rates of survival, as compared with agencies serving majority White catchment areas, and survival differences were partly attenuated after adjusting for practice differences between EMS groups. In the United States, we identified differences in dispatcher, first responder, and EMS practices for OHCA between agencies with majority Black/Hispanic and White catchment areas. These practice differences may partly account for disparities in OHCA survival between the 2 EMS agency groups.

Background/Objective: Part of the workload of ambulance service involves patients with low-acuity health events that do not require the specific resources provided by ambulance services or emergency departments (EDs). The problem of inappropriateness is also present in Italy. However, research is limited to the perspective of triage nurses only, excluding patients and emergency medical service (EMS) staff. This study aims to identify the presence of inappropriate ambulance use in the study context by comparing patients’ perception of emergency with appropriateness perspectives of both triage nurses and emergency service staff. Methods: A cross-sectional study involving 109 patients transported by ambulance was performed between January and March 2020. Questionnaires were distributed to patients, EMS staff, and triage nurses operating in the chief town and hinterland of a region of Italy. Results: Non-penetrating trauma was the most frequent cause for calling an ambulance. Patients referred that activation of the service was necessary, while triage nurses and EMS technicians were in line in believing the non-urgency of the call due to non-emergent health conditions. Conclusions: Although we cannot conclude that citizens use the emergency system inappropriately, the results of this study make us think about the need to implement educational interventions that increase citizens’ knowledge of how the service works and the territorial services available.

BackgroundGerman Emergency Medical Services (EMS) face growing scrutiny due to regional disparities in quality of care. It is unclear if and how feedback in general is currently provided to EMS staff in Germany, and whether EMS staff receives feedback on patients’ diagnoses and outcomes.MethodsA web-based survey was conducted from June to August 2024 among physician and non-physician EMS staff, focusing on current feedback reception and the perceived need for feedback systems.ResultsA total of N = 428 EMS professionals participated in the survey. One-third of the participants reported receiving no feedback (n = 136, 31.8%), while over half of those who did, received feedback infrequently (n = 157, 55.5%). Informal feedback was the main source, with 95.4% of respondents desiring official feedback on the confirmed in-hospital diagnosis, e.g., to learn from previous cases. While 57.5% of emergency physicians occasionally or frequently receive information about the further course of treatment for patients after transport to the hospital, this was reported by only 14.3% (advanced emergency medical technicians) to 29.2% (emergency medical technicians) of non-physician EMS staff. More than 85% of the respondents stated that diagnosis feedback would improve the quality of EMS.ConclusionStructured feedback mechanisms, essential for quality assurance and improvement, are largely absent for EMS staff in Germany, especially for non-physicians. A strong desire among EMS staff for structured feedback on patients’ diagnoses and outcomes was found, which could improve quality of care and staff competence development. However, significant infrastructural and legal barriers persist, hindering the implementation of standardized digital feedback systems within Germany’s federalized EMS structure.

Objectives For underserved rural communities with limited geographical access to comprehensive stroke centers, emergency medical services (EMS) play a crucial role in timely, high-quality acute stroke care. This qualitative study aimed to understand rural EMS perspectives on barriers and facilitators to optimal acute stroke care in rural communities. Methods Qualitative, individual semi-structured interviews were conducted with rural EMS professionals. Ten EMS agencies in North Carolina were contacted for participation in virtual 45–60 minute interviews and interested agency professionals self-selected into the study. Covered topics included stroke training and education; stroke care experience and expertise; clinical and sociodemographic patient characteristics; EMS workflows; and system- and patient-level interactions and outcomes. Recorded interviews were transcribed and then coded using an inductive and deductive, iterative approach by two independent reviewers in MAXQDA software. Facilitators and barriers to optimal acute stroke care were derived from thematic analysis. Results Twelve EMS professionals from 4 rural EMS agencies and 1 mixed urban-rural agency were interviewed. Participants worked in clinical (6 Paramedics, 1 EMT) and leadership (2 chiefs, 1 supervisor, 1 field training officer, 1 quality assurance manager) roles for a mean of 4 years (range 1–11 years). Commonly noted facilitators of high-quality stroke care were comprehensive stroke assessment and destination decision protocols, as well as bidirectional communication between EMS and hospital staff. Identified barriers included patient and bystander delays in calling 9-1-1, long transport distances to stroke centers, and limited EMS staffing. EMS professionals noted challenges interacting with nursing home staff and hospital clinicians during patient transfer. Interviewees also discussed the importance of educating the public about stroke signs and symptoms and community engagement. Conclusions Within rural populations, EMS professionals determined that public education and community engagement are high-priority needs. Professionals also noted EMS’ opportunities to enhance rural stroke care through consistent bidirectional communication and improved prehospital protocols. Future research is needed to further explore these themes in rural EMS agencies outside of North Carolina.

ObjectiveTo explore the Welsh public’s views of violence and aggression (V&A) directed at EMS (emergency medical services) staff, awareness of policy changes and the reach of media campaigns.Design/setting/participantsSurvey involving non-probabilistic purposive sampling of 1010 Wales adults (aged 18+) from a matched panel, representative of the population, derived from a UK YouGov panel of >360 000 adults registered.ResultsMost (62.5%) participants had heard of V&A directed towards EMS staff; 81.1% had heard about it through the media. 21.0% of participants had witnessed V&A towards EMS staff; younger participants were more likely to have witnessed an incident 18.7% via a social setting and 81.1% through the media. 90.4% disagreed with the statement that V&A towards EMS staff can be acceptable in some cases, and 53.3% were not aware of related media campaigns. Participants thought intoxication with alcohol (92.4%), drugs (90.5%) and altered mental status following illness and/or injury (84.3%) would likely contribute to V&A towards EMS staff. 22.0% of participants were aware of the Assaults on Emergency Workers Act. Although I thought the act was unlikely to deter perpetrators who were intoxicated with drugs (75.2%), alcohol (75.2%), with altered mental status following illness and/or injury (75.6%) or other member of the public (42.4%). Younger participants were more likely to think the act would deter those intoxicated with drugs, alcohol, with altered mental status following illness and/or injury and other members of the public. Those with social grades of C2/D/E thought the act was likely to deter those intoxicated with drugs.ConclusionThere is good public awareness of V&A directed towards EMS staff in Wales who find it unacceptable. Our survey found limited awareness and perceived effectiveness of related legislation and media campaigns in the last 2 years. Participants thought legislation would not deter those intoxicated with drugs, alcohol or altered mental status. Therefore, we recommend further research to understand and develop evidence-based interventions for these groups of people. We also recommend amplifying messages targeted towards young people and through social settings where V&A may be encountered.

BackgroundLanguage barriers significantly impact healthcare delivery, particularly in emergency medical services (EMS) operating in linguistically diverse environments. The demographic composition of Qatar, with its predominantly expatriate population, presents unique challenges for effective communication in pre-hospital care settings. The aim of this was to assess the opinions of personnel from the Hamad Medical Corporation Ambulance Service (HMCAS) regarding the impact of language barriers on pre-hospital emergency care. MethodsA cross-sectional study was conducted using an anonymous survey with a five-point Likert scale among 312 frontline personnel of HMCAS. Fisher's exact and Kruskal–Wallis tests were used to compare ordinal outcomes across groups. Machine learning algorithms, including ordinal logistic regression, support vector machines (SVM), and naive Bayes, were used to develop predictive models for HMCAS staff opinions on their language learning needs. ResultsBoth bivariate and multivariate analyses revealed significant differences in the frequency of experiencing communication challenges. The most influential factors identified were strong opinions on language barriers and the willingness of staff to enhance their language skills. Variables related to using family members as interpreters showed relatively low importance. The SVM model demonstrated the best predictive capability concerning staff perceptions about language learning needs, with an accuracy of 0.50 and an average area under the curve score of 0.74. ConclusionLanguage barriers significantly impact pre-hospital emergency care in Qatar. The findings highlight the need for targeted interventions, such as language training programs and mobile translation apps. These strategies could enhance communication in multicultural EMS settings, improving patient care and reducing miscommunication risks. Future research should evaluate the long-term impact of these interventions on patient outcomes.

Multiple casualty incident (MCI) are critical situations mandating an immediate response. Traditionally, members of emergency medical services (EMS) are notified about MCI through radio signals. However, communication failures can lead to delays in activation time of EMS operations. The use of bell signals is proposed as a solution to address these issues. This study uses a retrospective pre-post design evaluating the impact of the bell and radio signal on activation times for EMS operation in MCI. Data were collected from January 2020 to December 2023 and divided into two phases: radio signal use during 2020–2021 (pre-design), and bell signal use during 2022–2023 (post-design). In the event of MCI, the bell or radio is used primarily to alert medical personnel. After the MCI was recognized during the pre-design phase, the dispatcher utilized the radio signal, calling out all EMS personnel twice via radio at 171.425 MHz, with a one-minute interval between communication to notify them of the incident. The ED staff would be informed of these incidents through radio or telephone communication by EMS personnel. In the post-design phase, the dispatcher utilized the bell signal, ringing it three times to alert all staff. Activation time and equipment used by EMS during MCI operations was recorded for both phases. A total of 105 MCI with EMS operations were recorded. In the bell signal group, 52.1% (n = 199) of the participants were male. Mass transportation incidents accounted for the most of the MCI, comprising 73.6% in the bell signal group and 73.1% in the radio signal group. The average activation time was significantly shorter for the bell signal (1.54 min) compared to the radio signal (3.60 min) (P < 0.001). The average response time for the bell signal was 13.20 min, while the radio signal response time averaged 16.10 min (P = 0.042). Early activation time (less than 2 min after EMS dispatch) was significantly more likely in the Bell signal group (adjusted odds ratio, 1.25; 95% confidence interval, 1.10–2.45) than in the Radio signal group. The activation and response times for EMS operations during MCI were significantly reduced by using bell signals to alert EMS staff.

The recording of an electrocardiogram (ECG) is anessential part of basic diagnostics in the emergency medical services (EMS). To provide initial care and make a preliminary diagnosis, paramedics and emergency physicians (EP) need knowledge about the ECG interpretation. Nevertheless, afew studies show that knowledge of ECG interpretation of paramedics and emergency physicians must improve. The aim of this study was to analyze the ECG interpretation skills among EMS staff and EP in Germany. An online survey was conducted to assess these skills from 22February to 22March 2023. The survey collected details about gender, age, professional training, years of professional experience, time since the last ECG training, and self-rated ECG interpretation ability. Subsequently, 9different ECG had to be interpreted in the form of single-choice questions. In all, 908participants (EMS: 803; EP: 105) were evaluated. The survey identified aknowledge deficit in the interpretation of ECG. On average, 63.3% (EMS: 61.4%; EP: 76.5%) of the ECG were interpreted correctly. The ECG with ST-elevation myocardial infarction (STEMI) of the posterior wall was identified correctly by 79.1% (EMS: 78.1%; EP: 86.7%) of the participants. Specific weak points in interpreting ECG were AV-blocks, tachycardias, atrial fibrillation, bundle branch blocks, pacemaker ECG and determining the ventricular axis. The participants' self-assessment of their ECG skills correlated significantly with the results actually achieved (p ≤ 0.001; pbonf = 0.016; ρ = 0.378). Based on the lack of diagnostic skills in the interpretation of a12lead ECG, continuous education programs should be revised to improve the quality of patient care in prehospital emergency medicine.

Burn injuries are a worldwide health issue, significantly burdening healthcare facilities. Specialized burn centres are only sometimes available near the site of burn injury. First aid greatly impacted the outcomes of burns by evaluating the severity of the burn and associated injuries. Pre-hospital Emergency Medical Services (EMS) have more remarkable contributions to healthcare systems. We aimed to reveal the interventions provided by the EMS staff on the scene of burn injuries and the impact of these interventions on the outcomes of burn injuries. Furthermore, the study aimed to identify areas for improvement in pre-hospital burn care. A systematic literature review was carried out from inception to 1st July 2023 using twelve databases. All original articles that included patients with burn injuries who received the necessary pre-hospital care by EMS staff were included. Nine articles comprehending 6149 patients with burn injuries were retrieved. The analysis revealed that EMS interventions significantly improved the outcomes of burn management. This included better control for pain and vital parameters, and lower mortality risk. The EMS provided analgesic administration, cooling of the burn wound, and the necessary urgent therapies. However, the study identified a need for better EMS training in assessing burn severity and managing burn injuries effectively. Enhancing EMS providers' knowledge and skills in pre-hospital burn management could substantially improve patient outcomes and reduce the burden on healthcare systems. Improving the understanding of EMS providers towards burn care can minimize the risk of burn-related poor outcomes and reduce the burden on healthcare facilities.

Background: Workplace incivility can severely affect healthcare workers and patients. It creates an unhealthy and unsafe environment, reduces job satisfaction, and often leads to higher staff turnover rates. Therefore, it is crucial to establish a culture of respect and civility in healthcare workplaces to prevent these adverse outcomes. Aims: Research on the relationship between safety culture and workplace incivility in emergency medical service (EMS) settings in Iran needs to be improved, and more studies are required to examine patient safety culture globally. This study examines the relationship between workplace incivility and safety culture among the EMS staff. Research Design: Cross-sectional analytical survey. Methods: This study included 203 EMS staff members who were selected using census population sampling from emergency medical centers in Ardabil City. Researchers used the EMS-Safety Attitudes Questionnaire (EMS-SAQ), the workplace incivility scale, and a demographic characteristics' form to gather information. The study employed multivariable logistic regression and multiple linear regression analyses to analyze the impact of various factors on workplace incivility and safety culture amongst EMS staff. Results: According to the study, EMS workers' average patient safety culture was 51.32%. The study also revealed that more than half of EMS workers (52.7%) experience workplace incivility at least once a month. This behavior negatively affects the staff's adherence to patient safety guidelines during EMS missions, leading to high turnover rates. The study also found that workplace incivility is linked to patient safety culture, and these negative experiences can decrease patient safety culture. Conclusion: EMS workers in Iran exhibit a poor attitude toward patient safety culture, exacerbated by workplace incivility. This negative behavior impacts adherence to safety guidelines and contributes to high staff turnover intention rates. To improve outcomes, healthcare organizations need to implement policies and training programs to address inappropriate behaviors. Cultivating a culture of respect, professionalism, and effective communication can enhance staff safety and improve the quality of patient care.

By the beginning of the coronavirus disease 2019 (COVID-19) pandemic, emergency medical services (EMSs) played a key first-line role in patients affected by this disease care. In Iran, EMSs is a main part of health system that has a substantial role in managing emerging crisis and disasters. This study aimed to investigate the experience of the EMSs staff encountering with COVID-19 patients. This was a descriptive qualitative study conducted on 14 EMSs staff selected by purposive sampling from August 2021 to September 2022. This study was conducted in the southern part of Iran. Data were collected using a semi-structured interview, and Graneheim, U.H. and Lundman, B. (2004) conventional content analysis method applied for their analysis MAXQDATA 2020 was used to store the interview data and codes. Till reaching data saturation, sampling was continued. Data analysis contributed to the extraction of 783 primary codes, 15 subclasses, 4 classes, and 2 main themes, including "committed care" (with two classes of "respect to the personal identity of the patient" and "facilitators to adhere to care") and "the bottleneck of care in the shadow of fear" (with two classes of "the fine line between fear and responsibility" and "the sacrifice in care"). Although there was a fear of encountering COVID-19 patients among the EMSs staff, they provided devotional and committed care to patients considering moral values and human principles. Health policymakers should minimize the challenges of EMSs staff encountering with emerging infectious diseases with effective planning.