Emergency Medical Services Workers Research Articles

Working in emergency services in Germany: cross-sectional data on violence experience and perception

Abstract Background Violence in emergency medical services (EMS) continues to be a topic of concern. Experiencing violence impedes the workers’ wellbeing, thus impairing the coverage and quality of EMS. We explored employment-related factors associated with violence experience and perception. Methods We conducted an anonymous online-based survey among EMS staff in Germany (09.2023-01.2024). Participants reported on their work setting, frequency of violent experiences and perception of violence. Descriptive statistics and logistic regression were calculated. Results Of 224 participants with completed questionnaires, 86 reported to have been exposed to physical violence (PV) in the past 12 months (Median number of events=2.00) and 129 reported to have experienced non-physical violence (NPV; Median number of events=5.00) with the majority of participants reporting that all cases occurred during assignment (n(PV)=79; n(NPV)=86). Of those, 78 reported PV by patients and 5 by colleagues, while in NPV cases 113 participants experienced violence by patients and 40 by colleagues. Women had a higher probability of reporting PV experiences compared to men (OR = 2.214, p=.010). Reporting NPV experiences was negatively associated with age between 45 and 49 (compared to ≤ 24 years, OR=.291, p=.019) and having worked for the current employer for ≥16 years (OR=.339, p=.035). Participants who have experienced violence in the past year had a higher likelihood of perceiving a general increase in the prevalence of violence in EMS (PV: OR = 6.766, p<.001; NPV: OR = 1.688, p=.047). Conclusions Younger EMS workers with juniority have a higher probability of reporting experiencing NPV. Women are more likely to report experiencing PV. It remains to be explored, if these associations refer to the experiences of violence, to reporting frequency or both. Regardless, the majority of respondents perceive an increase in violence within the work setting of EMS, especially if they have been subjected to it themselves. Key messages • EMS professionals experience significant levels of physical and non-physical violence originating from patients and colleagues. • Sex, age and seniority may affect the likelihood of EMS professionals of experiencing physical or non-physical violence.

Change in occupational burnout measures in emergency medical service workers after a psychedelic experience induced by a single self-administered dose of psilocybin mushrooms

AbstractBackground and AimsThis naturalistic mixed methods field study, aimed to assess the potential of a psilocybin induced experience, to help Emergency Medical Service Workers (EMSW) to address psychological and stress related symptoms stemming from a challenging working environment, known to contribute to occupational burnout (OB).MethodsThis exploration was conducted with an intentional sample of five participants, recruited through an online survey who self-administered a therapeutic dose of psilocybin mushrooms to manage psychological symptoms resulting from their work as EMSW, allowing the authors to assess the outcome. To measure the impact of the experience, changes in OB measures were assessed with psychometric instruments previously used in this population at three timepoints, before and after the session. The subjective impact of the psychedelic experience, through psychological insights and emotional breakthroughs, was also assessed, and two follow-up interviews were conducted to collect further data.ResultsThe results showed that, two weeks after the session, a visible improvement was noticed in several measures of pre-existent OB, that remained stable after two months. Additionally, most participants reported a strong subjective impact, that they perceived as fundamental for the positive outcome.ConclusionsAfter one therapeutic psylocibin session, several measures of OB showed an encouraging level of improvement and may constitute an important step towards finding alternative and innovative solutions to address high rates of psychological distress experienced by EMSWs, also benefiting the organization and the quality of patient care. The limitations and implications of the study and suggestions for future research are discussed.

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) 2024 APA, all rights reserved).

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.

Hygienic assessment of health risks for employees of the Omsk ambulance service due to tobacco smoking

The results of many studies indicate that there is a cause-effect relationship between active tobacco smoking and risks of various diseases, lung and bronchial cancer (C34) and coronary heart disease (I25) being the most common among them. These diseases are one of the main causes of death in working age. The aim of this study was to perform hygienic assessment of risks of lung and bronchial cancer and coronary heart disease due to active tobacco smoking. Healthcare workers employed at the Omsk ambulance station were chosen as the research object. Additional risk levels were calculated for lung and bronchial cancer and coronary heart disease in accordance with the methodical guidelines MR 2.1.10.0033-11 Assessment of Risks Associated with Impacts of Lifestyle Factors on Public Health. Smoking was a health risk factor for 27.5 % of emergency medical services workers, including 42.5 % of men and 21.3 % of women. Sixty-six point seven percent of men aged between 31 and 40 years smoked. Prevalence of smoking among the females in the sample did not depend on age. The risk analysis revealed that smokers, equally men and women (p > 0.1) were the most likely to have lung and bronchial cancer and coronary heart disease. The corresponding median levels of additional risk equaled 1.45E-05 and 9.0E-06. The proportion of people with unacceptable levels of additional risks of the analyzed diseases (> 1.4E-04) equaled 43.3 and 53.3 % respectively among people older than 40 years. Likelihood of lung and bronchial cancer and coronary heart disease statistically significantly depends on the intensity of smoking.

Гигиеническая оценка рисков здоровью сотрудников службы скорой медицинской помощи в связи с курением табака (на примере г. Омска)

The results of many studies indicate that there is a cause-effect relationship between active tobacco smoking and risks of various diseases, lung and bronchial cancer (C34) and coronary heart disease (I25) being the most common among them. These diseases are one of the main causes of death in working age. The aim of this study was to perform hygienic assessment of risks of lung and bronchial cancer and coronary heart disease due to active tobacco smoking. Healthcare workers employed at the Omsk ambulance station were chosen as the research object. Additional risk levels were calculated for lung and bronchial cancer and coronary heart disease in accordance with the methodical guidelines MR 2.1.10.0033-11 Assessment of Risks Associated with Impacts of Lifestyle Factors on Public Health. Smoking was a health risk factor for 27.5 % of emergency medical services workers, including 42.5 % of men and 21.3 % of women. Sixty-six point seven percent of men aged between 31 and 40 years smoked. Prevalence of smoking among the females in the sample did not depend on age. The risk analysis revealed that smokers, equally men and women (p > 0.1) were the most likely to have lung and bronchial cancer and coronary heart disease. The corresponding median levels of additional risk equaled 1.45E-05 and 9.0E-06. The proportion of people with unacceptable levels of additional risks of the analyzed diseases (> 1.4E-04) equaled 43.3 and 53.3 % respectively among people older than 40 years. Likelihood of lung and bronchial cancer and coronary heart disease statistically significantly depends on the intensity of smoking.

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.

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

Emergency Medical Services (EMS) workers are critical to effective disaster response. Therefore, it is important to understand their knowledge, skills, and preparedness for disasters. This study investigated factors influencing EMS workers' disaster knowledge, skills, and preparedness in the Saudi Arabian context. The study also sought to identify challenges to disaster preparedness among Saudi Arabian EMS workers. A descriptive cross-sectional survey using The Disaster Preparedness Evaluation Tool was distributed to EMS workers in military and government hospitals across 3 Saudi Arabian cities. Responses were recordedon a 6-point Likert scale where higher scores indicated higher knowledge, skills, or preparedness. The results were analysed using descriptive and inferential statistical analysis. 272EMS 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 this, 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. EMS workers have moderate disaster knowledge, skills, and preparedness levels. Knowledge, skill, and preparedness have a significant relationship on the EMS workers' demographics. These findings demonstrate the need to invest in preparing Saudi Arabian EMS workers to effectively respond to bioterrorism disasters.

Emergency medical service interventions and experiences during pandemics: A scoping review.

The global impact of COVID-19 has been profound, with efforts to manage and contain the virus placing increased pressure on healthcare systems and Emergency Medical Services (EMS) in particular. There has been no previous review of studies investigating EMS interventions or experiences during pandemics. The aim of this scoping review was to identify and present published quantitative and qualitative evidence of EMS pandemic interventions, and how this translates into practice. Six electronic databases were searched from inception to July 2022, supplemented with internet searches and forward and backward citation tracking from included studies and review articles. A narrative synthesis of all eligible quantitative studies was performed and structured around the aims, key findings, as well as intervention type and content, where appropriate. Data from the qualitative studies were also synthesised narratively and presented thematically, according to their main aims and key findings. The search strategy identified a total of 22,599 citations and after removing duplicates and excluding citations based on title and abstract, and full text screening, 90 studies were included. The quantitative narrative synthesis included seven overarching themes, describing EMS pandemic preparedness plans and interventions implemented in response to pandemics. The qualitative data synthesis included five themes, detailing the EMS workers' experiences of providing care during pandemics, their needs and their suggestions for best practices moving forward. Despite concerns for their own and their families' safety and the many challenges they are faced with, especially their knowledge, training, lack of appropriate Personal Protective Equipment (PPE) and constant protocol changes, EMS personnel were willing and prepared to report for duty during pandemics. Participants also made recommendations for future outbreak response, which should be taken into consideration in order for EMS to cope with the current pandemic and to better prepare to respond to any future ones. The review protocol was registered with the Open Science Framework (osf.io/2pcy7).

Prevalence of methicillin sensitive and resistant Staphylococcus aureus carriage among German emergency medical providers.

Health care workers (HCW) in Emergency Medical Services (EMS) frequently come into contact with carriers of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) strains and may acquire and transmit them to patients. However, there is little data on MSSA and MRSA colonization of medical personnel in the emergency services. Additionally, few studies have analyzed the association between personal hygiene of staff and colonization. Therefore, we examined the prevalence of MSSA and MRSA in EMS staff of two German regions and evaluated their personal hygiene behavior. Throat and nasal swabs from 300 EMS workers were analyzed. Both direct and pre-enriched cultures of the swabs were cultivated on culture media to identify MSSA and MRSA. Results were analyzed together with questionnaires about sociodemographic data and a self-assessment of hygiene behavior. Statistical analysis was done using the R statistical software. Of the total 300 swabs, 55% were from paramedics, 39% were from emergency medical technicians (EMT) and 5% were from emergency physicians. With 1%, the MRSA prevalence was comparable to that of the German population, while the MSSA rate - 43.7% - was higher than expected. Colonization with MSSA was significantly associated with poor hand hygiene and male sex, and was inversely correlated to time on the job in EMS. The sample size of 300 and a MRSA prevalence of 1% made a meaningful analysis of potential influencing factors on the prevalence of MRSA infeasible. The comparatively high prevalence of MSSA and the association with decreasing frequency of hand antisepsis suggests an influence of personal hygiene on MSSA colonization. HCW in EMS should be encouraged to make use of their personal protective equipment and practice frequent hand hygiene. The implementation of diagnostic tools such as the Hand Hygiene Self-Assessment Framework of the WHO could be utilized to reveal problems in organizations, followed by an individual program to promote hand hygiene.

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 providers for traumatic cardiac arrest patients before and after the COVID-19 pandemic in Korea: an observational study.

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. 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. 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. 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.