Emergency Medical Services System Research Articles

332 The Hidden Factors of Health: A Mixed Methods Study of EMS Provider Knowledge and Perceptions of Social Risk Factors

332 The Hidden Factors of Health: A Mixed Methods Study of EMS Provider Knowledge and Perceptions of Social Risk Factors

185 Identification of At-Risk Patients in a Statewide EMS “Naloxone Leave Behind” Program

Naloxone Leave Behind (NLB) programs are an effective intervention Emergency Medical Services (EMS) can utilize to expand access to naloxone and reduce opioid overdose deaths in high-risk patients with opioid use disorder (OUD). Identification of “At-Risk” persons, patients who experience an opioid-related overdose or have indicators of OUD, is critical for successful program implementation. While many EMS systems have implemented NLB programs, few have reported on program success or areas for improvement.

184EMF Implementation of a Novel Fluid Resuscitation Device for the Care of Sepsis Patients: Processes and Perceptions in the Out-of-Hospital Setting

Early fluid infusion is a key performance metric in the care of sepsis patients, yet this benchmark is often unmet. Emergency Medical Services (EMS) transports one-third of sepsis patients, presenting an opportunity for increased achievement of fluid goals. To enhance sepsis care, one large urban EMS system (∼120,000 EMS responses/year) introduced a novel rapid fluid infusion device, LifeFlow® Plus, to its sepsis protocol (∼700 patients/year). The study objective is to assess the implementation of this device in EMS fluid administration for out-of-hospital sepsis care.

Evaluating Nebraska EMS Providers' Ability and Willingness to Respond to Emergencies Resulting from Bioterrorist Attacks.

Previous studies have found that public health systems within the United States are inadequately prepared for an act of biological terrorism. As the coronavirus disease (COVID-19) pandemic continues, few studies have evaluated bioterrorism preparedness of Emergency Medical Services (EMS), even in the accelerating environment of biothreats. This study utilized an Internet-based survey to assess the level of preparedness and willingness to respond to a bioterrorism attack and identify factors that predict preparedness and willingness among Nebraska EMS providers. The survey was available for 1 month in 2021 during which 190 EMS providers responded to the survey. Only 56.8% of providers were able to recognize an illness or injury as potentially resulting from exposure to a biological agent. The provider Clinical Competency levels ranged from a low of 13.6% (ability to initiate patient care within his/her professional scope of practice and arrange for prompt referral appropriate to the identified condition(s)) to a high of 74% (the ability to respond to an emergency within the emergency management system of his/her practice, institution, and community). Only 10% of the respondents were both willing and able to effectively function in a bioterror environment. To effectively prepare for and respond to a bioterrorist attack, all levels of the health care system need to have the clinical skills, knowledge, and abilities necessary to treat patients exposed to biological agents. Policy changes and increased focus on training and drills are needed to ensure a prepared EMS system, which is crucial to a resilient state. EMS entities need to be aware of the extent of their available workforce so that the country can be prepared for the increasing threat of bioterrorism or other novel emerging infectious disease outbreaks. A resilient nation relies on a prepared set of EMS providers who are willing to respond to biological terrorism events.

Implementing Oral Systemic Corticosteroids for Pediatric Asthma into EMS Treatment Guidelines: A Qualitative Study

Introduction: Respiratory distress accounts for approximately 14% of all pediatric emergency medical services (EMS) encounters, with asthma being the most common diagnosis. In the emergency department (ED), early administration of systemic corticosteroids decreases hospital admission and speeds resolution of symptoms. For children treated by EMS, there is an opportunity for earlier corticosteroid administration. Most EMS agencies carry intravenous (IV) corticosteroids; yet given the challenges and low rates of EMS pediatric IV placement, oral corticosteroids (OCS) are a logical alternative. However, previous single-agency studies showed low adoption of OCS. Therefore, qualitative study of OCS implementation by EMS is warranted. Methods: This study’s objective was to explore uptake and implementation of OCS for pediatric asthma treatment through semi-structured interviews and focus groups with EMS clinicians. We thematically coded and analyzed transcripts using the domains and constructs of the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators that most strongly influenced OCS implementation and adoption by EMS clinicians. Results: We conducted five focus groups with a total of ten EMS clinicians from four EMS systems: one urban region with multiple agencies that hosted two focus groups, one suburban agency, one rural agency, and a mixed rural/suburban agency. Of the 36 CFIR constructs, 31 were addressed in the interviews. Most constructs coded were in the CFIR domains of the inner setting and characteristics of individuals, indicating that EMS agency factors as well as EMS clinician characteristics were impactful for implementation. Barriers to OCS adoption included unfamiliarity and inexperience with pediatric patients and pediatric dosing, and lack of knowledge of the benefits of corticosteroids. Facilitators included friendly competition with colleagues, having a pediatric medical director, and feedback from receiving EDs on patient outcomes. Conclusion: This qualitative focus group study of OCS implementation by EMS clinicians for the treatment of pediatric asthma found many barriers and facilitators that mapped to the structure of EMS agencies and characteristics of individual EMS clinicians. To fully implement this evidence-based intervention for pediatric asthma, more education on the intervention is required, and EMS clinicians will benefit from further pediatric training.

An improved EMS simulation-optimization model with Poisson mixture distribution

A Discrete Event System (DES) simulation and optimization model is proposed for the ambulance allocation problem in an Emergency Medical Service (EMS) system. The accuracy of the proposed model was improved by estimation of input parameters using the Poisson mixture model and the Expectation Maximization Algorithm. The results were proven by Mann–Whitney and Kolmogorov–Smirnov tests. The DES model was run by the OptQuest program embedded in Arena software. The response times of the cases within the urban and rural regions were improved by 40% and 45%, respectively, and the station success rates in urban and rural areas were raised to 95% and 96%, respectively. Our results indicated that the number of ambulances must be revised, and their allocations to stations in the real system need to be reorganized to achieve the required EMS system performance standards.

The impact of COVID-19 on emergency medical service-led out-of-hospital cardiac arrest resuscitation: a qualitative study.

Following the emergence of COVID-19, there have been local and national changes in the way emergency medical service (EMS) staff respond to and treat patients in out-of-hospital cardiac arrest (OHCA). The views of EMS staff on the impact of COVID-19 and management of OHCA have not previously been explored. This study aimed to explore the views of staff, with a specific focus on communication during resuscitation, resuscitation procedures and the perception of risk. A qualitative phenomenological enquiry was conducted. A purposive sample of n = 20 participants of various clinical grades was selected from NHS EMS providers in the United Kingdom. Data were collected using semi-structured interviews, transcribed verbatim and inductive thematic analysis was applied. Three main themes emerged which varied according to clinical grade, location and guidelines.Decision making: Staff generally felt supported to make best-interest termination of resuscitation decisions. Staff made informed decisions to compromise on recommended levels of personal protective equipment (PPE), since it felt impractical in the pre-hospital context, to improve communication or to reduce delays to care.Service pressures: Availability of operational staff and in-hospital capacity were reduced. Staff felt pressure and disconnect from the continuous updates to clinical guidelines which resulted in organisational change fatigue.Moral injury: The emotional impacts of prolonged and frequent exposure to failed resuscitation attempts and patient death caused many staff to take time away from work to recover. This qualitative study is the first known to explore staff views on the impacts of COVID-19 on OHCA resuscitation, which found positive outcomes but also negative impacts important to inform EMS systems. Staff felt that COVID-19 created delays to the delivery of resuscitation, which were multi-faceted. Staff developed new ways of working to overcome the barriers of impractical PPE. There was little impact on resuscitation procedures. Moving forwards, EMS should consider how to limit organisational change and better support the ongoing emotional impacts on staff.

Integrating Spatial Risk Factors with Social Media Data Analysis for an Ambulance Allocation Strategy: A Case Study in Bangkok

Emergency medical service (EMS) base allocation plays a critical role in emergency medical service systems. Fast arrival of an EMS unit to an incident scene increases the chance of survival and reduces the chance of victim disability. However, recently, the allocation strategy has been performed by experts using past data and experiences. This may lead to ineffective planning due to a lack of consideration of a recent and relevant data, such as disaster events, population density, public transportation stations, and public events. Therefore, we propose an approach of the integration of using spatial risk factors and social media factors to identify EMS bases. These factors are combined into a single domain by using the kernel density estimation technique, resulting in a heatmap. Then, the heatmap is used in a modified maximizing covering location problem with a heatmap (MCLP-Heatmap) to allocate ambulance base. To acquire recent data, social media is then used for collecting road accidents, traffic, flood, and fire incidents. Additionally, another data source, spatial risk information, is collected from Bangkok GIS. These data are analyzed using the kernel density estimation method to construct a heatmap before being sent to the MCLP-heatmap to identify EMS bases in the area of interest. In addition, the proposed integrated approach is applied to the Bangkok area with a smaller number of EMS bases than that of the existing approach. The simulated results indicated that the number of covered EMS requests was increased by 3.6% and the number of ambulance bases in action was reduced by approximately 26%. Additionally, the bases defined by the proposed approach covered more area than those of the existing approach.

Educational perspectives in emergency paramedicine : Interdisciplinary discourse on education, professional practice, and challenges in the field of emergency medical services

Societal developments that result in an increase in geriatric, psychosocial, and subacute (i.e. not time-critical) emergencies are changing the demands on emergency care and posing challenges to the system of emergency care and emergency medical services (EMS). The training of emergency paramedics (NotSan) lays the foundation for finding aqualified systemic response to evolving patient needs and requirements. By extending and strengthening their competencies, NotSan are to be understood as basic emergency care providers. Their training should therefore be further developed in terms of evidence-based and patient-centered care in order to increase their competency to act and to achieve demand-oriented holistic (outpatient) care. New EMS resources such as community paramedics (GNFS) and telemedical support systems offer opportunities to strengthen competencies in patient care. The guiding principles of care should be patient safety and patient centeredness. In addition to increasing the basic competencies and equipment of existing EMS resources as well as continuous training opportunities, innovative cross-sectoral and cross-professional care concepts are necessary and must be supported.

Locating emergency medical services to reduce urban-rural inequalities

Emergency Medical Service (EMS) systems provide fundamental services in relation to public health and safety. The spatial configuration of EMS stations is crucial to the efficiency and equality of service provision. While urban-rural inequalities in EMS have been widely acknowledged, how to optimize EMS station locations to reduce such inequalities remains challenging. This research proposes a multi-objective optimization model to reduce urban-rural inequalities in EMS accessibility and coverage, in addition to maximizing the total covered population. The proposed model is applied in an empirical study in Wuhan, China, to seek locations for new EMS stations in order to improve local EMS capacity in the pandemic period. The results indicate that the total covered population, particularly in urban area, decreases when urban-rural equality in service accessibility increases, but it has a U-shaped relationship with urban-rural inequality in service coverage. Pareto-optimal solutions suggest that all new stations should be located in rural areas if lower urban-rural inequality in EMS is to be obtained, but one new station is needed in the urban area if higher coverage of total population is more desirable. The work presented in this paper can aid the planning practice of public services like EMS systems where reducing urban-rural inequalities is an essential concern.

The Correlation between COVID-19 Hospitalizations and Emergency Medical Services Responses for Time-Sensitive Emergencies during the COVID-19 Pandemic

Objective COVID-19 has had significant secondary effects on health care systems, including effects on emergency medical services (EMS) responses for time-sensitive emergencies. We evaluated the correlation between COVID-19 hospitalizations and EMS responses for time-sensitive emergencies in a large EMS system. Methods This was a retrospective study using data from the Los Angeles County EMS Agency. We abstracted data on EMS encounters for stroke, ST-elevation myocardial infarction (STEMI), out-of-hospital cardiac arrest (OHCA), and trauma from April 5, 2020 to March 6, 2021 and for the same time period in the preceding year. We also abstracted daily hospital admissions and censuses (total and intensive care unit [ICU]) for COVID-19 patients. We designated November 29, 2020 to February 27, 2021 as the period of surge. We calculated Spearman’s correlations between the weekly averages of daily hospital admissions and census and EMS responses overall and for stroke, STEMI, OHCA, and trauma. Results During the study period, there were 70,616 patients admitted for confirmed COVID-19, including 12,467 (17.7%) patients admitted to the ICU. EMS responded to 899,794 calls, including 9,944 (1.1%) responses for stroke, 3,325 (0.4%) for STEMI, 11,207 (1.2%) for OHCA, and 114,846 (12.8%) for trauma. There was a significant correlation between total hospital COVID-19 positive patient admissions and EMS responses for all time-sensitive emergencies, including a positive correlation with stroke (0.41), STEMI (0.37), OHCA (0.78), and overall EMS responses (0.37); and a negative correlation with EMS responses for trauma (-0.48). ICU COVID-19 positive patient admissions also correlated with increases in EMS responses for stroke (0.39), STEMI (0.39), and OHCA (0.81); and decreased for trauma (-0.53). Similar though slightly weaker correlations were found when evaluating inpatient census. During the period of surge, the correlation with overall EMS responses increased substantially (0.88) and was very strong with OHCA (0.95). Conclusion We found significant correlation between COVID-19 hospitalizations and the frequency of EMS responses for time-sensitive emergencies in this regional EMS system. EMS systems should consider the potential effects of this and future pandemics on EMS responses and prepare to meet non-pandemic resource needs during periods of surge, particularly for time-sensitive conditions.

Utilization and Effect of Direct Medical Oversight during Out-of-Hospital Cardiac Arrest

Study Objective Direct medical oversight (DMO), where emergency medical services (EMS) clinicians contact a physician for real-time medical direction, is used by many EMS systems across the United States. Our objective was to characterize the recommendations made by DMO during out-of-hospital cardiac arrests (OHCA) and to determine their effect on EMS transport decisions and patient outcomes. Methods This is a secondary analysis of DMO call recordings from OHCA cases in the Portland, Oregon metropolitan area from January 1, 2018 to February 28, 2021. Data extracted from the audio recordings were linked to OHCA cases in the Portland Cardiac Arrest Epidemiologic Registry (PDX Epistry). The primary outcomes are recommendations made by DMO: transport, continued field resuscitation, or termination of resuscitation (TOR). Secondary outcomes include EMS transport decisions, survival to hospital admission, and survival to hospital discharge. We used descriptive statistics, unpaired t-tests, and chi-square tests as appropriate for data analysis. Results There were 239 OHCA cases for which DMO was contacted by EMS. The median time from EMS arrival to DMO contact was 25.6 min, and EMS requested TOR for 72.0% of patients. Compared to patients where EMS requested further treatment advice, patients for whom EMS requested TOR had poor prognostic signs including older age, asystole as an initial rhythm, and lower rates of transient return of spontaneous circulation prior to DMO call compared with cases where EMS did not request TOR. DMO recommended transport, continued field resuscitation, or TOR in 21.8%, 18.0%, and 60.2% of patients, respectively. Of the 239 patients, 59 (24.7%) were ultimately transported by EMS to the hospital, 14 (5.9%) survived to admission, and only 1 patient (0.4%) survived to hospital discharge and had an acceptable neurologic outcome (Cerebral Performance Category score of 2). Conclusions Patients for whom EMS contacts DMO for further treatment advice or requesting field TOR after prolonged OHCA resuscitation have poor outcomes, even when DMO recommends transport or further resuscitation, and may represent opportunities to reduce unnecessary DMO contact or patient transports. More research is needed to determine which OHCA patients benefit from DMO contact.

Treatment of Presumed Hyperkalemia in the Prehospital Setting.

Hyperkalemia (HK) is common and potentially a life-threatening condition. If untreated, HK can progress to ventricular arrhythmia and cardiac arrest. Early treatment reduces mortality in HK. This study evaluates a novel protocol for identification and empiric management of presumed HK in the prehospital setting. This was a retrospective, observational chart review of a single, large, suburban Emergency Medical Services (EMS) system. Patients treated for presumed HK, with both a clinical concern for HK and electrocardiogram (ECG) changes consistent with HK, from February 2018 through February 2021 were eligible for inclusion. Patients were excluded if found to be in cardiac arrest on EMS arrival. Empiric treatment of HK included administration of calcium, sodium bicarbonate, and albuterol. Post-treatment, patients were placed on cardiac monitoring and adverse events recorded enroute to receiving hospital. Protocol compliance was assessed by two independent reviewers. Serum potassium (K) level was obtained from hospital medical records. A total of 582 patients were treated for HK, of which 533 patients were excluded due to cardiac arrest prior to EMS arrival. The remaining 48 patients included in the analysis had a mean age of 56 (SD = 20) years and were 60.4% (n = 29) male with 77.1% (n = 37) Caucasian, 10.4% (n = 5) African American, and 12.5% (n = 6) Hispanic. Initial blood draw at the receiving facilities showed K >5.0mEq/L in 22 (45.8%), K of 3.5-5.0mEq/L in 23 (47.9%), and K <3.5mEq/L in three patients (6.3%). Independent review of the EMS ECG found the presence of hyperkalemic-related change in 43 (89.6%) cases, and five (10.4%) patients did not meet criteria for treatment due to lack of either appropriate ECG findings or clinical suspicion. No episodes of unstable tachyarrhythmia or cardiac arrest occurred during EMS treatment or transport. The study evaluated a novel protocol for detecting and managing HK in the prehospital setting. It is feasible for EMS crews to administer this protocol, although a larger study is needed to make the results generalizable.

The Impact of the Coronavirus Disease 2019 (Covid-19) Pandemic on the Use of Emergency Medical Services System in Bangkok, Thailand.

BackgroundCoronavirus disease 2019 (COVID-19) has widely affected the global public health system, especially the emergency medical service (EMS), which has been the first responders since 2020. However, this pandemic persists with still limited studies on its impact on EMS. This study aimed to compare the number of EMS patients and the operation periods of Bangkok EMS in Thailand between 2020 (severe COVID-19 pandemic) and 2019 (prepandemic).Patients and MethodsWe retrospectively analyzed data of patients with severe COVID-19 were collected from the emergency medical information system of Bangkok EMS center. Data were compared between the two periods. The COVID-19 pandemic period (study period) spanned from January 01, 2020 to December 31, 2020, whereas the control period referred to the same period in the previous year (January 01, 2019 to December 31, 2019).ResultsA total of 178,594 patients were serviced by EMS, with 93,288 during the study period and 85,306 during the control period. The study period had more EMS patients overall by 9.36% (95% confidence interval [CI]: 9.16–9.55) and significantly more EMS patients per day, with a mean difference of 21.19 (254.90 ± 25.55 vs 233.71 ± 23.49; 95% CI: 17.63–24.76, p < 0.001), than the control period. Furthermore, all EMS operation periods studied were significantly longer during the study period.ConclusionDuring COVID-19 pandemic period, a significantly increased number of EMS patients compared to one during non-COVID-19 pandemic period for both traumatic and non-traumatic patients, as well as remarkably increased every EMS operation period of both groups during COVID-19 pandemic period were found in the present study. From this knowledge, provision of necessary EMS resources and preparation of emergency staff to be ready for management of future pandemics should be obtained to reduce EMS operation period in the future pandemics.

Nebulized Ketamine for Analgesia in the Prehospital Setting: A Case Series

We report the initial seven patients treated with nebulized ketamine for moderate to severe pain, via breath-actuated nebulizer, in an urban, ground-based emergency medical services (EMS) system. Ketamine for analgesia in the emergency setting has become widespread over the past decade. The addition of a non-parenteral, inexpensive, and well-tolerated ketamine delivery option is extremely desirable. We believe these initial data demonstrate promising pain reduction coupled with minimal side effects, indicating a potential role for nebulized ketamine in EMS.

Importance of Analyzing Intervals to Emergency Medical Service Treatments

Background Although most US emergency medical services (EMS) systems collect time-to-treatment data in their electronic prehospital patient care reports (PCRs), analysis of these data seldom appears in publications. We believe EMS agencies should routinely analyze the initial time-to-treatment data for various potentially life-threatening conditions. This not only assures that protocol-required treatments have been provided but can discover avoidable delays and drive protocol/treatment priority change. Our study purpose was to analyze the interval from 9-1-1 call receipt until the first administration of naloxone to adult opioid overdose victims to demonstrate the quality assurance importance of analyzing time-to-treatment data. Methods Retrospective analysis of intervals from 9-1-1 call receipt to initial naloxone treatment in adult opioid overdose victims. We excluded victims <18 years of age and cases where a bystander, police, or a health care worker gave naloxone before EMS arrival. We compared data collected before and during the COVID-19 pandemic to determine its effect on the analysis. Results The mean patient age of 582 opioid overdose victims was 40.7 years [95% CI 39.6, 41.8] with 405 males (69.6%). EMS units’ scene arrival was 6.7 minutes from the 9-1-1 call receipt. It took 1.8 minutes to reach the victim, and 8.6 additional minutes to administer the first naloxone regardless of administration route (70.4% intravenous, 26.1% intranasal, 2.7% intraosseous, 0.7% intramuscular). EMS personnel administered the first naloxone 17.1 minutes after the 9-1-1 call receipt, with 50.3% of the delay occurring after patient contact. There was no statistically significant difference in the times-to-treatment before vs. during the pandemic. Conclusion The prepandemic interval from 9-1-1 call receipt until initial EMS administration of naloxone was substantial and did not change significantly during COVID-19. Our findings exemplify why EMS agencies should analyze initial time-to-treatment data, especially for life-threatening conditions, beyond assuring that protocol-required treatments have been provided. Based on our analysis, fire department crews now carry intranasal naloxone, and intranasal naloxone is given to “impaired" opioid overdose victims the first-arriving fire department or EMS personnel. We continue to collect data on intervals-to-treatment prospectively and monitor our critical process/treatment intervals using the plan-do-study-act model to improve our process/carry out change, and publish our results in a future publication.

The A to E (ABCDE) Pit Crew Model: A Novel Approach to Team Based Care of Critical Patients in the Prehospital Setting.

This study aimed to evaluate the effectiveness of a Pit Crew intervention to improve team dynamics and time to performance of critical actions in a prehospital critical care scenario. The primary outcome was successful completion of critical actions and time to completion of these critical actions. Secondary outcomes included effectiveness of communication and overall team functioning. The study was conducted with a fire-based Emergency Medical Services (EMS) system with 233 paramedics and 115 Emergency Medical Technicians (EMT). Eight EMS crews comprised of five members each were randomly selected and assigned to either the intervention or the control group. The intervention group (n=20) watched a thirty-minute video prior to the training describing the "Pit Crew Approach;" the control group (n=20) did not watch the video. Each crew was given the same simulation scenario of a pediatric patient that had overdosed on a beta-blocker. Completion of predetermined critical tasks were noted and timestamped. A survey was administered to the participants following the training to assess team dynamics and level of confidence. Three outcomes were statistically significant between the two arms: The interventional group felt they themselves had a more defined role in the resuscitation in comparison to the non-interventional group (p= 0.021). The interventional group also felt that their team members had a clearer and more defined role than the nonintervention group (p= 0.018). The interventional group also felt more confident managing a beta blocker overdose than the nonintervention group (p.007). The only statistically significant secondary outcome finding was in scene departure decision: the interventional arm spent more time on-scene (p=0.031). Of note, the non-intervention group missed performing tasks more often than the interventional group and team leaders of these groups often performed task(s) while also directing the patient care. The Pit Crew model was developed to optimize communication and team function. Our data identified that a formal instruction of the pit crew approach to a critical care scenario improved comfort in patient care. Future studies are needed evaluate other methods of training and the effects of continued formal pit-crew training over time.

Post-Crash First Response by Traffic Police in Nepal: A Feasibility Study.

Background: Road traffic injuries are a significant and increasing public health burden in Nepal, but there is no national coverage of regulated and standardized emergency medical service systems. Therefore, this study was designed to develop a first responder trauma training program for the Nepal traffic police and to evaluate the feasibility of its delivery and follow up. Methods: A training needs assessment with traffic-police officers in a single district of Nepal informed the development of a 3-day first-response course which was provided to officers in May 2019. Participants were supplied with a trauma-pack and asked to complete a report form when first-responder skills were used. Knowledge and confidence face-to-face surveys were used before and after training to assess learning, and were repeated at 6 months to assess retention of knowledge. The surveys at 6 months assessed the factors affecting application of first response skills. Results: Most (97%) participants believed giving first-aid was part of their responsibilities and 95% had experience of transporting road crash victims to hospital with a range of injuries. Low levels of first-aid training and variable course content were reported. Knowledge and confidence scores improved post-intervention but were reduced at 6-months. During attendance at 303 road crashes in the 6-months follow-up period, 44% of the participants self-reported using at least one skill from the course; applying them on 92 occasions. Incident report-forms were frequently not completed. Barriers to providing treatment included: the patient already en-route to hospital when police arrived at scene; resistance to providing care from relatives or bystanders; and competing police duties (e.g., traffic management). Conclusions: Delivering a first-response training program for traffic-police in Nepal is feasible. Knowledge was retained and used, and skills were in frequent demand. A study of effectiveness and cost-effectiveness appears warranted to determine if extending the training to other districts can improve outcomes in road traffic injury patients in the absence of formal emergency medical services.

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.

Caregiver Perceptions Regarding Alternative Emergency Medical Services Dispositions for Children: A Cross-Sectional Survey Analysis.

IntroductionEmergency medical services (EMS) systems have developed alternative disposition processes for patients (including leaving the patient at the scene, using taxis, and transporting to clinics) vs taking patients directly to an emergency department (ED). Studies show that patients favorably support these alternative options but have not included the perspectives of caregivers of children. Our objective was to describe caregivers’ views about these alternative disposition processes and analyze whether caregiver support is associated with sociodemographic factors.MethodsWe surveyed a convenience sample of caregivers in a pediatric ED. We asked caregivers 15 questions based on a previously validated survey. We then conducted logistic regressions to determine whether sociodemographic factors were associated with levels of support.ResultsWe enrolled 241 caregivers. The median age of their children was five years. The majority of respondents were non-Hispanic Black (57%) and had public insurance (65%). We found that a majority of respondents supported all alternative EMS disposition options. The overall level of agreement for survey questions ranged from 51–93%. We grouped questions by theme: non-transport; alternative destinations; communication with EMS physician; communication with primary care physician and sharing records; restricted EMS role; and shared decision-making. Regression analyses for each theme found that race/ethnicity, public insurance, and patient age were not significantly associated with the level of support.ConclusionMost caregivers were supportive of alternative EMS disposition options for children with low-acuity complaints. Support did not vary significantly by respondent race/ethnicity, public insurance status, or patient age.