Workers In Taiwan Research Articles

Beyond slavery scandals: Explaining working conditions among fish workers in Taiwan and Thailand

This paper draws on research on fisheries based in Taiwan and Thailand, to build an exploratory framework that identifies diverse and multilayered causes for unacceptable working conditions in industrial fisheries. We break down labour relations and working conditions into various elements that can be examined separately, including facilitation of individual and collective actions by workers, wages, recruitment, the role of crewing agencies, employment mobilities, mode of travel to a vessel, type of vessel and gear, locations of ports, working hours, physical and mental abuse, and everyday living conditions, including access to health care. Poor or good performance among these elements do not necessarily co-vary, and that policy actions to improve each of elements are distinct. Although the spotlight has been on labour conditions in Thai fisheries, we observe how there is significant room for improvement in Taiwanese fisheries, particularly the distant water fisheries, and that the improvements in Thailand suggests policy actions for the Taiwan fisheries. While improvements in working conditions require government regulation, monitoring and inspection, it is also crucial to facilitate the ability of workers to improve their situations through individual and collective action.

Solving The Problem of Indonesian Migrant Workers In Taiwan: An Analysis of Indonesian Government Response

The problems faced by Indonesian Migrant Workers (PMI) in Taiwan, there are still several problems such as unpaid salaries, work accidents, Indonesian Migrant Workers repatriation, sexual harassment, abuse, and illegal/runaway Indonesian Migrant Workers. This problem has prompted Indonesia and Taiwan to renew the Memorandum of Understanding (MoU) between the two countries to resolve Indonesian Migrant Worker problems. There are 3 (three) ways to solve the problem, namely conducting Indonesia-Taiwan cooperation, recruiting/re-collecting Indonesian Migrant Worker' data, and protecting Indonesian Migrant Workers. These efforts have been made since the reforms in 2018; this is because previous actions did not go well; therefore, the two countries agreed again so that Indonesian Migrant Workers in Taiwan get protection and the problem can be resolved quickly. Then, after the cooperation renewal, the issues experienced by Indonesian Migrant Workers in Taiwan in 2020 were determined with a percentage of 83.3%. It means Indonesia has succeeded in resolving the Indonesian Migrant Workers problem with the efforts that have been agreed upon by Taiwan.

Individual and family preferences of job qualities matter: association between face needs, locked-in job status, and burnout among high-tech workers in Taiwan

BackgroundStudies on the health impacts of being locked in a job are primarily conducted in Western countries, with the theory based on the value of individualism. But the socially-oriented concerns should be considered in workers’ locked-in status in Chinese society. So the current study aims at evaluating socially-oriented concerns on workers’ locked-in status in Taiwan.MethodsAnonymous surveys were conducted with 1102 workers at high-tech companies in Taiwan from October 2015 to January 2016 to assess their “face” needs-- a sociological concept linked to the dignity, prestige, and reputation that a person has in terms of their social relationships, locked-in status of the job, and burnout. In addition to being separated into three groups by lock-in score, participants were categorized by the conflict of preference of the job between themselves and their family. Chi-square, ANOVA, Pearson correlation, and regression tests were conducted.ResultsAmong the 1102 participants, 18% had jobs that they did not prefer but their family preferred. Participants with higher face needs and higher locked-in status had a significantly higher risk of developing personal and work-related burnout. However, the analysis using “locked-in job conflict of preference between themselves and their family” showed a more coherent result. Participants with a job which “self does not prefer but family do” had twice the risk of having personal and work-related burnout (OR = 2.03 and 2.34, respectively). Participants with a job which neither themselves nor their family prefer had four times the risk of having personal and work-related burnout (OR = 4.10 and 4.17, respectively).ConclusionsThe current study suggests an importance in considering a socially-oriented job preference in locked-in status evaluations within the Chinese culture. Workers’ whose locked-in status preference conflicted with their family’s preference showed a significantly negative impact on their health.

Health Service Access among Indonesian Migrant Domestic Workers in Taiwan.

The number of migrant workers in Taiwan increases annually. The majority is from Indonesia and most of them are female caregivers. This study aims to determine the access to health services and the associated factors among Indonesian female domestic workers in Taiwan. In this cross-sectional study, data were collected from February to May 2019, using a structured questionnaire. Subsequently, multiple logistic regression was used to examine the association between socio-demographic factors and health service access. Two hundred and eighty-four domestic migrant workers were interviewed. Eighty-five percent of the respondents declared sickness at work, but only 48.8% seek health care services. Factors associated with health service access were marital status, income, and the availability of an attendant to accompany the migrant workers to the healthcare facilities. Language barrier and time flexibility were the main obstacles. Further research and an effective health service policy are needed for the domestic migrant workers to better access health care services.

Willingness of Taiwan's Healthcare Workers and Outpatients to Vaccinate against COVID-19 during a Period without Community Outbreaks.

To control the spread of the novel coronavirus disease 2019 (COVID-19), COVID-19 vaccination has been quickly developed. However, the COVID-19 pandemic will not be controlled if the COVID-19 vaccination uptake willingness is low. Therefore, the study aim was to explore the COVID-19 vaccination uptake willingness among the outpatient population and healthcare workers in Taiwan during the worldwide pandemic period without community outbreaks. A cross-sectional survey was conducted among healthcare workers (HCWs; n = 500; mean age = 32.96 years) of National Cheng Kung University Hospital (NCKUH) and outpatients (n = 238; mean age = 34.43 years) arriving at NCKUH. We used an online survey conducted between September 24 and 21 November 2020, for healthcare workers, and between 27 October and 31 December 2020, for the outpatient sample. Information regarding willingness to receive vaccination, willingness to rapid test, fear of COVID-19, risk perception, and preventive behaviors was collected in both samples; information regarding willingness to care for patients was collected in healthcare workers. Willingness to receive vaccination was the main variable in the present study; willingness to rapid test, willingness to care for patients, fear of COVID-19, risk perception, and preventive behaviors were the secondary variables in the study. The factors associated with vaccination willingness were identified through logistic regression analysis. The participants’ willingness to receive vaccination was low for both healthcare workers (23.4%) and the outpatient sample (30.7%). Similarly, their willingness to take rapid tests was low (23.6% for healthcare workers and 28.6% for outpatient sample). Risk perception (crude odds ratio (COR) = 1.29; 95% confidence interval (CI) = 1.03, 1.63), willingness to take rapid test (COR = 9.24; 95% CI = 5.76, 14.83), and preventive COVID-19 infection behaviors (COR = 2.32; 95% CI = 1.52, 3.56) were significant factors explaining the healthcare workers’ willingness to receive vaccination. Willingness to take a rapid test (COR = 8.91; 95% CI = 4.71, 16.87) and preventive COVID-19 infection behaviors (COR = 1.69; 95% CI = 1.09, 2.60) were significant factors explaining the outpatient sample’s willingness to receive vaccination. Willingness to vaccinate against COVID-19 among HCWs and outpatients is low due to the relatively safe status of COVID-19 infection in Taiwan. These findings can help policymakers advocate for the effectiveness of and provide transparent information on COVID-19 vaccination uptake in a country/region with a relatively safe COVID-19 outbreak status.

Exposure profiles of workers from indium tin oxide target manufacturing and recycling factories in Taiwan.

Indium tin oxide exposure poses a potential health risk, but the exposure assessment in occupational setting remains incomplete and continues to be a significant challenge. To this end, we investigated the association of work type, airborne indium concentration, respirable fraction of total indium, and cumulative indium exposure index (CEI) with the levels of plasma indium (P-In) and urinary indium (U-In) among 302 indium tin oxide target manufacturing and recycling workers in Taiwan. We observed that recycling-crushing produced the highest concentrations of total indium (area: 2084.8μg/m3; personal: 3494.5μg/m3) and respirable indium (area: 533.4μg/m3; personal: 742.0μg/m3). Powdering produced the highest respirable fraction of total indium (area: 58.6%; personal: 81.5%), where the workers had the highest levels of P-In (geometric mean: 2.0μg/L) and U-In (1.0μg/g creatinine). After adjusting for the confounder, the CEIs of powdering (βPR=0.78; βPR=0.44), bonding (βPT=0.61; βPT=0.37), and processing workers (βPT=0.43; βPT=0.28) showed significant associations with P-In and U-In, validating its utility in monitoring the exposure. Also, the respirable fraction of total indium significantly contributed to the increased levels of P-In and U-In among workers. The varying levels of relationship noted between indium exposure and the levels of P-In and U-In among workers with different work types suggested that setting the exposure limits among different work types is warranted.

Indonesian Migrant Workers in Taiwan: The State Dilemma and People’s Realities

The role of migrant workers is frequently marginalized amid industrial development, labor shortages, and the domination of state to state arrangements. In fact, the position of migrant workers should be considered as a primary factor in bilateral relations and trade agreements, notably between Indonesia and Taiwan. The reason is that the influx of migrant workers has undoubtedly given many benefits to both Indonesia and Taiwan governments. The Indonesian government considered that in the midst of insufficient job opportunities, migrant workers working in Taiwan indirectly lowered the unemployment rate. In addition, Indonesia acknowledged the high contribution of migrant workers by remittances to national income. At the same time, Taiwan recognized the importance of Indonesian migrant workers in the national economy, as well as strengthening Taiwan’s second-track diplomacy with Indonesia vis-à-vis China. This article argues the dynamics of Indonesian migrant workers in Taiwan, influenced by two factors: (1) the state dilemma and (2) people’s realities, affecting the international relations between Indonesia and Taiwan. Therefore, this paper aims to explore possible answers by discussing the state dilemma and peoples’ realities from the perspective of Indonesian workers in Taiwan. This study represents qualitative research supplemented by data obtained from interviews with Indonesian workers in Taiwan. The authors are also intensively contacted and involved through activities with Indonesian workers and communities.

Gender differences and site-specific incident risks of musculoskeletal disorders among 224506 workers in the food and beverage service industry in Taiwan: A 15-year Nationwide Population-Based Cohort Study.

ObjectivesOccupational characteristics in the food and beverage service industry (FBSI) have been found to be associated with musculoskeletal disorders (MSDs). This study aimed to examine gender and site‐specific incident risks of MSDs among FBSI workers in Taiwan using a national population‐based database.MethodsWe conducted a 15‐year population‐based cohort study among 224 506 FBSI workers in Taiwan using data from five large nationwide databases to estimate direct standardized incidence ratios (SIRs) for identifying specific MSDs related to overexertion and repetitiveness during work. Overall, MSDs risks were also investigated by gender, sub‐industrial categories, and certificate types.ResultsWe found SIRs for overall MSDs for male and female workers of 1.706 (95% CI, 1.688‐1.724) and 2.198 (95% CI, 2.177‐2.219), respectively. Our findings indicate significantly increased WMSD risk for both men and women, including median/ulnar nerve disorders (ICD‐9 354.0‐354.2); spondylosis and allied disorders (ICD‐9 721); intervertebral disc disorders (ICD‐9 722); disorders of the back (ICD‐9 724); peripheral enthesopathies and allied syndromes (ICD‐9 726); synovium, tendon, and bursa disorders (ICD‐9 727); and soft tissues of the peripheral system disorders (ICD‐9 729). Food stall workers and workers with Chinese cuisine or baking licenses were at higher risk among sub‐industrial categories and certificate types.ConclusionThis large‐scale study revealed that FBSI workers were at higher risk for several MSDs than the general population. This information could help prioritize MSD problems and identify a high‐risk population. Relevant policy and ergonomic improvements and interventions could be implemented for health promotion in this industry.

The Disparity of Culture Vicissitudes in Happiness, Mental Health and Parental Bonding During Coronavirus Disease 2019 between Changchun and Taiwan

Background: The consequence of quarantine might have increased the emotional distress during the period of COVID-19 pandemic. Parental bonding plays an important role in the developing of emotional problems. Hence, this study tried to compare the difference of parental bonding in the developing of mental distress during the COVID-19 pandemic in Changchun of China and Taiwan.Methods: Total of 191 healthcare workers in Changchun area of China, and 458 healthcare workers in Taiwan, including 374 healthcare workers in two general hospitals and 84 in psychiatric center were recruited in this study.Findings: The findings showed that the healthcare workers tend to have more maternal affectionate constraint features in Changchun, compared to those with more maternal affectionless control features in Taiwan. Linear regression analysis showed the maternal affectionate constraint have contributed to the developing of mental health problems, and maternal affectionate constraint and maternal optimal bonding to developing of happiness in Changchun; comparing gender, hospital type and maternal optimal bonding have impact to the developing of mental health problems, and age, gender, hospital type, paternal optimal bonding and maternal affectionless control to the developing of happiness in Taiwan. SEM model also verified better mental health and maternal affectionate constraint have mainly contributed to the developing of happiness in Changchun.Interpretation: In conclusion, Changchun and Taiwan presented different kinds of parental bonding. Even in different culture vicissitudes, the maternal caring seems to be the unique contributing factor in developing of mental health problem and happiness, whether in Changchun or Taiwan, and, whether in 2003 SARS or 2020 COVID-19 pandemic. The results of the study may provide the references to policy-maker and prevention programs in the community. Further larger sample size with follow-up studies have to be considered to verify the role of parental bonding in the developing of resilience, emotional distress and suicidal ideation.Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: The Institutional Review Board of the Kaohsiung Armed Forces General Hospital in Taiwan approved the study (KAFGHIRB 108-037).

Social Workers’ Attitudes on Social Justice in Taiwan

As social justice is an essential social work concept, this study examined the factors that influenced the attitudes of social workers in Taiwan toward social justice through an analysis of Social Justice Scale-TW (SJS-TW) questionnaires conducted on a sample of 276 social workers. It was found that years of work experience, human rights training, and past participation in social protests were important moderating factors of supporting social justice. It was concluded that including a human rights–based approach in social work education has the potential to increase the social workers’ knowledge of and actions in support of social justice.

Misperception of cardiometabolic risks and health needs among agriculture and aquaculture workers in Taiwan.

Many people work in agriculture and aquaculture. Owing to the specific working environments and climate changes, some literatures indicated that agriculture and aquaculture workers have cardiovascular diseases. It is important to attain sustainable development goal for these workers. However, few studies have investigated the factors associated with cardiometabolic risks and their perception among these workers. To explore the health needs and perception of cardiometabolic risks and associated factors among agriculture and aquaculture workers. A community-based, cross-sectional study design was used. This study was part of a nurse-led health-promotion programme designed to examine the health needs of agriculture and aquaculture workers between March and December 2019 in Yunlin County, Taiwan. This study was conducted in 30 rural villages. Health screening for five cardiometabolic risks was identified by a local hospital collaborated with the study. Six hundred and fifty-six participants with a mean age of 66 years completed this study. The mean number of cardiometabolic risk factors was 2.6, and the prevalence of metabolic syndrome was 54.1%. Most participants had misperceptions regarding their abnormal biomarkers. Age, education level, female gender, increased biomarker misperception (P < 0.001), and betel nut chewing (P < 0.01) were the determinant factors associated with cardiometabolic risks. These findings demonstrated a high prevalence of cardiometabolic risks, unhealthy behaviours, and misperceptions of cardiometabolic risk among the study population. This study highlights the need for clinicians and primary healthcare providers to attempt to increase the level of cardiometabolic risk literacy by initiating culturally tailored health-promotion programmes.

Developing an assessment scale for long-term care reablement literacy in home care workers in Taiwan using a modified Delphi method

BackgroundReablement is a philosophy of change in long-term care (LTC). Assessing the knowledge and competence of LTC professionals who provide reablement services is vital in LTC research. This study aimed to develop a scale for the assessment of long-term care reablement literacy (LTCRL) and employ this scale to assess the performance of home care workers in Taiwan.MethodsTo develop this scale, we employed the modified Delphi technique based on the theoretical framework of health literacy and the content of service delivery in reablement. Home care workers from northern, central, and southern Taiwan were selected through purposive sampling (N = 119). Participants answered a self-administered questionnaire that included items related to basic demographic characteristics and questions to assess LTCRL.ResultsBased on the experts’ consensus on the procedure of the modified Delphi technique, the LTCRL assessment sale consists of 29 questions on four aspects of knowledge acquisition: the abilities to access/obtain, understand, process/appraise, and apply/use. The results revealed that higher education levels and better Chinese language proficiency are associated with higher LTCRL outcomes among home care workers.ConclusionsThe LTCRL assessment scale based on a modified Delphi technique is useful and feasible for evaluating LTCRL in home care workers who provide reablement services in Taiwan.

Children’s rights in Taiwan: A qualitative study on social workers’ perspectives

The aim of this study was to investigate the perspectives of social workers in Taiwan on children’s rights. Among the 94 social workers who were interviewed, most were familiar with children’s rights terminology. From the results of this study, parental needs and the inability of young children to communicate effectively hindered the balance between protection of and participation by children. To better implement children’s rights, social workers should gain a deeper understanding of the United Nations Convention on the Rights of the Child (UNCRC) and develop skills for communicating well with children and parents.

Debt and (un)freedoms: The case of transnational labour migration from Vietnam

Transnational labour migration in Asia is largely organised by sophisticated networks of commercial brokers who thrive on highly restrictive migration regimes and disparities in the distribution of labour and employment across the region. The commercialisation of migration brokerage has important implications for migrants’ mobility and wellbeing, not least because of the inflated cost of migration and the increased financial pressure on migrant families as a result. While there is growing attention to debt in the migration scholarship, broader debates on the migration and development nexus continue to underestimate the significance of the issue. Drawing on qualitative research on Vietnamese migrant workers in Taiwan and their families in Vietnam, this paper provides nuanced insights into how debt shapes the ways migrants navigate the transnational migration industry and reproduces inequalities in labour-sending countries. Debt might enable or constrain people’s agency and mobility, a relationship that is not static but fluid and context-specific. The study shows that debt is vital for our understanding of transnational contract labour migration in Asia and emphasises temporality and subjectivity in migrants’ experience of and response to debt.

Comparison of Labor and Delivery Complications and Delivery Methods Between Physicians and White-Collar Workers.

To evaluate labor and delivery complications and delivery modes between physicians and white-collar workers in Taiwan, this retrospective population-based study used data from Taiwan’s National Health Insurance Research Database. We compared 1530 physicians aged 25 to 50 years old who worked and had singleton births between 2007 and 2013 with 3060 white-collar workers matched by age groups, groups of monthly insured payroll-related premiums, previous cesarean delivery, perinatal history anemia, and gestational diabetes mellitus. The logistic regression models were used to assess the labor and delivery complications between the two groups. Multivariate analysis revealed that physicians had a significantly higher risk of placenta previa (odds ratio (OR) 1.35, 95% confidence interval (CI) 1.08–1.69) and other malpresentation (OR 1.86, 95% CI 1.45–2.39) than white-collar workers, whereas they had a significantly lower risk of placental abruption (OR 0.53, 95% CI 0.40–0.71), preterm delivery (OR 0.75, 95% CI 0.61–0.92), and premature rupture of membranes (OR 0.72, 95% CI 0.59–0.88). Increased risks of some adverse labor and delivery complications were observed among physicians, when compared to white-collar workers. These findings suggest that working women should take preventative action to manage occupational risks during pregnancy.

Labor migration from Southeast Asia to Taiwan: issues, public responses and future development

PurposeThis paper is mainly focused on labor migration from Southeast Asia to Taiwan, showing a route of south–south mobility and discussing the causes of migrant workers in Taiwan, the issues faced by migrant workers as well as public response to migrant workers.Design/methodology/approachBesides a literate review on the topic of migrant worker researches in Taiwan, the data for this research was also based on qualitative interviews and observations conducted both in the fieldwork in Taiwan and in Indonesia between June and August during the summer of 2018.FindingsThe transnational mobility let many migrants from Southeast Asian countries to Taiwan end up losing their cultural capital and “make money” instead. For these migrants, they have experienced a downward social mobility of class through transnational mobility.Research limitations/implicationsBecause of the chosen research approach, the research results may lack generalizability. More migrant laborers from various origin countries were encouraged to include for further research.Practical implicationsLabor migration cases from Southeast Asia to Taiwan could very well serve as good examples in the carrying out of a reflection on the limit of focusing on social science only inside nation-states in order to push a forward thinking on the transnationalization of social inequality.Originality/valueThis paper calls attention to the close linkage between transnational mobility and social inequality. It showed how the transnationalization of social inequality could get new faces through the new waves of labor migration.

Social capital affects job performance through social media

PurposeThis study aims to explore the impact of social capital on job performance when workers interact with coworkers through social media in organizations.Design/methodology/approachStructural equation modeling was conducted, and a sample of 230 workers in Taiwan was investigated.FindingsThis study found that bonding social capital has a greater impact on job performance than bridging social capital for interactions among coworkers through social media in organizations. Moreover, bridging social capital affects job performance more strongly for male workers than for female workers, but bonding social capital affects job performance more strongly for female workers than for male workers.Research limitations/implicationsThis study extended social capital theory by adding the mediating effects of job satisfaction and relational satisfaction and the moderating effect of gender into the model.Practical implicationsThis study suggests that company managers need to train workers how to use social media to appropriate their affordances and consider the work team relationship to position adequate strategies for male and female workers.Originality/valueThis study advances the previous knowledge of social capital theory for workers interacting with coworkers through social media in organizations.

The Lived Experiences of Indonesian Nurses Who Worked as Care Workers in Taiwan.

Despite the large number of Indonesian nurses currently working as migrant care workers in Taiwan, no studies in the literature have been found that explore this phenomenon or assess the working situation of Indonesian nurses working in care facilities in Taiwan. This study aimed to elicit and describe the lived experiences of Indonesian nurses serving as care workers in Taiwan. Phenomenological research was used to explore the experiences of Indonesian nurses working in long-term care facilities. The participants were recruited from care facilities in Taiwan. This study utilized semistructured interviews conducted with 16 Indonesian nurses in a suitable setting. All of the interviews were transcribed, and the work of Van Manen was used to analyze the data. Four main themes were identified, including motives for working abroad, feelings of being trapped, experiencing a difficult journey, and the feeling of being supported. These themes reflect the lived experiences of Indonesian nurses who work in Taiwan's long-term care industry. Nurses from Indonesia choose to who work as nurses in Taiwan because of poor financial background and the chance of gaining a better life. However, the participants in this study felt stressed, challenged, and disappointed when faced with the unmet expectations of being employed as care workers without a clear career path. Furthermore, the need to communicate in an unfamiliar language was mentioned as a significant barrier to fulfilling their role. Better policies should be put in place to achieve improved outcomes for both countries.

The Analysis of Critical Information of Cross-cultural Training for Foreign Workers in Taiwan

ABSTRACT As a result of the rapid economic development that has led to changes in the industrial structure, Taiwan is facing an ever-increasing pressure of labor shortage, with the number of foreign workers increasing year by year. Industrialization has brought many foreign workers into a country, and this situation is an inevitable event. The inflow of foreign workers may help to resolve unnecessary vacancies rejected by local workers. However, the influx of foreign workers has actually brought many effects that affect the country’s economic growth. With the booming economy in Taiwan, the industrial structure is undergoing more and more changes. Because foreign workers are different from our culture, education and training programs should be fully prepared. Therefore, while training foreign workers, there should be a concept of “intercultural training”. Because data analysis is the process of systematically applying statistical and/or logical techniques to describe and illustrate, condense and recap, and evaluate data. Therefore, this study will focus on “intercultural training” for foreign workers. This study used relationship analysis, factor analysis and regression analysis as statistical tools. The research findings showed that national cultural differences and cross-cultural training had significant positive effects on the overseas adaptation of foreign workers. Furthermore, this study compared the results of analysis on foreign workers from Thailand to find out how many the workers from Thailand, will be affected by the national cultural differences and cross-cultural training.

Sleepiness and injury risk in emergency medical service workers in Taiwan.

BackgroundInsufficient sleep is a common health and safety risk factor in high-impact workplaces where workers are required to take rotating shifts. However, studies on sleepiness-related risks and incidents, particularly among emergency medical services (EMS) workers are limited.ObjectiveThis study sought to investigate the prevalence of sleepiness and related workplace incidents among EMS workers.MethodsThis study utilized a cross-sectional survey design on a convenient sample of 500 EMS workers from 41 EMS squads across Taiwan. Data were collected using structured online questionnaires on workplace sleepiness and related safety incidents based on the Epworth Sleepiness Scale (ESS) and a modified 25-item EMS Safety Inventory respectively.ResultsWith a response rate of 79.8% (n = 399), 36.9% of the respondents were identified as having mild daytime sleepiness, while 39.2% of the respondents were identified as having excessive daytime sleepiness. Multivariate analysis indicated that not only was working on rotating shifts the main cause of the high ESS scores among EMS workers, but also that higher ESS scores increased their risk of sustaining a workplace injury. Furthermore, ill-at-work incidents were associated with an increased risk of workplace-related injuries.ConclusionOverall, the findings indicated a correlation among working on rotation shifts, the prevalence of sleepiness, and a higher risk of workplace injury among EMS workers.