Conflict in the EMS Workforce: An Analysis of an Open-Ended Survey Question Reveals a Complex Assemblage of Stress, Burnout, and Pandemic-Related Factors Influencing Well-Being.

Emergency Medical Services (EMS) clinicians provide patient care within a high-stakes, unpredictable, and complex work environment in which conflict is inevitable. Our objective was to explore the extent to which added stressors of the pandemic exacerbated EMS workplace conflict. We administered our survey to a sample of U.S. nationally certified EMS clinicians during the COVID-19 pandemic in April 2022. Out of 1881 respondents, 46% (n = 857) experienced conflict and 79% (n = 674) provided free-text descriptions of their experience. The responses were analyzed for themes using qualitative content analysis, and they were then sorted into codes using word unit sets. Code counts, frequencies, and rankings were tabulated, enabling quantitative comparisons of the codes. Of the fifteen codes to emerge, stress (a precursor of burnout) and burnout-related fatigue were the key factors contributing to EMS workplace conflict. We mapped our codes to a conceptual model guided by the National Academies of Sciences, Engineering, and Medicine (NASEM) report on using a systems approach to address clinician burnout and professional well-being to explore implications for addressing conflict within that framework. Factors attributed to conflict mapped to all levels of the NASEM model, lending empirical legitimacy to a broad systems approach to fostering worker well-being. Our findings lead us to propose that active surveillance (enhanced management information and feedback systems) of frontline clinicians' experiences during public health emergencies could increase the effectiveness of regulations and policies across the healthcare system. Ideally, the contributions of the occupational health discipline would become a mainstay of a sustained response to promote ongoing worker well-being. The maintenance of a robust EMS workforce, and by extension the health professionals in its operational sphere, is unquestionably essential to our preparedness for the likelihood that pandemic threats may become more commonplace.

The implementation of green supply chain management (GSCM) and environmental management system (EMS) practices and its impact on market competitiveness during COVID-19.

Despite great academic interest in global green supply chain management (GSCM) practices, its effectiveness for environmental management systems (EMS) and market competitiveness during COVID-19 remains untapped. Existing literature suggests that a fundamental link between GSCM, EMS, and market competitiveness is missing, as supply management is critical to maintain market competitiveness. To fill this gap in the literature, this study examines whether environmental management systems influence the link between GSCM practice and market competitiveness in China. We also propose the articulating role of big data analytics and artificial intelligence (BDA-AI) and environmental visibility toward these associations in the context of the COVID-19 pandemic. We evaluated the proposed model using regression-based structural equation modeling (SEM) with primary data (n = 330). This result provides empirical evidence of the impact of GSCM on EMS and market competitiveness. Moreover, the results show that the BDA-AI and the environmental visibility enhanced the positive relationship between GSCM-EMS and EMS and market competitiveness in China. Recent research shows that supply chain professionals, policymakers, managers, and researchers are turning to formal EMS, BDA-AI, and environmental visibility to help their organizations achieve the competitiveness that the market indicates they need.

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

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

Evaluate the Features of Ohca Patients Living in Pakistan Both before and after the Covid-19 Epidemic in Order to Determine Their Outcomes

Aim: Bystander cardiopulmonary resuscitation (CPR) combined with public-access defibrillation has been shown to enhance overall survival for out-of-hospital cardiac arrest. This is one of top reasons of mortality across the globe. The COVID-19 global epidemic has modeled numerous problems for emergency medical services, along with reference of compression-only resuscitation also guidelines for comprehensive protective equipment. These suggestions and advice have created shortcomings and protracted fast response. On the other hand, the risk variables that determine the results of OHCA while the pandemic is ongoing are not well established. The main aim of our research remained to exploremedical features in addition results of OHCA individuals in Pakistan both before and after the COVID-19 epidemic. Method(s): The electronic medical records and paper records kept by EMS were utilized to compile the data for this single-center, retrospective observational analysis. The number of emergency hospital returns based on varying qualities in Sir Ganga Ram Hospitalized patients during and prior to the COVID-19 pandemic in Pakistan were collected. Patients with OHCA who went to the emergency department at Sir Ganga Ram Hospital in Lahore before the COVID-19 pandemic (April 2019 to March 2020) were identified. Result(s): Here were a total of 145 patients who participated in this study (80 males, or 58.2% of the total;mean [SD] age, 64.7 years);64 among those individuals contributed in our currentresearch during the COVID-19 era, and 75 among those individuals contributed in our currentresearch before COVID-19 period. Bystander witnessing and method of chest compression was always the two general baseline features that were found to be substantially different between the two groups (p-values of less than 0.002 and less than 0.002, accordingly). Duringthe COVID-19 era, the ED ROSC was substantially lower than it had been before the COVID-19 period (25.68 percent vs 45.04 percent;adjusted odds ratio of 0.22;p-value less than 0.002) Survival to admission remainedsuggestivelyinferiorthroughout COVID-19 phase compared to the previous time period (26.01 percent vs 41.78 percent, accustomed odds ratio of 0.27, p-value of 0.006). On the other hand, there was no important statistically substantial difference in the 28-day survival rates (4.5% throughout COVID-19 era also 11.54% earlier COVID-19 period). Conclusion(s): Patients who had cardiac arrest outside of a hospital in Pakistan had a much lower chance of surviving long enough to be admitted during the COVID-19 epidemic that occurred there. In addition, the two groups' witness reactions and methods of cardiopulmonary resuscitation couldn't have been more different from one another.Copyright © 2023, Anka Publishers. All rights reserved.

Impact of the COVID-19 pandemic on prehospital characteristics and outcomes of out-of-hospital cardiac arrest among the elderly in Japan: A nationwide study.

Aim: To assess the impact of the 2020 coronavirus disease (COVID-19) pandemic on the prehospital characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) in the elderly. Methods: In this population-based nationwide observational study in Japan, 563,100 emergency medical service-unwitnessed OHCAs in elderly (≥65 years) patients involving any prehospital resuscitation efforts were analysed (144,756, 140,741, 140,610, and 136,993 cases in 2020, 2019, 2018, and 2017, respectively). The epidemiology, characteristics, and outcomes associated with OHCAs in elderly patients were compared between 3 years pre-pandemic (2017-2019) and the pandemic year (2020). The primary outcome was neurologically favourable one-month survival. The secondary outcomes were the rate of bystander cardiopulmonary resuscitation (CPR), defibrillation by a bystander, dispatcher-assisted (DA)-CPR attempts, and one-month survival. Results: During the pandemic year, the rates of neurologically favourable 1-month survival (crude odds ratio, 95% confidence interval: 1.19, 1.14-1.25), bystander CPR (1.04, 1.03-1.06), and DA-CPR attempts (1.10, 1.08-1.11) increased, whereas the incidence of public access defibrillation (0.88, 0.83-0.93) decreased. Subgroup analyses based on interaction tests showed that the increased rate of neurologically favourable survival during the pandemic year was enhanced in OHCA at care facilities (1.51, 1.36-1.68) and diminished or abolished on state-of-emergency days (0.90, 0.74-1.09), in the mainly affected prefectures (1.08, 1.01-1.15), and in cases with shockable initial rhythms (1.03, 0.96-1.12). Conclusions: The COVID-19 pandemic increased the bystander CPR rate in association with enhanced DA-CPR attempts and improved the outcomes of elderly patients with OHCAs.

Influence of coronavirus disease 2019 case surges on prehospital emergency medical service for patients with trauma in Kobe, Japan.

Aim: In the current era of the coronavirus disease 2019 (COVID-19) pandemic, the responsiveness of emergency medical service (EMS) transport for patients with internal illness is often delayed. However, the influence of the COVID-19 pandemic on prehospital transport for patients with trauma has not yet been fully elucidated. This study aims to examine the effect of COVID-19 case surges on EMS transport for patients with trauma during the COVID-19 states of emergency in Kobe, Japan. Methods: EMS data during the states of emergency were compared with those in the 2019 prepandemic period. The incidence of difficulty securing hospital acceptance (four or more calls to medical institutions and ambulance staying at the scene for 30 min or more) was evaluated as a primary outcome. Secondary outcomes were the time spent at the trauma scene and the number of calls requesting hospital acceptance. The time spent at the trauma scene was stratified by trauma severity. Results: The incidence of difficulty securing hospital acceptance increased (1.2% versus 3.2%, P < 0.01). Logistic regression analysis revealed that the duration of the states of emergency was associated with difficulty securing hospital acceptance (odds ratio [OR] 2.08, 95% confidence interval 1.77-2.45; P < 0.01). Although the mean time spent at the trauma scene among the less severe, moderately severe, and severe trauma groups was prolonged, the time for the life-threatening group did not change. The number of request calls increased during the states of emergency. Conclusion: Difficulty securing hospital acceptance increased; however, the time spent at the trauma scene did not significantly change for the life-threatening group.

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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Investigation of Psychological Stress and Sleep Quality of Emergency Medical Technicians in Taiwan Fire Department during the COVID-19 Pandemic.

When the coronavirus disease 2019 (COVID-19) began to ravage the world in 2019, the World Health Organization became concerned. The epidemic has a high mortality and contagion rate, with severe health and psychological impacts on frontline emergency medical service system practitioners. There are many hospital staff surveys, but few have covered the stress among emergency medical technicians. DASS-21, PSQI, and AUDIT questionnaires were used to evaluate the sources of psychological stress factors of firefighters in Taiwan. Multiple logistic regression was used to analyze the questionnaire content. We conducted questionnaire surveys from May 2022 to July 2022. Our sample comprised 688 participants. The odds ratios of increased depression, anxiety, and stress levels due to reduced family or peer understanding and support were 2.72 (95% CI: 1.50−4.92), p = 0.001; 2.03 (95% CI: 1.11−3.68), p = 0.021; and 3.27 (95% CI: 1.83−5.86), p < 0.001, respectively. The odds ratios of poor sleep quality due to depression, anxiety, and increased stress levels were 5.04 (3.18−7.99), p < 0.001; 2.44 (95% CI: 1.57−3.81), p < 0.001; and 4.34 (95% CI: 2.76−6.82), p-value < 0.001, respectively. During the COVID-19 pandemic, poor sleep quality and a lack of understanding and support from the Taiwan firefighting agency staff, family, or peers resulted in increased depression, anxiety, and stress levels.

Time indices of pre-hospital EMS missions before and during the COVID-19 pandemic: a cross-sectional study in Iran.

BACKGROUND: The COVID-19 pandemic resulted in many changes in pre-hospital emergency medical services (EMS), including wearing full-body protective suits and well-fitted face masks, which can influence time indices in the course of service delivery. The present study aimed to compare the time indices of pre-hospital EMS missions before and during the COVID-19 pandemic in Iran. METHODS: This descriptive cross-sectional study used census sampling to select 17,860 emergency calls that caused patient transfer to medical facilities from March 2018 to March 2021 and then examined the time indices of pre-hospital EMS missions during the COVID-19 pandemic. The data collection tool was a two-part checklist: patients' individual characteristics and pre-hospital EMS mission time indices. The data were further analyzed using the SPSS16 and independent samples t-test. RESULTS: Out of the patients transferred by the EMS, 11,773 cases (65.9%) were male and 6,087 (34.1%) were female. The most common reason for the emergency calls was accidents (28.0%). Moreover, response time (P < 0.001), on-scene time (P < 0.001), transfer time (P < 0.001), total run time (P < 0.001), and round trip time (P < 0.001) increased significantly during the COVID-19 pandemic. CONCLUSIONS: We concluded that the EMS time indices elevated following the COVID-19 pandemic. Updating pre-hospital information management systems, ambulances and medical equipment, as well as holding training courses for pre-hospital EMS personnel could effectively enhance the time indices of pre-hospital EMS missions.

Raising Awareness of Hearing and Communication Disorders Among Emergency Medical Services Students: Are Knowledge Translation Workshops Useful?

OBJECTIVE: In numerous countries, emergency medical services (EMS) students receive curriculum training in effective patient-provider communication, but most of this training assumes patients have intact communication capabilities, leading to a lack of preparedness to interact with patients, who have communication disorders. In such cases, first responders could end up delivering suboptimal care or possibly wrong procedures that could harm the disabled person. METHOD: A quasi-experimental design (pretest-posttest) was used to assess the knowledge of EMS students both before and after a translation workshop on how to deal with patients who have hearing and communication disorders during emergencies. Comparisons between pretest and posttest scores were examined using the Wilcoxon signed rank test. The level of knowledge scores was compared before and after the workshop. RESULTS: The results indicated that EMS students' scores improved after the workshop. There was a 0.763 increase in the average score of knowledge level. The results of this study show that knowledge translation workshops are a useful intervention to enhance the level of knowledge among EMS students when interacting with hearing and communication patients. CONCLUSIONS: Our results show that such training workshops lead to better performance. Communication is a vital element in a medical encounter between health care providers and patients at all levels of health care but specifically in the prehospital arena. Insufficient or lack of communication with a vulnerable population, who may suffer from various disabilities, has a significant impact on the outcome of treatment or emergency management.

Interplay between Safety Climate and Emotional Exhaustion: Effects on First Responders' Safety Behavior and Wellbeing Over Time.

Various job demands continuously threaten Emergency Medical Service (EMS) first responders' safety and wellbeing. Drawing on Job Demands-Resources Theory, the present study examines the effects of the organizational context-safety climate-and the psychological context-emotional exhaustion-on safety behaviors and wellbeing over time. We tested our hypotheses in a longitudinal study of 208 EMS first responders nested within 45 stations from three fire departments in US metropolitan areas over 6 months during the beginning of the COVID-19 pandemic. Multilevel modeling showed that the relationship between safety climate and safety compliance behaviors can be attenuated when EMS first responders experience high emotional exhaustion. Emotional exhaustion was also negatively associated with morale while safety climate was positively associated with morale. Additionally, EMS first responders experienced increased depression when their emotional exhaustion levels were high. Higher safety climate was associated with decreased depression when emotional exhaustion was within a low-to-medium range. Higher safety climate was also associated with lower absolute levels of depression across the entire range of emotional exhaustion. These findings suggest that promoting safety climate and mitigating emotional exhaustion can augment EMS first responders' safety behaviors and wellbeing.].

The impact of COVID-19 on myocardial infarctions, strokes and out-of-hospital cardiopulmonary arrests: an observational retrospective study on time-sensitive disorders in the Friuli Venezia Giulia region (Italy).

The COVID-19 global pandemic has changed considerably the way time-sensitive disorders are treated. Home isolation, people's fear of contracting the virus and hospital reorganisation have led to a significant decrease in contacts between citizens and the healthcare system, with an expected decrease in calls to the Emergency Medical Services (EMS) of the Friuli-Venezia Giulia (FVG) region. However, mortality in clinical emergencies like acute ST-elevation myocardial infarction (STEMI), stroke and out-of-hospital cardiopulmonary arrest (OHCA) remained high. An observational retrospective cross-sectional study was carried out in FVG, taking into account the period between March 1, 2020, and May 31, 2020, the first wave of the COVID-19 pandemic, and comparing it with the same period in 2019. The flow of calls to the EMS was analysed and COVID-19 impact on time-sensitive disorders (STEMIs, ischemic strokes and OHCPAs) was measured in terms of hospitalisation, treatment and mortality. Despite a -8.01% decrease (p value ˂0.001) in emergency response, a 10.89% increase in calls to the EMS was observed. A lower number of advanced cardiopulmonary resuscitations (CPR) (75.8 vs 45.2%, p=0.000021 in April) and ROSC (39.1 vs 11.6%, p=0.0001 in April) was remarked, and survival rate dropped from 8.5 to 5%. There were less strokes (-27.5%, p value=0.002) despite a more severe onset of symptoms at hospitalisation with NHISS˃10 in 38.47% of cases. Acute myocardial infarctions decreased as well (-20%, p value=0.05), but statistical significances were not determined in the variables considered and in mortality. Despite a lower number of emergency responses, the number of calls to the EMS was considerably higher. The number of cardiac arrests treated with advanced CPR (ALS) was lower, but mortality was higher. The number of strokes decreased as well, but at the time of hospitalisation the clinical picture of the patient was more severe, thus affecting the outcome when the patient was discharged. Finally, STEMI patients decreased; however, no critical issues were observed in the variables taken into account, neither in terms of response times nor in terms of treatment times.

Effect of the COVID-19 pandemic on violence against pre-hospital emergency health workers.

BACKGROUND: Violence against pre-hospital emergency health workers is a growing problem worldwide and negatively impacts the effectiveness of emergency services. The social distancing, isolation and quarantine measures that have been employed to reduce the spread of COVID-19 have also had economic and psychosocial effects. Therefore, it is important to explore how the negative repercussions of the COVID-19 pandemic have influenced these violent incidents that interfere with the work of emergency medical services (EMS). OBJECTIVE: This study aims to evaluate how violence against EMS workers has been impacted by the effects of the COVID-19 pandemic. METHODS: This study takes an interpretive social science approach, using the qualitative method of in-depth semi-structured interviewing. Audio of the interviews was recorded with the interviewee's consent. Sound recordings were transcribed and their content was categorised into themes. Categorised texts were then evaluated using descriptive analysis. RESULTS: Participants reported that, during the COVID-19 pandemic, they encountered more violence than usual on EMS assignments to non-emergency situations, though a sense of gratitude towards health workers at the beginning of the pandemic and positives attitudes towards health workers also contributed to reduced violence towards them. The data indicate that workplace violence among EMS employees has increased as the problems caused by the pandemic have intensified, suggesting that additional measures need to be taken to protect them. CONCLUSION: In parallel with an increase in social violence during the COVID-19 pandemic, violence against EMS workers also increased in prevalence. A multidimensional approach should now be taken to determine how violence against EMS employees will be affected by risks such as the intergenerational transmission of social violence, a psychosocial repercussion of the COVID-19 pandemic, especially considering the increasing workplace violence among EMS employees.

Analysis of severe hand trauma injury frequency during "Munich's Oktoberfest" within the last 9 years in comparison to years with absence due to the COVID-19 pandemic.

INTRODUCTION: Within its 2 week period, the Oktoberfest attracts around 6 million visitors yearly to Munich, Germany. Due to alcohol intake, congested halls, and disorderly activities, numerous accidents occur. Although many hand injuries are observed, the impact of Oktoberfest on severe hand trauma injury frequency is under investigated. MATERIALS AND METHODS: Data from the regional emergency medical service (EMS) was analyzed over a 9 year period regarding the frequency of severe hand injuries during the world's largest fair and compared to the corresponding period in the years 2020 and 2021 where the event was cancelled due to the world-wide COVID-19 pandemic. Additionally, we compared the patient numbers during the same period in one Emergency Department of a level-1-trauma and hand trauma center located close to the venue. RESULTS: An exploratory description is made from data collected over a 9 year period (2013-2021) with focus on hand injuries before, during and after the "Oktoberfest". A total of 4017 hand injuries were allocated to hospitals by EMS. There was an increase in severe hand injuries by 66% during the 2-weeks-Oktoberfest-period compared to years where the Oktoberfest did not take place. Pre-pandemic statistics show an increasing severe hand trauma frequency of 57.5% in September, compared to EMS-referrals during the remanding year. CONCLUSION: The risk of injuring relevant structures of the hand during Oktoberfest is extremely high as compared to other parts of the body due to beer stein and fall-associated injuries. These injuries can lead to lifelong impairments. Our data are the first that quantifies and pinpoints the risk of severe injury to the hand during Oktoberfest and therefore, it is of great interest for visitors, hand surgeons, paramedics and emergency department healthcare workers.

Epidemiology of patients with dizziness over a 3-year period, requiring utilization of the emergency medical serviced system: A pre- and post-COVID pandemic comparative study using the population-based ORION registry.

OBJECTIVE: We aimed to identify the proportion of each medical condition or disease contributing to dizziness and their disposition in the Emergency Department (ED). METHODS: This retrospective, descriptive study examined data from the Osaka Emergency Information Research Intelligent Operation Network system in Japan for the period from January 1, 2018 to December 31, 2020. The inclusion criteria were patients with presumptive ICD-10 codes including "dizziness" or "vertigo". Patient demographics were compared using the χ2 test and Kruskal-Wallis test. Logistic regression analysis was performed to calculate disposition from ED (emergency admission or discharge) over the 3-year study period. The adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated using multivariate analyses. RESULTS: During the 3-year study period, a total of 1,346,457 patients (462,773 in 2018, 468,697 in 2019, and 414,987 in 2020; P < 0.001), including 53,190 patients with dizziness (18,396 in 2018, 18,649 in 2019, and 16,145 in 2020; P = 0.058), were identified as having been transported to hospitals by ambulance in Osaka Prefecture. Dizziness and giddiness (R42) was the most common form of dizziness, in 27,075 cases (9,570 in 2018, 9,613 in 2019, and 7,892 in 2020; P < 0.001; Gender composition showed 10,483 males and 16,592 females.) Vestibular Neuronitis (H81.2) showed significant increase in 2020 compared to the two preceding years (91 in 2018, 119 in 2019, and 130 in 2020, P = 0.003; including 174 males and 167 females, respectively). Of the 53,190 patients with dizziness, 11,862 (22.3%; 4,323 males, 7,539 females) were admitted to hospital. The odds ratio (OR) for emergency admission for dizziness in 2020 during the COVID-19 pandemic was 0.98 (95% confidence interval (CI), 0.93- 1.03) with reference to 2018. CONCLUSION: Patients with dizziness accounted approximately 4% of ED transportations, with about 20% requiring hospital admission, irrespective of the COVID-19 pandemic. Vestibular neuronitis was significantly increased in 2020.

Out-of-Hospital Cardiac Arrest during the COVID-19 Pandemic: A Systematic Review.

Objective: Out-of-hospital cardiac arrest (OHCA) is a prominent cause of death worldwide. As indicated by the high proportion of COVID-19 suspicion or diagnosis among patients who had OHCA, this issue could have resulted in multiple fatalities from coronavirus disease 2019 (COVID-19) occurring at home and being counted as OHCA. Methods: We used the MeSH term "heart arrest" as well as non-MeSH terms "out-of-hospital cardiac arrest, sudden cardiac death, OHCA, cardiac arrest, coronavirus pandemic, COVID-19, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)." We conducted a literature search using these search keywords in the Science Direct and PubMed databases and Google Scholar until 25 April 2022. Results: A systematic review of observational studies revealed OHCA and mortality rates increased considerably during the COVID-19 pandemic compared to the same period of the previous year. A temporary two-fold rise in OHCA incidence was detected along with a drop in survival. During the pandemic, the community's response to OHCA changed, with fewer bystander cardiopulmonary resuscitations (CPRs), longer emergency medical service (EMS) response times, and worse OHCA survival rates. Conclusions: This study's limitations include a lack of a centralised data-gathering method and OHCA registry system. If the chain of survival is maintained and effective emergency ambulance services with a qualified emergency medical team are given, the outcome for OHCA survivors can be improved even more.

Can the Ebola experience in West Africa help to combat the COVID-19 pandemic? Testing the critical incident management systems model in the COVID-19 context

Purpose This study explored whether the critical incident management systems (CIMS) model can predict the EMS performance in the COVID-19 context. Past research has established the significance of early detection and response (ER) in the context of Ebola virus disease (EVD), prompting a question of whether the model can also be helpful in the COVID-19 context. Consequently, the authors assessed whether ER influences the impact of communication capacity (CC), reliable information channel (RC) and environment (EN) on COVID-19 EMS performance. Assessing these relationships will advance emerging infectious disease (EID) preparedness. Design/methodology/approach The authors employed standardized measurement instruments of the CIMS model (CC, ER, RC and EN) to predict the performance of COVID-19 EMS using structural equation modeling (SEM) in a study of 313 participants from frontline responders. Findings The results show that the relationship of ER and EN with COVID-19 EMS performance is positive, while that of EN on CC is negative. The relationship between EN and COVID-19 EMS performance was insignificant. Contrary to the hypothesis, CC was negatively significant to COVID-19 EMS performance due to poor communication capacities. Research limitations/implications The authors acknowledge some limitations due to challenges faced in this study. First, Data collection was a significant limitation as these questionnaires were built and distributed in June 2020, but the response time was prolonged due to the recurring nature of the pandemic. The authors had wanted to implore the inputs of all stakeholders, and efforts were made to reach out to various Ministry of Health, the local CDC and related agencies in the region via repeated emails explaining the purpose of the study to no avail. The study finally used the frontline workers as the respondents. The authors used international students from various countries as the representatives to reach out to their countries' frontline workers. Second, since the study was only partially supported using the CIMS model, future studies may combine the CIMS model with other models or theories. Subsequent research reassesses this outcome in other contexts or regions. Consequently, further research can explore how CC can be improved with COVID-19 and another future EID in the region. This may improve the COVID-19 EMS performance, thereby expanding the lesson learned from the pandemic and sustaining public health EID response. Additionally, other authors may combine the CIMS model with other emergency management models or theories to establish a fully supported theoretical model in the context of COVID-19. Practical implications The findings have practical implications for incident managers, local CDCs, governments, international organizations and scholars. The outcome of the study might inform these stakeholders on future direction and contribution to EID preparedness. This study unfolds the impact of lessons learned in the region demonstrated by moderating early detection and responses with other constructs to achieve COVID-19 EMS performance. The findings reveal that countries that experienced the 2013-2016 Ebola outbreak, were not necessarily more prepared for an epidemic or pandemic, judging by the negative moderating impact of early detection and response. However, these experiences provide a foundation for the fight against COVID-19. There is a need for localized plans tailored to each country's situation, resources, culture and lifestyle. The localized plan will be to mitigate and prevent an unsustainable EID management system, post-epidemic fund withdrawals and governance. This plan might be more adaptable and sustainable for the local health system when international interventions are withdrawn after an epidemic. Public health EID plans must be adapted to each country's unique situation to ensure sustainability and constantly improve EID management of epidemics and pandemics in emergency response. The high to moderate importation risk in African countries shows Africa's largest wind w of vulnerability to be West Africa (Gilbert et al., 2020). Therefore, they should be in the spotlight for heightened assistance towards the preparedness and response for a future pandemic like COVID-19. The West African region has a low capacity to manage the health emergency to match the population capacities. The COVID-19 outbreak in West Africa undoubtedly inflicted many disruptions in most countries' economic, social and environmental circumstances. The region's unique challenges observed in this study with CC and reliable information channels as being negatively significant highlight the poor maintenance culture and weak institutions due to brain drain and inadequate training and monitoring. This outcome practically informs West African stakeholders and governments on aspects to indulge when trying to improve emergency preparedness as the outcomes from other regions might not be applicable. Originality/value This study explored the relevance of the CIMS model in the context of the COVID-19 pandemic, revealing different patterns of influence on COVID-19 EMS performance. In contrast to the extant literature on EVD, the authors found the moderating effects of ER in the COVID-19 context. Thus, the authors contribute to the COVID-19 EMS performance domain by developing a context-driven EMS model. The authors discuss the theoretical and practical implications.

SARS-CoV-2 Contamination of Ambulance Surfaces and Effectiveness of Routine Decontamination Procedure: A Classic Hygiene Lesson for A Novel Pathogen.

The efficacy of standard operating procedures (SOPs) for the decontamination of ambulances against SARS-CoV-2 has been debated. In Italy, the differential use of ambulances was implemented by regional health authorities, with selected vehicles being used exclusively for transporting COVID-19 patients. We investigated the presence of SARS-CoV-2 on high-touch surfaces in ambulances to assess contamination dynamics and the effectiveness of decontamination SOPs. Four high-touch surfaces were sampled before and after decontamination (T0; T1). The gloves of the EMS crew chief were also sampled. RNA extraction was performed with a commercial kit, followed by RT-qPCR molecular detection of SARS-CoV-2. A total of 11 transports were considered. Seven transports had at least one positive sample; all were related to a COVID-19 patient. Three of the negative transports had dealt with COVID-19 case, and one had dealt with a COVID-19-negative patient. One door handle and one oxygen knob were positive at T0, with negative T1 swabs. The monitors were positive in 5 transports at T0, yet they were never positive at T1. Three stretcher handles tested positive at T0, and two of them also at T1, possibly having bypassed decontamination during personnel dismounting. Gloves were contaminated in five transports, in which 1 to 3 additional samples (monitor, knob, stretcher) resulted as positive. Overall, the efficacy of decontamination SOPs was confirmed under the unprecedented conditions of the COVID-19 emergency. However, the importance of correct hand-hygiene and glove-disposal should be further emphasized through the dedicated training of EMS personnel.

Public awareness and use of 997 emergency medical service phone number during the COVID-19 pandemic.

Background: Emergency medical services (EMSs) are an important element of the healthcare system as it provides an opportunity to respond to critical medical conditions and save people's lives. In Saudi Arabia, EMS is offered via the EMS phone number "997" and mobile application "Asefny". Methods: This was an observational cross-sectional survey study exploring public awareness and use of the EMS phone number during the COVID-19 pandemic in Saudi Arabia. A bivariate analysis was performed to investigate factors affecting awareness and use of the EMS phone number and to compare the EMS acceptance to transport and timelines of ambulance arrival between requests made via the "997" EMS phone number and the "Asefny" mobile application during the country's emergency lockdown. Results: A total of 805 participants were included in the analysis, where 66% reported awareness of the EMS phone number and 75% of them accurately identified the nature of the service provided by dialing the number. The men who participated, those with a bachelor's degree, with children, and with chronic conditions were more aware of the EMS phone number compared to the other participants. Of the total sample, 46.7% used EMS phone numbers at least one time (ever users). During the COVID-19 lockdown, the EMS accepted to transport 87% of the calls made by 997 phone number and 56.2% of the mobile application requests (P < 0.00). The ambulance arrived in ≤ 8 min in 53.6% of the 997 phone calls and 35.5% of the Asefny mobile requests (P < 0.00). Conclusions: Findings showed commendable levels of awareness and the use of EMS phone numbers. However, the results suggest room for improvement by developing promotional and educational campaigns inspired by the factors identified as influential on both awareness and use. Mobile applications in EMS are promising to improve prehospital emergency service accessibility, which needs to be further investigated to assess its impact on the public health informatics experience.