[Factors related to sleep quality in Emergency Medical Technicians and their sleep habits during COVID-19 pandemic.]

OBJECTIVE: Emergency Medical Technicians (EMTs) show a high prevalence of sleep problems. Adding to these problems, another factor appeared two years ago: the COVID-19 pandemic. The objectives of this study were to describe the sleep quality and habits in a sample of EMTs in Spain during COVID-19 pandemic considering the factors related to them. METHODS: A national cross-sectional study was carried out in Spain between October 2020 and February 2021. EMTs who worked in basic and advanced life support ambulances were invited to participate in an online survey. Several sociodemographic variables were analyzed, as well as sleep quality, stress symptoms, pain, food consumption and physical activity. Logistic regression models were used to examine the associations between these variables and sleep quality. RESULTS: 340 EMTs participated in the study. Of them, 59.4% had poor sleep quality and the habits of 32.2% got worse during the pandemic. The EMTs with a poor sleep quality presented in higher proportion stress symptoms (OR: 4.19;95% CI: 2.16-8.11;p<0.001), pain (OR: 3.19;95% CI: 1.7-6.01;p<0.001) and a weekly consumption of sugar-sweetened beverages greater than two glasses (OR: 3.6;95% CI: 1.86-6.98;p<0.001). CONCLUSIONS: EMTs show a high prevalence of poor sleep quality, which got worse during the pandemic. The factors related to them are stress, pain and consumption of sugar-sweetened beverages. This study provides important information so that the emergency services can develop health promotion programs focused on these professionals.

Infection prevention and control practices and related factors among paramedics during the coronavirus disease 2019 outbreak in Korea.

This study aimed to investigate the coronavirus disease 2019 (COVID-19) infection prevention and control (IPC) practices and related factors among paramedics. We selected 249 paramedics using convenience sampling from three areas in Korea. Data on the demographics, infection-related characteristics, awareness, and practice of IPC were collected using self-reported questionnaires. The mean IPC practice score was 4.47 ± 0.54. The compliance with IPC practices was relatively high among those with a disease history (B = 0.194, p = 0.045) and who were aware of the safety management standard guidelines. Provision of sufficient protective equipment and infection prevention monitoring were associated with higher IPC practice scores. Education for increasing awareness of the recent IPC guidelines and the allocation of personal protective equipment would be helpful in improving the practice.

Ethical work climate and the intention to leave the service in emergency medical technicians during the COVID-19 pandemic.

Emergency medical technicians (EMTs) are very likely to leave the profession due to their obligation to work in critical situations such as the COVID-19 pandemic. This study aimed to investigate the relationship between the ethical work climate and the intention to leave the service among EMTs. In this descriptive correlational study, 315 EMTs working in Zanjan province were surveyed using the census method in 2021. The research tools included the Ethical Work Climate and the Intention to Leave the Service questionnaires. Data were analyzed using SPSS software version 21. We found the mean (SD) score of the organization's ethical work climate to be 73.93 (±12.53), and the intention to leave the service 12.54 (±4.52), which are at a moderate level. A statistically significant positive correlation existed between these variables (r = 0.148, P = 0.017). Also, there was a statistically significant relationship between age and employment status among the demographic variables, and the ethical work climate and the intention to leave (P < 0.05). Our findings indicate that ethical work climate is one of the influential but less noticed factors that affect the performance of EMTs. Therefore, it is suggested that managers implement measures to develop a positive ethical work climate to reduce the tendency to leave the service among EMTs.

Reduced quality of life, more technical challenges, and less study motivation among paramedic students after one year of the COVID-19 pandemic - a survey study.

INTRODUCTION: Despite the lack of knowledge about the SARS-CoV2 virus, the lack of personal protection gear among frontline healthcare workers, and lack of vaccines in the beginning of the pandemic, paramedic students in Norway contributed to the National response against the COVID-19 pandemic by working in test-stations, ambulance services, ambulance decontamination stations etc. Despite fear of contracting the COVID-19 reported by healthcare workers worldwide, paramedic students in Norway reported higher-than-average quality of life after four months of the COVID-19 pandemic (first pandemic wave). In this study we aimed to investigate how students reported their quality of life, study motivation and job satisfaction after one year of living with the COVID-19 pandemic. METHOD: At two data collection point, all paramedic students enrolled at Oslo Metropolitan University were invited to participate in a digital, online, self-administered survey. The first data collection was in June 2020 (the first pandemic wave), while the second data collection was in March 2021 (the third pandemic wave). Results from both samples were analyzed independently with descriptive statistics. Differences between the groups were analyzed using an independent T-test and Mann-Whitney-U test to discover changes over time. Multiple linear regression analysis was used to estimate the difference attributable to timing (first vs. the third wave), seniority, and student gender. RESULTS: The samples consist of slightly more female students than male students. The mean age in both samples is 24.6 years. Despite the higher-than-average level of quality of life in the first pandemic wave, results show that there was a significant reduction in students' health-related quality of life (p < 0.001, B -0.059, SE 0.016), study motivation (p = 0.002, 95% CI:0.09,0.41), and job satisfaction (p = 0.005, 95% CI:1.62,9.00) after the third pandemic wave in Norway. Surprisingly, students experienced more technical challenges in the third wave, e.g., poor internet connection, sound pollution, and poor picture quality, despite more experience among students and teachers. CONCLUSION: Our results show that paramedic students had significant worsening experiences in the late pandemic wave compared to the first pandemic wave. Universities and governments should learn from the COVID-19 pandemic to develop better preparedness plans for future pandemics and knowledge about students' well-being should be considered in future preparedness plans for higher education and the government plans for the education of front-line healthcare workers during a pandemic to facilitate the continuation of necessary education.

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.

Moral Courage and Its Related Factors in Emergency Medical Technicians during the Covid-19 Pandemic in 2021: A Cross-sectional Study

Background: Emergency medical technicians (EMTs) at the forefront of the health system face Covid-19 cases. In such situation, they may have doubts about their abilities or priorities and may not make the right decisions. They need moral courage to survive this global crisis's stress and strengthen their decision-making power. Aim: The present study aimed to investigate the moral courage and its related factors in EMTs during the Covid-19 pandemic. Method: This cross-sectional study was performed in 2021 on 194 EMTs of Zanjan University of Medical Sciences. Sampling was done by the cluster random method. A demographic information questionnaire and standard moral courage questionnaire were used to collect data. Data were analyzed using independent t-test, ANOVA, Pearson correlation coefficient and Logistic regression. P<0.05 was considered statistically significant. Results: The mean total score of moral courage was high in 88.1% of EMTs (433.31± 49.70 out of 510). The mean score of moral courage in the dimensions of moral self-actualization was 228.98±32.46, risk-taking was 159.04±15.68, and the ability to defend the right was 45.28±7.70. There was statistically significant relationship between the mean score of total moral courage and marital status, age, work experience, and number of working hours (p <0.05). Implications for Practice: The findings of this study showed that EMTs had a high level of moral courage, so it is possible to maintain this important ethical virtue through reinforcements, planning, effective training, and organizational support, and consequently increase the quality of pre-hospital care. Copyright © 2022 Mashhad University of Medical Sciences, All rights reserved.

The impact of COVID-19 on first responders in the United States of America

Purpose: This project specifically aims to examine (1) the individual impact of coronavirus disease 2019 (COVID-19) on first responders, (2) the organizational impact of COVID-19 on first response agencies and (3) policy and organizational response and support efforts to mitigate potentially harmful effects of the pandemic. Design/methodology/approach: The authors' conducted a mixed-methods analysis, including a review of secondary sources (e.g. government documents, organizational policies and news pieces), state-level policies, encompassing surveys, in-depth semi-structured interviews and PhotoVoice focus groups. Findings: COVID-19 compounded many of the inherent risks facing first responders and added new stressors. First responders assumed added responsibilities during the pandemic which increased workloads, job-related stress, burnout, distance from the community and first responders' feelings of frustration. Even with personal protective equipment (PPE), first responders faced greater exposure to individuals with COVID-19 and were primarily concerned with transmitting the virus to family members, or other members of the first responders' support networks. State-level COVID-19 policies that were geared toward first responders aimed to improve the first responders' personal lives outside of work and mitigate burnout within the profession. First response agencies adapted to the pandemic by implementing a wide range of measures. Practical implications: First responders also identified several weaknesses in the first responders' agencies' approach to the pandemic. To prepare for the next public health emergency, first response agencies should proactively train employees, build up the first responders' supplies of equipment and PPE, implement policies to strengthen their workforce (e.g. increase hiring for understaffed positions, reduce turnover and mitigate role abandonment), allow for greater employee autonomy, improve communication between leaders and employees and prioritize employees' mental health, as well as other factors relating to departments' informal culture. Originality/value: This is one of the largest studies conducted on three types of first responders (police officers, fire firefighters, emergency medical technicians (EMTs) and paramedics) across the United States of America during a public health crisis. © 2023, Emerald Publishing Limited.

Ethical work climate and the intention to leave the service in emergency medical technicians during the COVID-19 pandemic

Emergency medical technicians (EMTs) are very likely to leave the profession due to their obligation to work in critical situations such as the COVID-19 pandemic. This study aimed to investigate the relationship between the ethical work climate and the intention to leave the service among EMTs. In this descriptive correlational study, 315 EMTs working in Zanjan province were surveyed using the census method in 2021. The research tools included the Ethical Work Climate and the Intention to Leave the Service questionnaires. Data were analyzed using SPSS software version 21. We found the mean (SD) score of the organization's ethical work climate to be 73.93 (±12.53), and the intention to leave the service 12.54 (±4.52), which are at a moderate level. A statistically significant positive correlation existed between these variables (r = 0.148, P = 0.017). Also, there was a statistically significant relationship between age and employment status among the demographic variables, and the ethical work climate and the intention to leave (P < 0.05). Our findings indicate that ethical work climate is one of the influential but less noticed factors that affect the performance of EMTs. Therefore, it is suggested that managers implement measures to develop a positive ethical work climate to reduce the tendency to leave the service among EMTs. © 2022 Tehran University of Medical Sciences.

Persistent/Late Complications of COVID-19 in Affected Emergency Medical Technicians: A Case Series and Brief Literature Review

Background: The present study aimed to assess the prevalence of persistent/late complications after recovery from the acute phase of COVID-19 in emergency medical technicians (EMTs). Methods: This is a cross-sectional case-series study performed during the last quarter of 2020 in Tehran, Iran. All EMTs who had been diagnosed with COVID-19 were eligible. The researcher contacted the EMTs via telephone to determine any complications following their recovery. Those who suffered from any complication were referred to an internal specialist physician for a detailed history and physical examination. Based on the physician’s opinion, some paraclinical or clinical evaluations were requested to be performed. Results: Four hundred thirty-one confirmed cases and two deaths due to this disease were registered among the Tehran EMS center’s EMTs during the study period. Two hundred thirty-eight EMTs were contacted, and 22.7% of them had at least one persistent/late complication following recovery of the acute phase of COVID-19;of whom, 28 EMTs were visited by an internist and completed the tests. The final participants mentioned seventy-five persistent/late complications. Only one EMT had a residual lesion among those who underwent lung CT scans. There were also some pathological findings in the echocardiographic examination and spirometry. Conclusion: Our study showed that persistent/late-onset complications could likely accompany by COVID-19. © 2022 Bentham Science Publishers.

Incorporating medical students into an interdisciplinary, population-based study of SARSCoV-2 infection in asymptomatic individuals in South Texas

Background Asymptomatic and pre-symptomatic infections may play a significant role in the spread of COVID-19 but determining prevalence of these infections in the general population is labor intensive. Purpose This approach describes an innovative surveillance strategy using teams of medical students and emergency medical technicians (EMTs). Medical students represent a highly trained but underutilized workforce in the pandemic response. Methods A household-level sampling frame generated a populationweighted representative sample of households in San Antonio, Texas. Households were included if an English or Spanish-speaking adult (=18yo) answered the door and was willing to participate;excluded if household members had past or present COVID-19 symptoms or close contact with confirmed COVID-19 infection. Interdisciplinary teams of medical or medical/public health dual degree students paired with EMTs conducted a survey and instructed participants on how to self-administer nasal swabs among 502 community members without symptoms of COVID-19 from June 1-6, 2020, weeks prior to a community case surge. Results Of 502 participants, median age was 52 years and average household size was 3.1. Only 40% reported no medical risk factors for COVID-19 complications. Hypertension (23.6%) and diabetes (13.4%) were the most common pre-existing medical conditions;29% of respondents reporting feeling at risk for SARS-CoV-2 during daily outside-of-the-home activities. All 502 SARS-CoV-2 PCR tests were negative, suggesting a prevalence range of 0%-1.2%. Public Health Significance It is unlikely that pre-symptomatic and asymptomatic COVID-19 infections in households without existing COVID-19 infections played a major role in the propagation of the epidemic at this point in time. While community-wide testing of individuals without symptoms of COVID-19 may be low yield in the context of low prevalence of symptomatic cases of COVID-19, medical students provided valuable support for community-based surveillance at a time when public health infrastructure was severely taxed. [ FROM AUTHOR] Copyright of Texas Public Health Journal is the property of Texas Public Health Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A Clinical Response Team Providing Support to Long-Term Care Homes with COVID-19 Outbreaks in Eastern Ontario-a Cohort Study.

Background: The greatest impact of the COVID-19 pandemic in Canada has been on long-term care facilities which have accounted for a large majority of the mortality seen in this country. We developed a clinical response team to perform mass assessment and provide support to long-term care facilities in Eastern Ontario with large outbreaks in the hope of reducing the impact of the outbreaks. Methods: This is a retrospective cohort study of all residents of LTC facilities supported by our multidisciplinary clinical response team. We collected data about the timing of the outbreak and our deployment, as well as the total number of COVID-19 cases and deaths, and measured the correlation between the timing of our deployment and the observed mortality rate. Results: Our clinical team was deployed to 14 long-term care facilities, representing 719 cases and 243 deaths (mean ± standard error of mortality 34% ± 4%). Our team was deployed a mean ± standard error of 16 ± 2 days after the declaration of an outbreak. There was a significant correlation between an earlier deployment of our clinical team and a lower mortality rate for that outbreak (Pearson's r = 0.70, p < .01). Interpretation: This retrospective, uncontrolled study of a non-standardized intervention has many potential limitations. However, the data suggest that timely deployment of our clinical response team may improve outcomes in the event of a large outbreak. This clinical team may be useful in future pandemics.

Changes in COVID-19 IgM and IgG antibodies in emergency medical technicians (EMTs).

INTRODUCTION: Serologic testing can provide a safe and fast approach for assessing SARS-CoV-2 antibodies. These tests can be utilized as a complementary method in diagnosis and patients' follow-up, and can also be helpful in epidemiological studies. This study aimed to describe temporal changes in the incidence of COVID-19 IgM and IgG antibodies in emergency medical technicians (EMTs) within a specified time period. METHODS: All EMTs working for Tehran Emergency Medical Service (EMS) center during May to September 2020 were eligible for this study. Those EMTs who were suspected/probable/confirmed cases of COVID-19, based on WHO defined criteria and were willing to participate, entered the study. The EMTs underwent serology testing four weeks after the occurrence of exposure (in suspected cases) or onset of their symptoms (in probable/confirmed cases). Cases were further confirmed by RT-PCR and/or lung CT, and antibody testing was performed for the second and third time with 12-week intervals. Finger-stick blood sampling was utilized for the specimen collection in three different phases. Samples were then analyzed by a commercial immunochromatography-based kit for qualitative measurement of serum IgM and IgG antibodies against the COVID-19 S-protein antigen. RESULTS: Two hundred eighty-four participants met the inclusion criteria; their mean age was 35.9 (SD = 7.6) years and consisted of 244 (85.9%) males. COVID-19 was confirmed in 169 out of 284 participants. Subsequently, 142 and 122 participants were included in phases 2 and 3 of the study, respectively. The number of seronegative patients exceeded seropositive ones in all three phases. At baseline, 162 (57%) patients were seronegative, 27 (9.5%) were only positive for IgG, 3 (1.1%) were only positive for IgM, and 92 (32.4%) were positive for both antibodies; Seventy-eight (54.9%) were seronegative, and 31 (21.8%) were positive for both antibodies in the second phase; These values were 85 (69.6%) and 8 (6.6%) for the third phase, respectively. Among the people who were positive IgG in the first phase (80 people), 56.3% were still positive in the second phase and 27.5% in both subsequent phases. CONCLUSION: The results of our study show that there is a significant reduction in COVID-19 antibody seropositivity over time.

A retrospective survey study of paramedic students' exposure to SARS-CoV-2, participation in the COVID-19 pandemic response, and health-related quality of life.

BACKGROUND: Healthcare workers have reported increased anxiety while working in hospitals during the COVID-19 pandemic, and the role of healthcare students in a health crisis has been discussed among clinicians and researchers. The simultaneous international shortage of personal protection equipment (PPE) during the first wave of the pandemic potentially exposed healthcare workers and students to the virus during their work and clinical training. Our aim was therefore to evaluate the extent to which paramedic students in Oslo, Norway, were exposed to the SARS-CoV-2 virus and were involved in voluntary and/or paid healthcare-related work. An evaluation was also made of the students' COVID-19-related symptoms and of their health-related quality of life (HRQoL) during the first wave of the pandemic. METHODS: Paramedic students (n = 155) at Oslo Metropolitan University, Norway, were invited to complete an online survey five months after the first cases of COVID-19 were detected. The university was situated in the epicenter of the pandemic in Norway. The responses were analyzed using descriptive statistics, independent sample t-tests, and linear regression analysis. RESULTS: Of the 109 respondents (70.3%), 40 worked in patient-related healthcare work. Of those, seven (17.5%) students experienced insufficient supplies of PPE, six (15.0%) participated in aerosol-generating procedures without adequate PPE, and nine (22.5%) experienced insufficient time to don PPE. Seventy-five (70.1%) students experienced no COVID-19-related symptoms, and no students tested positive for COVID-19. HRQoL was scored 0.92 (sd 0.12), which was significantly higher than for the general population before the pandemic (p = 0.002). Students continued with their education and participated in a variety of pandemic-related emergency tasks during the first wave of the pandemic. CONCLUSIONS: Paramedic students were valuable contributors to the national pandemic response. Despite potential exposure to SARS-CoV-2 in unpredictable emergency settings with limited supplies of personal protection equipment, no students tested positive for COVID-19. Their health-related quality of life remained high. Students' participation and utilization in similar health crises should be considered in future health crises.