Mental health and life satisfaction among Canadian paramedics during the COVID-19 pandemic: an update

IntroductionPrevious results suggest that COVID-19 adversely impacted a number of health and coping measures among Canadian paramedics, particularly females. Estimated prevalence for meeting screening criteria for mental health disorders and suicidal thoughts were higher than previously reported.ObjectivesTo provide an update on the impact of the COVID-19 pandemic on the wellbeing of Canadian paramedics with the inclusion of an additional year of participant data.MethodsSelf-reported questionnaire data was collected from paramedics across five Canadian provinces as part of the COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) project. Validated psychological assessment tools were used to screen for major depressive disorder (MDD, PHQ-9 questionnaire) and probable post-traumatic stress disorder (PTSD, PC-PTSD-5 questionnaire). Satisfaction with life (SWL) scores were adapted from validated Canadian Census questions and confirmed by reliability analysis. All measures were compared before versus during the pandemic using Wilcoxon signed-ranked, Cliff's d, and differences in proportions tests where appropriate.ResultsQuestionnaires from an additional 1662 recruited paramedics were included, now totaling 3568 participants. Prevalence meeting screening criteria remained similar for MDD (31.6%) and PTSD (41.4%), with PTSD risk continuing to not be impacted by COVID-19. Paramedics continued to report higher median SWL scores (20 vs. 17, p<.001) prior to the pandemic, with a large effect size (d=0.58) that suggests a greater probability of reporting higher SWL prior to COVID-19. Suicidal ideation (i.e., ‘thoughts that you would be better off dead, or of hurting yourself in some way') was reported by 9.0% of paramedics, which was consistent with original findings.ConclusionOriginal findings appear stable with the addition of another year of participant data. Future analyses will be employed to investigate whether health and satisfaction measures differed between the original cohort and added participants by adjusting for questionnaire responses with respect to the pandemic timeline.

Changes to infection prevention and control measures used by Canadian paramedics in response to COVID-19

IntroductionCanadian Paramedic services modified infection prevention and control (IPAC) practices in response to COVID-19. These changes may affect risk of exposure to infectious disease agents and can be used to inform future IPAC practices. We characterized COVID-19-related IPAC changes in the provinces of Alberta, British Columbia, Manitoba, Ontario, and Saskatchewan.Materials & MethodsQuestionnaire data (January 2021-Feb 2022) from the national COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) project was used to identify which IPAC practices were in place prior to COVID-19, and which were modified in response to COVID-19, including the timing of changes (March-May 2020;June-Aug 2020;Sept-Nov 2020;Nov 2020-present).Results2939 participants were included (146, 1249, 139, 1317, 88 from Alberta, BC, Manitoba, Ontario, and Saskatchewan, respectively), of whom 2674 (91%) reported receiving IPAC training. IPAC measures that were common prior to COVID-19 included: personal protective equipment (PPE) training, patient screening, hand hygiene, N95/P100 respirators, gowns, impermeable suits, and cleaning/disinfection. COVID-related IPAC changes included: screening staff, social distancing, restricting aerosol generating procedures, masking patients, cloth face coverings, surgical masks, face shields, and elastomeric respirators. Changes were reported for all IPAC measures. Most (71%) of these changes were made early in the COVID-19 pandemic (March-May 2020). Differences in proportions across provinces, community practice settings, and professional regulation status were reported (p < .05) for hand hygiene, PPE training, screening of patients, face shields, and various respirator types.ConclusionCanadian paramedic services were quick to modify available IPAC measures. However, these changes were variable across provinces, regulation status, and setting for specific IPAC measures. Inconsistent IPAC measures across jurisdictions may contribute to variable risk of infectious disease exposure. An evidence-informed and nationally coordinated approach may provide more equitable exposure risk mitigation for paramedic workers.

Effects of with holding treatment on mental health in Canadian paramedics during the COVID-19 pandemic

IntroductionPsychological effects of withholding treatment that could have benefited a patient during a pandemic remain largely unknown. It is also unclear to what extent their reasons for withholding treatment contributed to the subsequent impact on mental health outcomes. Paramedics may have withheld treatments either due to fear of exposure, being directed by their service, or both. As such, the present research aimed to characterize withholding treatment and investigate potential negative mental health outcomes.Materials and MethodsParamedics from five provinces (Alberta, British Columbia, Manitoba, Ontario, Saskatchewan) working during the COVID-19 pandemic completed online questionnaires assessing withholding treatment (i.e., due to fear of exposure, directed by their service, or both), and mental health outcomes including depression (PHQ-9) and post-traumatic stress (PTSD) symptoms (PC-PTSD-5) as part of the COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) study.ResultsOf the 1453 participants, 54.2% reported withholding treatment due to fear of exposure (4.3%), as directed by their service (76.5%) or both (19.2%). Participants who withheld treatment reported higher rates of PTSD (M=2.6, p < .01) and depression (M=8.2, p < .001) symptoms than those that did not withhold treatments (MPTSD=2.3;Mdepression=6.4). Reason for withholding treatment and PTSD symptom severity were associated (p<.01). Paramedics who withheld treatment due to fear of exposure were more likely to report probable PTSD symptoms (23.5%) than those who withheld treatments as directed by their service (8.7%) or both (12.2%). Depression symptom severity did not differ by reasons for withholding treatment.ConclusionsWithholding treatment is potentially traumatic and may influence the development of depression and PTSD symptoms. Withholding due to fear of exposure rather than being directed to increased PTSD symptoms. Further research will investigate the mental health impact of withholding treatment and reported reasons for withholding over time.