The Effect of Shift Work on Sleep Patterns of Paramedics in Saudi Arabia.

Purpose: Shift work poses significant sleep health challenges for paramedics, affecting their ability to respond effectively in emergencies. This study aimed to evaluate the impact of shift work on sleep parameters among paramedics in Saudi Arabia, identifying key factors influencing insomnia. Patients and Methods: A cross-sectional, online survey was conducted, gathering data on sociodemographic characteristics, work-related factors, sleep duration, and insomnia among paramedics in Saudi Arabia. The Athens Insomnia Scale was used to define insomnia. The association between shift work and sleep parameters was examined. Predictors of insomnia were identified through logistic regression models by inspecting the adjusted odds ratio (aOR). Results: 1076 Saudi paramedics were included, most of whom were 26-35 years old, males, married, had a Bachelor's degree, worked in hospital-based settings for private agencies in rural areas, and had 6-10 years of experience. Occupational stress was reported by 52.96% of paramedics. All shift work characteristics (working hours, number of shifts, work schedule, and off-work days) were significantly associated with insomnia (p=0.0001). The multivariate regression revealed that work setting (aOR=18.71, p=0.02), coffee consumption (aOR=36.83, p=0.01), work schedule (aOR=21.93, p=0.01), and time to bed (aOR=0.01, p=0.01), sleep duration (aOR=0.03, p=0.03), and occupation stress (aOR=9.31, p=0.001) were predictors for insomnia. Conclusion: Our findings underscores the need for targeted interventions to mitigate the adverse effects of shift work on sleep health among paramedics.

The prevalence of depression among paramedical students and workers with highlights from the COVID-19 pandemic: A meta-analysis of prevalence.

OBJECTIVE: To estimate the prevalence and risk factors of depression among paramedical workers/students. METHOD: 6205 paramedics (reported in 25 cross-sectional studies) were meta-analyzed after searching seven electronic databases. The main outcome was the prevalence of depression. Subgroup analyses were conducted based on year and country of investigation, pandemic status and wave, population type, and disease severity. Several risk factors were also examined (gender, marital status, and population type). RESULTS: 34% [95%CI: 26-43%] of paramedics have depression, mostly of the mild form [19%, 95%CI: 13-27%]. Depression was highest in India and Australia. Students [45%, 95%CI: 30-62%] were more vulnerable to depression than workers [29%, 95%CI: 18-40%]. No linear trend was observed for depression over the years. Depression was lower during the pandemic compared to the pre-pandemic period [25% vs. 39%] with similar rates across all pandemic waves. Male [MD = 1.40; 95%CI: 0.57: 2.23] and married paramedics [MD = -1.33, 95%CI: -2.04: -0.62] were significant predictors of depression; however, no significant difference in depression was noted between paramedics and non-paramedics [logOR = 0.08; 95%CI: -0.10: 0.25]. CONCLUSIONS: One in every three paramedics have depression, with higher rates among students and before the COVID-19 pandemic. Gender and marital status are risk factors of depression.

The Global Prevalence and Associated Factors of Burnout among Emergency Department Healthcare Workers and the Impact of the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

BACKGROUND/AIM: Emergency medicine (EM) settings are very stressful, given the high workload, intense working environment, and prolonged working time. In turn, the rate of burnout and its three domains have been increasingly reported among healthcare workers (HCWs). Therefore, we conducted this meta-analysis to determine the prevalence and risk factors of burnout among EM HCWs. METHODS: Six databases were searched in February 2023, yielding 29 articles (16,619 EM HCWs) reporting burnout or its three domains (emotional exhaustion "EE", depersonalization "DP", and personal accomplishment "PA"). The primary outcome was the prevalence of burnout and its domains, while secondary outcomes included the risk factors of high burnout, EE, DP, or low PA. Burnout rates were pooled across studies using STATA software. The prevalence was measured using the pooled effect size (ES), and the random-effects model was used when heterogeneity was encountered; otherwise, the fixed-effects model was used. RESULTS: The prevalence of overall burnout was high (43%), with 35% of EM HCWs having a high risk of burnout. Meanwhile, 39%, 43%, and 36% of EM workers reported having high levels of EE and DP and low levels of PA, respectively. Country-specific changes in the rate of burnout were observed. The rate of high burnout, high EE, high DP, and low PA was higher during the COVID-19 pandemic as compared to the pre-pandemic period. The type of profession (nurses, physicians, residents, etc.) played a significant role in modifying the rate of burnout and its domains. However, gender was not a significant determinant of high burnout or its domains among EM workers. CONCLUSIONS: Burnout is a prevalent problem in emergency medicine practice, affecting all workers. As residents progress through their training years, their likelihood of experiencing burnout intensifies. Nurses are most affected by this problem, followed by physicians. Country-associated differences in burnout and its domains are evident.

Prehospital Time Interval for Urban and Rural Emergency Medical Services: A Systematic Literature Review.

The aim of this study was to discuss the differences in pre-hospital time intervals between rural and urban communities regarding emergency medical services (EMS). A systematic search was conducted through various relevant databases, together with a manual search to find relevant articles that compared rural and urban communities in terms of response time, on-scene time, and transport time. A total of 37 articles were ultimately included in this review. The sample sizes of the included studies was also remarkably variable, ranging between 137 and 239,464,121. Twenty-nine (78.4%) reported a difference in response time between rural and urban areas. Among these studies, the reported response times for patients were remarkably variable. However, most of them (number (n) = 27, 93.1%) indicate that response times are significantly longer in rural areas than in urban areas. Regarding transport time, 14 studies (37.8%) compared this outcome between rural and urban populations. All of these studies indicate the superiority of EMS in urban over rural communities. In another context, 10 studies (27%) reported on-scene time. Most of these studies (n = 8, 80%) reported that the mean on-scene time for their populations is significantly longer in rural areas than in urban areas. On the other hand, two studies (5.4%) reported that on-scene time is similar in urban and rural communities. Finally, only eight studies (21.6%) reported pre-hospital times for rural and urban populations. All studies reported a significantly shorter pre-hospital time in urban communities compared to rural communities. Conclusions: Even with the recently added data, short pre-hospital time intervals are still superior in urban over rural communities.

Emergency medical services in rural and urban Saudi Arabia: A qualitative study of Red Crescent emergency personnel' perceptions of workforce and patient factors impacting effective delivery.

Individuals who experience a traumatic injury or an acute illness are often reliant on initial healthcare assessment and support from a pre-hospital emergency medical service (EMS). These community-based support models perform a vital role in the provision of life-saving support, but research indicates that the availability, accessibility and resources of EMS are not equivalent in rural and urban areas, and there has been little recognition of the issues facing rural EMS provision outside of the USA, Europe and Australia. The purpose of the current study was to examine the lived experiences of Saudi Arabian EMS personnel, defined as emergency medical technicians, paramedics and local station managers. A semi-structured interview approach was used to collect data from 20 interviewees (10 each with rural and urban personnel) in the Riyadh region of the Kingdom of Saudi Arabia. This methodology was used to identify the key issues that these staff face in their day-to-day work practice and ascertain factors that may lead to service delivery issues in rural and urban areas. Data analyses identified three thematic categories impacting EMS delivery; two of these, Personnel Factors and Patient Factors, are the focus of this paper. The participants noted a number of key issues, including a lack of appropriate local training and limited resources in rural areas, as well as general areas of concern regarding the wider EMS staff demographic makeup and poor public awareness about the exact role of the EMS. Three key recommendations arising from this study include specialised training and ongoing accessible education for rural EMS staff to allow for better support for patients; consideration of supplementing the current EMS with additional external specialist staff; and the development and implementation of national public education programmes focusing on the role of the EMS within the community.

Organisational factors affecting emergency medical services' performance in rural and urban areas of Saudi Arabia.

BACKGROUND: There is a disparity in outcomes between rural and urban emergency medical services (EMS) around the world. However, there is a scarcity of research that directly asks EMS staff in both rural and urban areas how service delivery could be improved. The aim of the present study is to gain insights from frontline workers regarding organisational factors that may underpin discrepancies between rural and urban EMS performance. SUBJECT AND METHODS: The study was undertaken in the Riyadh region of Saudi Arabia. Potential participants were currently employed by Saudi Red Crescent EMS as either a technician, paramedic or an EMS station manager, and had a minimum of five years experience with the EMS. Semi-structured interviews were undertaken between October 2019 and July 2020 with first respondents to a call for participants, and continued until data saturation was reached. All interviews were conducted in Arabic and transcribed verbatim. The Arabic transcript was shared with each participant, and they were asked to confirm their agreement with the transcription. The transcribed interviews were then translated into English; the English versions were shared with bi-lingual participants for validation, while independent certification of the translations were performed for data from participants not fluent in English. A thematic analysis methodological approach was used to examine the data. RESULTS: The final sample involved 20 participants (10 rural, 10 urban) from Saudi Red Crescent EMS. Data analyses identified key organisational factors that resulted in barriers and impediments for EMS staff. Differences and similarities were observed between rural and urban respondents, with identified issues including response and transportation time, service coordination, reason for call-out, as well as human and physical resourcing. CONCLUSION: The findings identified key issues impacting on EMS performance across both rural and urban areas. In order to address these problems, three changes are recommended. These recommendations include a comprehensive review of rural EMS vehicles, with a particular focus on the age; incentives to improve the numbers of paramedics in rural areas and more localised specialist training opportunities for rurally-based personnel; and the implementation of national public education program focusing on the role of the EMS.

Nontransported Cases after Emergency Medical Service Callout in the Rural and Urban Areas of the Riyadh Region.

BACKGROUND: Callouts resulting in patient nontransportation can impact the overall quality of prehospital Emergency Medical Service (EMS), as resources in health care are finite. While some studies have investigated the causes of nontransportation, few have examined whether there are differences between urban and rural patients. Similarly, there has been limited research focused on rural EMS in locations such as the Middle East. OBJECTIVES: This study investigated EMS cases that resulted in nontransportation in the urban and rural areas of the Riyadh region in the Kingdom of Saudi Arabia. METHODS: A cross-sectional study of 800 (400 rural and 400 urban) patient records was undertaken, using 12 months (January 1 to December 31, 2017) of data from the Saudi Red Crescent EMS. A random sampling method was used to select ambulance records from the 78 urban and rural EMS stations in the Riyadh region, with demographic data and reasons for patient nontransport analyzed comparatively. RESULTS: A total of 310 cases were nontransported (39%) (rural: 146; urban = 164). The highest rates of nontransportation cases were of medical and trauma callouts (44.6% and 39.6%, respectively), which was consistent in both areas. The most common reason for nontransportation in both urban and rural areas was refusal of treatment and transportation (66.5% and 59.9%, respectively). Further, 10 patients were treated on-scene and released by rural EMS, while no urban patients were treated and released. Overall, the case presentations of nontransported patients did not differ significantly between both areas, and it was found that gender, age, and geographic location were not predictors for nontransportation. CONCLUSIONS: The high rate of nontransportation, particularly in medical and trauma callouts, indicates that a review of current EMS protocols may be required, along with consideration of relevant community education programs.

Factors Impacting Patient Outcomes Associated with Use of Emergency Medical Services Operating in Urban Versus Rural Areas: A Systematic Review.

The goal of this systematic review was to examine the existing literature base regarding the factors impacting patient outcomes associated with use of emergency medical services (EMS) operating in urban versus rural areas. A specific subfocus on low and lower-middle-income countries was planned but acknowledged in advance as being potentially limited by a lack of available data. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed during the preparation of this systematic review. A comprehensive literature search of PubMed, EBSCO (Elton B. Stephens Company) host, Web of Science, ProQuest, Embase, and Scopus was conducted through May 2018. To appraise the quality of the included papers, the Critical Appraisal Skills Programme Checklists (CASP) were used. Thirty-one relevant and appropriate studies were identified; however, only one study from a low or lower-middle-income country was located. The research indicated that EMS in urban areas are more likely to have shorter prehospital times, response times, on-scene times, and transport times when compared to EMS operating in rural areas. Additionally, urban patients with out-of-hospital cardiac arrest or trauma were found to have higher survival rates than rural patients. EMS in urban areas were generally associated with improved performance measures in key areas and associated higher survival rates than those in rural areas. These findings indicate that reducing key differences between rural and urban settings is a key factor in improving trauma patient survival rates. More research in rural areas is required to better understand the factors which can predict these differences and underpin improvements. The lack of research in this area is particularly evident in low- and lower-middle-income countries.