Interstitial Lung Disease and Progressive Pulmonary Fibrosis: a World Trade Center Cohort 20-Year Longitudinal Study.

PURPOSE: World Trade Center (WTC) exposure is associated with obstructive airway diseases and sarcoidosis. There is limited research regarding the incidence and progression of non-sarcoidosis interstitial lung diseases (ILD) after WTC-exposure. ILD encompasses parenchymal diseases which may lead to progressive pulmonary fibrosis (PPF). We used the Fire Department of the City of New York's (FDNY's) WTC Health Program cohort to estimate ILD incidence and progression. METHODS: This longitudinal study included 14,525 responders without ILD prior to 9/11/2001. ILD incidence and prevalence were estimated and standardized to the US 2014 population. Poisson regression modeled risk factors, including WTC-exposure and forced vital capacity (FVC), associated with ILD. Follow-up time ended at the earliest of incident diagnosis, end of study period/case ascertainment, transplant or death. RESULTS: ILD developed in 80/14,525 FDNY WTC responders. Age, smoking, and gastroesophageal reflux disease (GERD) prior to diagnosis were associated with incident ILD, though FVC was not. PPF developed in 40/80 ILD cases. Among the 80 cases, the average follow-up time after ILD diagnosis was 8.5 years with the majority of deaths occurring among those with PPF (PPF: n = 13; ILD without PPF: n = 6). CONCLUSIONS: The prevalence of post-9/11 ILD was more than two-fold greater than the general population. An exposure-response gradient could not be demonstrated. Half the ILD cases developed PPF, higher than previously reported. Age, smoking, and GERD were risk factors for ILD and PPF, while lung function was not. This may indicate that lung function measured after respirable exposures would not identify those at risk for ILD or PPF.

The Psychological Challenges of Emergency Medical Service Providers During Disasters: A Mini-Review February 2022.

The provision of emergency medical services (EMS) is an inherently stressful job. Depression, anxiety, and posttraumatic stress disorder (PTSD) are common psychological challenges affecting EMS providers. As disasters increase worldwide, the need for EMS also increases, as they are an essential part of any disaster management system. Studies have shown that EMS providers experience psychological challenges due to disaster response without receiving the needed psychological support. There is a scarcity of research focusing on EMS providers' psychological challenges in disaster times, especially in the Eastern world. This review highlights the psychological challenges faced by EMS providers in disaster times and discusses the amount of mental health care they receive. By emphasizing the need for mental health support, more research can be conducted to view EMS providers' perspectives on mental health needs before, during, and after disasters, and EMS policy makers can find programs to meet EMS providers' mental health needs, which might reflect positively on EMS and disaster management systems.

Occupational blood and body fluid exposure among emergency medical service providers in the eThekwini metropole of South Africa.

INTRODUCTION: Emergency Medical Service (EMS) providers in South Africa are among health care workers (HCW) most at risk of contracting infectious diseases due to occupational exposure to blood and body fluids (BBF). While the austere, dynamic, and challenging nature of the prehospital environment appears to be one of the primary drivers to this risk, the growing prevalence of bloodborne infections within the country; particularly Hepatitis B, C and Human Immunodeficiency Virus (HIV), has inevitably compounded the problem. The aim of this study was to investigate the knowledge, practices, and prevalence of BBF exposure among EMS providers in the eThekwini metropole of KwaZulu-Natal, South Africa. METHODOLOGY: This cross-sectional questionnaire-based study was completed by 96 randomly selected EMS providers who worked for the state-run ambulance service and were stationed within the eThekwini metropole. RESULTS: A total of 41 (42.7%) of the 96 respondents indicated memorable exposure to BBF at some point in their operational career. Exposure appeared to be mostly as a result of needlestick injuries (NSI) (63.4%), followed by BBF exposure into the eyes (19.5%). At the time of exposure, a total of 40 participants (97.6%) were wearing gloves, 22% (n = 9) were wearing facemasks, and 9.8% (n = 4) were wearing eye protection. Less than half of the respondents (46, 47.9%) were aware of existing EMS espoused BBF exposure policies, and 55 (57.3%) knew about post-exposure prophylaxis for HIV. Majority of the respondents (n = 74; 77.1%) indicated that they always recapped needles, and 46.9% (n = 45) dispose of sharps containers when completely full. CONCLUSION: The findings suggest that BBF related knowledge and practices among EMS providers working in the eThekwini metropole may be inadequate, and may increase the risk of blood exposure. In order to improve knowledge, immediate provision of EMS-specific BBF exposure training is required.

Anthropometric study of emergency medical services providers (EMSP) in the United States.

INTRODUCTION: Design of next-generation ambulance patient compartment requires up-to date anthropometric data of emergency medical service providers (EMSP). Currently, no such data exist in the U.S. A large-scale anthropometric study of EMSP in the U.S. were conducted. This report provided the summary statistics (means, standard deviation, and percentiles) of the study's results and examined the anthropometric differences between the EMSP dataset and the U.S. general population, and between the EMSP dataset and U.S. military personnel dataset, respectively. METHOD: An anthropometric study of 471 male and 161 female EMSP from across the continental US was conducted, using a sampling strategy that took into account age, sex, and race strata. RESULTS: On average, male EMSP were found to be 18 mm taller and 7 kg heavier than US male general population, and 19 mm taller and 11 kg heavier than US male military personnel. Female EMSP were found to be 25 mm taller than US female general population, and 10 kg heavier than US female military personnel. CONCLUSIONS: These results showed that it would be inappropriate to apply general population or military data to the design of next-generation ambulance patient compartment. This new dataset provided the most recent and accurate EMSP anthropometric measurements available in the US. Practical Application: Data from this study provided an invaluable resource for the design of next-generation ambulances in the US.