A Preliminary Description of the Health of Women Navy Divers: An Examination of Linked Medical, Personnel, and Dive Log Data for 47 Women Divers Who Separated Between 2008 and 2018.

INTRODUCTION: Although women have always served in the U.S. Armed Forces, it has only been in the last half century that systematic examinations have been done on the health issues experienced by military women. Still, little is known about how occupational health risks among Navy divers might vary between men and women. Our objective was to use available data to examine health issues among all separating divers and then determine how prevalence rates varied between men and women for diagnoses made within the diver's last year of active duty service. MATERIALS AND METHODS: For this retrospective observational study, medical records and personnel data were linked with dive logs at the individual level. We calculated sex-specific prevalence rates and relative risks per 1,000 divers by major diagnostic categories and by specific disease diagnoses. RESULTS: We identified 47 women among the 4,623 active duty Navy divers (1.0%) who separated between 2008 and 2018. Ages varied between 19 and 54 years (M = 33, SD = 8) for women, compared to men who were 18-65 years (M = 35, SD = 9). When compared to men, women had about six times the rate of diseases of the genitourinary system, twice the rate of respiratory system diseases, and about four times as many diagnoses of disorders of the lacrimal system. CONCLUSIONS: The findings of much higher relative risks for women for conditions such as genitourinary disease, skin conditions, and acute respiratory infections require follow-up research to look for causes and potential risk reduction interventions. Future research must determine specific and relative risks as a necessary precursor to developing, implementing, and testing potentially sex-specific risk reduction and health improvement interventions.

Occupational Injuries and Illnesses among Paramedicine Clinicians: Analyses of US Department of Labor Data (2010 - 2020).

OBJECTIVE: Paramedicine clinicians (PCs) in the United States (US) respond to 40 million calls for assistance every year. Their fatality rates are high and their rates of nonfatal injuries are higher than other emergency services personnel, and much higher than the average rate for all US workers. The objectives of this paper are to: describe current occupational injuries among PCs; determine changes in risks over time; and calculate differences in risks compared to other occupational groups. METHODS: This retrospective open cohort study of nonfatal injuries among PCs used 2010 through 2020 data from the US Department of Labor (DOL), Bureau of Labor Statistics; some data were unavailable for some years. The rates and relative risks (RRs) of injuries were calculated and compared against those of registered nurses (RNs), fire fighters (FFs), and all US workers. RESULTS: The annual average number of injuries was: 4,234 over-exertion and bodily reaction (eg, motion-related injuries); 3,935 sprains, strains, and tears; 2,000 back injuries; 580 transportation-related injuries; and over 400 violence-related injuries. In this cohort, women had an injury rate that was 50% higher than for men. In 2020, the overall rate of injuries among PCs was more than four-times higher, and the rate of back injuries more than seven-times higher than the national average for all US workers. The rate of violence-related injury was approximately six-times higher for PCs compared to all US workers, seven-times higher than the rate for FFs, and 60% higher than for RNs. The clinicians had a rate of transportation injuries that was 3.6-times higher than the national average for all workers and 2.3-times higher than for FFs. Their overall rate of cases varied between 290 per 10,000 workers in 2018 and 546 per 10,000 workers in 2022. CONCLUSIONS: Paramedicine clinicians are a critical component of the health, disaster, emergency services, and public health infrastructures, but they have risks that are different than other professionals.This analysis provides greater insight into the injuries and risks for these clinicians. The findings reveal the critical need for support for Emergency Medical Services (EMS)-specific research to develop evidence-based risk-reduction interventions. These risk-reduction efforts will require an enhanced data system that accurately and reliably tracks and identifies injuries and illnesses among PCs.

A Cohort Study of Occupational Fatalities among Paramedicine Clinicians: 2003 through 2020.

INTRODUCTION/STUDY OBJECTIVES: Emergency medical technicians (EMTs) and paramedics respond to 40 million calls for assistance every year in the United States; these paramedicine clinicians are a critical component of the nation's health care, disaster response, public safety, and public health systems. The study objective is to identify the risks of occupational fatalities among paramedicine clinicians working in the United States. METHODS: To determine fatality rates and relative risks, this cohort study focused on 2003 through 2020 data of individuals classified as EMTs and paramedics by the United States Department of Labor (DOL). Data provided by the DOL and accessed through its website were used for the analyses. The DOL classifies EMTs and paramedics who have the job title of fire fighter as fire fighters and so they were not included in this analysis. It is unknown how many paramedicine clinicians employed by hospitals, police departments, or other agencies are classified as health workers, police officers, or other and were not included in this analysis. RESULTS: An average of 206,000 paramedicine clinicians per year were employed in the United States during the study period; approximately one-third were women. Thirty percent (30%) were employed by local governments. Of the 204 total fatalities, 153 (75%) were transportation-related incidents. Over one-half of the 204 cases were classified as "multiple traumatic injuries and disorders." The fatality rate for men was three-times higher than for women (95% confidence interval [CI], 1.4 to 6.3). The fatality rate for paramedicine clinicians was eight-times higher than the rate for other health care practitioners (95% CI, 5.8 to 10.1) and 60% higher than the rate for all United States workers (95% CI, 1.24 to 2.04). CONCLUSIONS: Approximately 11 paramedicine clinicians are documented as dying every year. The highest risk is from transportation-related events. However, the methods used by the DOL for tracking occupational fatalities means that many cases among paramedicine clinicians are not included. A better data system, and paramedicine clinician-specific research, are needed to inform the development and implementation of evidence-based interventions to prevent occupational fatalities. Research, and the resulting evidence-based interventions, are needed to meet what should be the ultimate goal of zero occupational fatalities for paramedicine clinicians in the United States and internationally.

Prescription medication use and trends for U.S. Navy submariners from 2007 to 2018.

Introduction: This is the first study to examine population medication prescription rates among U.S. submariners by common therapeutic classifications. Methods: Individual-level pharmacy records during the years 2007 to 2018 were extracted from the Military Health System's Pharmacy Data Transaction Service (PDTS) file. Demographic and military factors captured from Navy personnel files were linked to PDTS records. Logistic regression models were used to identify characteristics and trends associated with prevalence. Published total rates for other active-duty components were compared to submariner rates. Results: There were data for 50,720 submariners, among whom 576,782 prescriptions were filled. Prevalence rates decreased significantly from 2007-2018 among most drug classes. Central nervous system agents accounted for 31% of the total prescriptions, followed by 12% for eye, ear, nose, and throat preparations, and 10% for anti-infective agents. Higher prescription rates were associated with being enlisted, younger, a woman, lower-ranked, or Hispanic. The mean yearly prescription rate was 2.7 per submariner, less than half of the overall rate of all military components. Conclusion: The survival benefit of HBO2 therapy observed in our unadjusted analysis suggests that there may be therapeutic benefits of HBO2 in treating COVID-19 hypoxia as an adjunct to standard care.

Health Conditions Among Navy Submariners at the End of Active Duty; A Retrospective Cohort Study.

INTRODUCTION: Maintaining healthy, well-trained, and highly qualified armed forces is critical for ensuring military readiness. The purpose of this article is to contribute to the body of research focused on the health of U.S. Navy submariners and to identify the health conditions of U.S. Navy submariners during their final year of active duty service. MATERIALS AND METHODS: In this retrospective cohort study, we examined medical records and personnel files of separating U.S. Navy sailors who were: (1) active duty between 2009 and 2018; (2) separated before 2019; and (3) were assigned to a submarine for at least 30 days. Both officers and enlisted service members were included. We linked, described, and analyzed data from the Defense Health Agency, Military Health System Data Repository (MDR), and the Bureau of Naval Personnel (BUPERS). International Classification of Diseases (ICD) diagnoses codes were obtained from MDR. Data collected from BUPERS include age, sex, and rank. We determined the number of individuals who had at least one diagnosed condition (identified as a three-digit ICD code). We report the number of diagnoses and calculate prevalence rates and confidence intervals per condition, as well as prevalence rates per year, using standard formulas. The study was approved by the Naval Submarine Medical Research Laboratory Institutional Review Board. RESULTS: During the study period, 26,014 submariners separated from the Navy. The average number of separations per year was 2,601. About a third of the separating submariners were in the 25 to 29 age group and over 50% were under 30 years of age. Of the three-digit individual ICD codes, some of the highest operationally relevant rates over the 10-year study period (2009-2018) were for joint disorders (prevalence rate [PR] = 180 per 1,000 submariners), back disorders (PR = 128), and sleep disorders (PR = 134). Three mental-health-related conditions were also among the 20 conditions with the highest rates. CONCLUSIONS: High rates of specific diagnoses such as joint disorders indicate the need for additional study to examine causal relationships, to determine which conditions may contribute to lost work time, early separations, or low rates of reenlistment and which conditions might be a result of specific military occupations or duties. Study strengths are the large number of subjects and the long period of observations. A study weakness was the inability to identify submariners who separated because of health conditions. The overall impact of the study is that it identifies urgent health risks and establishes a way to prioritize future research. Future research should include a focus on medically separated personnel; compare rates for submariners to other military groups including all-Navy and all-Department of Defense; and determine specific and relative risks as a necessary precursor to developing, implementing, and testing risk reduction and health improvement interventions.

Health conditions among Navy divers at end of service: a retrospective cohort study.

PURPOSE: To identify the most prevalent health conditions among divers during their last year of Navy service. METHODS: For this retrospective descriptive study we used data from the Dive Jump Reporting System to identify 4,623 active-duty divers who separated between 2008 and 2018. Medical records, dive histories, and personnel files were merged, linked and analyzed at the individual level. RESULTS: On average, 420 divers separated each year. Among the separating divers, 99% were male, 26% were aged 25 to 29 years old with a mean age of 35 (SD = 9, range 18 to 65). The major medical categories with the highest numbers of divers affected were: musculoskeletal system diseases (prevalence rate (PR) = 515.2 per 1,000 divers/year); nervous system (PR = 411.9); injury and poisonings (PR = 249.8); and mental disorders (PR = 237.3). Of the 50 specific conditions that affected the most divers the top four were joint disorders (PR = 34.5), disorders of refraction and accommodation (PR = 30.1), back disorders (PR = 26.8) and organic sleep disorders (PR = 21.6). Compared to divers with fewer than 29 dives, divers with 49-plus dives were about twice as likely to have diagnoses related to symptoms involving head and neck. CONCLUSIONS: The study found high rates of conditions such as musculoskeletal disorders, joint and back disorders, and some mental health related disorders. Special warfare divers have high rates of hearing loss, and other disorders of ear. The results show the need and to develop and implement group-specific mitigation programs.

Emergency Medical Services (EMS) Calls During COVID-19: Early Lessons Learned for Systems Planning (A Narrative Review).

BACKGROUND: Over the course of the COVID-19 progress, reports from many locations around the world indicated major increases in EMS call volume, which imposed great pressure on EMS dispatch centers (EMSDC) globally. No studies yet have been done to examine this phenomenon. OBJECTIVE: This paper examines the interrelated effects of the unprecedented global increase of EMS call, the effect of the COVID-19 crisis on responding to non-COVID-19 emergencies, and the concurrent effects of having overwhelmed dispatch centers. It tries to explain the current evidence of the bottleneck of EMS calls during the early phase of the worldwide pandemic. ELIGIBILITY CRITERIA: We examine the numbers of EMS calls internationally between March and June 2020, derived from published literature and news media. Only articles in English were selected, with certain keywords related to EMS calls, ambulance delay, stroke and cardiac arrest. SOURCE OF EVIDENCE: Google Scholar was the main searching source. RESULTS: After applying the selection criteria, a total of 29 citations were chosen, and a pattern of knowledge resulted in the emergence of five themes: EMS calls during COVID-19, Reduced EMS operator response time, Ambulance response delays, Collateral mortality and morbidity among non-COVID-19 cases, and Total ambulance call time. CONCLUSION: Over the course of COVID-19 progress, there was a global phenomenon of exponential increases in EMS calls, which is expected to impose a great pressure on EMS dispatch centers. Several factors contributing to the bottleneck of EMS calls are identified and explained.

Organisational interventions for preventing and minimising aggression directed towards healthcare workers by patients and patient advocates.

BACKGROUND: Workplace aggression is becoming increasingly prevalent in health care, with serious consequences for both individuals and organisations. Research and development of organisational interventions to prevent and minimise workplace aggression has also increased. However, it is not known if interventions prevent or reduce occupational violence directed towards healthcare workers. OBJECTIVES: To assess the effectiveness of organisational interventions that aim to prevent and minimise workplace aggression directed towards healthcare workers by patients and patient advocates. SEARCH METHODS: We searched the following electronic databases from inception to 25 May 2019: Cochrane Central Register of Controlled Trials (CENTRAL) (Wiley Online Library); MEDLINE (PubMed); CINAHL (EBSCO); Embase (embase.com); PsycINFO (ProQuest); NIOSHTIC (OSH-UPDATE); NIOSHTIC-2 (OSH-UPDATE); HSELINE (OSH-UPDATE); and CISDOC (OSH-UPDATE). We also searched the ClinicalTrials.gov (www.ClinicalTrials.gov) and the World Health Organization (WHO) trials portals (www.who.int/ictrp/en). SELECTION CRITERIA: We included randomised controlled trials (RCTs) or controlled before-and-after studies (CBAs) of any organisational intervention to prevent and minimise verbal or physical aggression directed towards healthcare workers and their peers in their workplace by patients or their advocates. The primary outcome measure was episodes of aggression resulting in no harm, psychological, or physical harm. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods for data collection and analysis. This included independent data extraction and 'Risk of bias' assessment by at least two review authors per included study. We used the Haddon Matrix to categorise interventions aimed at the victim, the vector or the environment of the aggression and whether the intervention was applied before, during or after the event of aggression. We used the random-effects model for the meta-analysis and GRADE to assess the quality of the evidence. MAIN RESULTS: We included seven studies. Four studies were conducted in nursing home settings, two studies were conducted in psychiatric wards and one study was conducted in an emergency department. Interventions in two studies focused on prevention of aggression by the vector in the pre-event phase, being 398 nursing home residents and 597 psychiatric patients. The humour therapy in one study in a nursing home setting did not have clear evidence of a reduction of overall aggression (mean difference (MD) 0.17, 95% confidence interval (CI) 0.00 to 0.34; very low-quality evidence). A short-term risk assessment in the other study showed a decreased incidence of aggression (risk ratio (RR) 0.36, 95% CI 0.16 to 0.78; very low-quality evidence) compared to practice as usual. Two studies compared interventions to minimise aggression by the vector in the event phase to practice as usual. In both studies the event was aggression during bathing of nursing home patients. In one study, involving 18 residents, music was played during the bathing period and in the other study, involving 69 residents, either a personalised shower or a towel bath was used. The studies provided low-quality evidence that the interventions may result in a medium-sized reduction of overall aggression (standardised mean difference (SMD -0.49, 95% CI -0.93 to -0.05; 2 studies), and physical aggression (SMD -0.85, 95% CI -1.46 to -0.24; 1 study; very low-quality evidence), but not in verbal aggression (SMD -0.31, 95% CI; -0.89 to 0.27; 1 study; very low-quality evidence). One intervention focused on the vector, the pre-event phase and the event phase. The study compared a two-year culture change programme in a nursing home to practice as usual and involved 101 residents. This study provided very low-quality evidence that the intervention may result in a medium-sized reduction of physical aggression (MD 0.51, 95% CI 0.11 to 0.91), but there was no clear evidence that it reduced verbal aggression (MD 0.76, 95% CI -0.02 to 1.54). Two studies evaluated a multicomponent intervention that focused on the vector (psychiatry patients and emergency department patients), the victim (nursing staff), and the environment during the pre-event and the event phase. The studies included 564 psychiatric staff and 209 emergency department staff. Both studies involved a comprehensive package of actions aimed at preventing violence, managing violence and environmental changes. There was no clear evidence that the psychiatry intervention may result in a reduction of overall aggression (odds ratio (OR) 0.85, 95% CI 0.63 to 1.15; low-quality evidence), compared to the control condition. The emergency department study did not result in a reduction of aggression (MD = 0) but provided insufficient data to test this. AUTHORS' CONCLUSIONS: We found very low to low-quality evidence that interventions focused on the vector during the pre-event phase, the event phase or both, may result in a reduction of overall aggression, compared to practice as usual, and we found inconsistent low-quality evidence for multi-component interventions. None of the interventions included the post-event stage. To improve the evidence base, we need more RCT studies, that include the workers as participants and that collect information on the impact of violence on the worker in a range of healthcare settings, but especially in emergency care settings. Consensus on standardised outcomes is urgently needed.

International Survey of Violence Against EMS Personnel: Physical Violence Report.

IntroductionEach year, Emergency Medical Services (EMS) personnel respond to over 30 million calls for assistance in the United States alone. These EMS personnel have a rate of occupational fatality comparable to firefighters and police, and a rate of non-fatal injuries that is higher than the rates for police and firefighters and much higher than the national average for all workers. In Australia, no occupational group has a higher injury or fatality rate than EMS personnel. Emergency Medical Services personnel in the US have a rate of occupational violence injuries that is about 22-times higher than the average for all workers. On average, more than one EMS provider in the US is killed every year in an act of violence.Hypothesis/ObjectiveThe objective of this epidemiological study was to identify the risks and factors associated with work-related physical violence against EMS personnel internationally. METHODS: An online survey, based on a tool developed by the World Health Organization (WHO; Geneva, Switzerland), collected responses from April through November 2016. RESULTS: There were 1,778 EMS personnel respondents from 13 countries; 69% were male and 54% were married. Around 55% described their primary EMS work location as "urban." Approximately 68% described their employer as a "public provider." The majority of respondents were from the US.When asked "Have you ever been physically attacked while on-duty?" 761 (65%) of the 1,172 who answered the question answered "Yes." In almost 10% (67) of those incidents, the perpetrator used a weapon. Approximately 90% of the perpetrators were patients and around five percent were patient family members. The influence of alcohol and drugs was prevalent. Overall, men experienced more assaults than women, and younger workers experienced more assaults than older workers. CONCLUSIONS: In order to develop and implement measures to increase safety, EMS personnel must be involved with the research and implementation process. Furthermore, EMS agencies must work with university researchers to quantify agency-level risks and to develop, test, and implement interventions in such a way that they can be reliably evaluated and the results published in peer-reviewed journals. MaguireBJ, BrowneM, O'NeillBJ, DealyMT, ClareD, O'MearaP. International survey of violence against EMS personnel: physical violence report. Prehosp Disaster Med. 2018;33(5):526-531.

Preventing EMS workplace violence: A mixed-methods analysis of insights from assaulted medics.

OBJECTIVE: To describe measures that assaulted EMS personnel believe will help prevent violence against EMS personnel. METHODS: This mixed- methods study includes a thematic analysis and directed content analysis of one survey question that asked the victims of workplace violence how the incident might have been prevented. RESULTS: Of 1778 survey respondents, 633 reported being assaulted in the previous 12 months; 203 of them believed the incident could have been prevented and 193 of them (95%) answered this question. Six themes were identified using Haddon's Matrix as a framework. The themes included: Human factors, including specialized training related to specific populations and de-escalation techniques as well as improved situational awareness; Equipment factors, such as restraint equipment and resources; and, Operational and environment factors, including advanced warning systems. Persons who could have prevented the violence were identified as police, self, other professionals, partners and dispatchers. Restraints and training were suggested as violence-prevention tools and methods CONCLUSIONS: This is the first international study from the perspective of victimized EMS personnel, to report on ways that violence could be prevented. Ambulance agencies should consider these suggestions and work with researchers to evaluate risks at the agency level and to develop, implement and test interventions to reduce the risks of violence against EMS personnel. These teams should work together to both form an evidence-base for prevention and to publish findings so that EMS medical directors, administrators and professionals around the world can learn from each experience.

Violence against ambulance personnel: a retrospective cohort study of national data from Safe Work Australia.

Objectives and importance: Paramedics have high rates of occupational injury and fatality. The objective of this study is to describe their specific risks of violence-related injury. STUDY TYPE: This retrospective cohort study is an examination of retrospective data provided by Safe Work Australia (SWA). METHODS: An examination of the 300 cases of serious claims of injury related to assaults, violence, harassment and bullying that occurred among individuals identified as ambulance officers and paramedics in Australia from 2001 to 2014. Paramedic risks likely vary by exposures such as hours worked and call volume. To examine how those exposures may influence risk, the available data were used to estimate rates based on hours worked and call volume. RESULTS: The data show that, for serious injuries among paramedics in Australia between 2001 and 2014, the total number of violence-related cases increased from 5 to 40 per year; the number of cases of injury secondary to assault tripled from 10 to 30; and the rate of cases by call volume doubled from 6 to 12. The cost of these injuries was approximately AUD$250 000 for the year 2013-14. The median time at work lost per individual case of 'work-related harassment and/or workplace bullying' was 9.6 weeks. Although females comprised 32% of the paramedic workforce, they were the victims in 42% of cases of exposure to violence and 40% of harassment cases. CONCLUSIONS: Although anecdotal reports indicate that some interventions have been attempted, violence against paramedics continues to be a growing problem in Australia. The data presented in this study allow for a better understanding of the problem and can support efforts by ambulance service administrators, physicians, paramedics and university researchers to work together to develop and publish evidence based, cost-effective solutions to reduce the risk of workplace violence. Effective solutions will likely be multifaceted and include training, engineering changes, community education and adjustments to agency policies. Because of the widespread nature of the risks, a national commission should be empowered to address this growing problem.

Violence against emergency medical services personnel: A systematic review of the literature.

BACKGROUND: Violence against emergency medical services (EMS) personnel is a growing concern. The aim of this systematic review is to synthesize the current literature on violence against EMS personnel. METHODS: We examined literature from 2000 to 2016. Eligibility criteria included English-language, peer-reviewed studies of EMS personnel that described violence or assaults. Sixteen searches identified 2655 studies; 25 studies from nine countries met the inclusion criteria. RESULTS: The evidence from this review demonstrates that violence is a common risk for EMS personnel. We identified three critical topic areas: changes in risk over time, economic impact of violence and, outcomes of risk-reduction interventions. There is a lack of peer reviewed research of interventions, with the result that current intervention programs have no reliable evidence base. CONCLUSIONS: EMS leaders and personnel should work together with researchers to design, implement, evaluate and publish intervention studies designed to mitigate risks of violence to EMS personnel.

Ketamine Sedation for Patients With Acute Behavioral Disturbance During Aeromedical Retrieval: A Retrospective Chart Review.

OBJECTIVE: The aim of this study was to determine the prevalence, safety (as measured by the incidence of adverse events), and effectiveness (as measured by the incidence of intubations) of ketamine sedation in patients with acute behavioral disturbance (ABD) during air medical retrieval. METHODS: This was a retrospective observational study. Eligible patients were identified by searching the electronic databases of 2 air medical retrieval services in Queensland, Australia, for adult patients with ABD transported between January 1, 2015, and June 30, 2016. Data abstraction was performed as per standard chart review criteria. The incidences of intubations and adverse reactions were the main outcomes. RESULTS: One hundred twenty-two patients met the inclusion criteria. Thirty-one (25.4%) patients were intubated, 21 (17.2%) for airway protection/respiratory depression and 10 (8.1%) for persistent ABD. Twenty-one (17.2%) patients received ketamine, 3 of whom (14.3%) were intubated for persistent ABD. Nine (42.9%) patients developed hypertension after ketamine, 2 of whom needed intervention. One patient developed hypoxia after ketamine that resolved without intervention, and 1 patient developed increased secretions. No patients developed nausea, vomiting, emergence phenomena, apnea, or laryngospasm. CONCLUSION: Our study suggests that ketamine is a safe and effective agent for sedating patients with ABD during air medical retrieval.

Emergency Medical Service Personnel's Risk From Violence While Serving the Community.

OBJECTIVES: To determine the risks of violence-related injury among emergency medical services (EMS) personnel in the United States. METHODS: We analyzed 1630 violence-related occupational injury cases reported to the US Bureau of Labor Statistics for the years 2012 to 2015 and conducted secondary searches within the Bureau of Labor Statistics Web site. RESULTS: The number of cases per year varied between 250 and 560. Perpetrators included patients (77%) and coworkers (8%). Female EMS personnel had a disproportionately greater risk of violence-related injuries. The most common (35%) injury type was "sprains-strains-tears"; about 4% of the assault cases resulted in fractures, 13% resulted in surface wounds, and 190 were head injuries. About a third of the cases were classified as intentional. CONCLUSIONS: The findings indicate a clear need for reliable interventions. The differences in risk for women indicate that some interventions may need to be demographic-specific. Because of the limitations of national data, future researchers will need access to agency-level data that include hours worked and call volume by demographic factors such as gender.

Occupational injury risk among Australian paramedics: an analysis of national data.

OBJECTIVE: To identify the occupational risks for Australian paramedics, by describing the rate of injuries and fatalities and comparing those rates with other reports. DESIGN AND PARTICIPANTS: Retrospective descriptive study using data provided by Safe Work Australia for the period 2000-2010. The subjects were paramedics who had been injured in the course of their duties and for whom a claim had been made for workers compensation payments. MAIN OUTCOME MEASURES: Rates of injury calculated from the data provided. RESULTS: The risk of serious injury among Australian paramedics was found to be more than seven times higher than the Australian national average. The fatality rate for paramedics was about six times higher than the national average [corrected].On average, every 2 years during the study period, one paramedic died and 30 were seriously injured in vehicle crashes. Ten Australian paramedics were seriously injured each year as a result of an assault. The injury rate for paramedics was more than two times higher than the rate for police officers. CONCLUSIONS: The high rate of occupational injuries and fatalities among paramedics is a serious public health issue. The risk of injury in Australia is similar to that in the United States. While it may be anticipated that injury rates would be higher as a result of the nature of the work and environment of paramedics, further research is necessary to identify and validate the strategies required to minimise the rates of occupational injury for paramedics.

Injuries and fatalities among emergency medical technicians and paramedics in the United States.

INTRODUCTION: Emergency medical services personnel treat 22 million patients a year, yet little is known of their risk of injury and fatality. PROBLEM: Work-related injury and fatality rates among US paramedics and emergency medical technicians (EMTs) are higher than the national average for all occupations. METHODS: Data collected by the Department of Labor (DOL) Bureau of Labor Statistics were reviewed to identify injuries and fatalities among EMTs and paramedics from 2003 through 2007. The characteristics of fatal injuries are described and the rates and relative risks of the non-fatal injuries were calculated and compared to the national average. RESULTS: Of the 21,749 reported cases, 21,690 involved non-fatal injuries or illnesses that resulted in lost work days among EMTs and paramedics within the private sector. Of the injuries, 3,710 (17%) resulted in ≥31 days of lost work time. A total of 14,470 cases (67%) involved sprains or strains; back injury was reported in 9,290 of the cases (43%); and the patient was listed as the source of injury in 7,960 (37%) cases. The most common events were overexertion (12,146, 56%), falls (2,169, 10%), and transportation-related (1,940, 9%). A total of 530 assaults were reported during the study period. Forty-five percent of the cases occurred among females (females accounted for 27% of employment in this occupation during 2007). In 2007, EMTs and paramedics suffered 349.9 injuries with days away from work per 10,000 full-time workers, compared to an average of 122.2 for all private industry occupations (Relative risk = 2.9; 95% CI: 2.7-3.0). During the study period, 59 fatalities occurred among EMTs and paramedics in both the private industry and in the public sector. Of those fatalities, 51 (86%) were transportation-related and five (8%) were assaults; 33 (56%) were classified as "multiple traumatic injuries." CONCLUSIONS: Data from the DOL show that EMTs and paramedics have a rate of injury that is about three times the national average for all occupations. The vast majority of fatalities are secondary to transportation related-incidents. Assaults are also identified as a significant cause of fatality. The findings also indicate that females in this occupational group may have a disproportionately larger number of injuries. Support is recommended for further research related to causal factors and for the development, evaluation and promulgation of evidence-based interventions to mitigate this problem.

Methicillin-resistant staphylococcus aureus nasal colonization prevalence among Emergency Medical Services personnel.

INTRODUCTION: The prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization among Emergency Medical Services (EMS) personnel is not well studied. Methicillin-resistant Staphylococcus aureus colonization can be a health hazard for both EMS personnel and patients. The aim of this study was to quantify the prevalence of MRSA colonization among EMS personnel. This study will help the scientific community understand the extent of this condition so that further protocols and policies can be developed to support the health and wellbeing of EMS personnel. Hypothesis/ Problem The hypothesis of this study was that the prevalence of MRSA colonization among EMS personnel is significantly higher than among the general population. METHODS: This was a cross-sectional study. A total of 110 subjects were selected from two major US Mid-Atlantic fire departments. Methicillin-resistant Staphylococcus aureus colonization was detected by nasal swabbing. Nasal swabs were inoculated onto a special agar medium (C-MRSAgar) with polymerase chain reaction testing performed. One-sided binomial distribution at the Study Size 2.0 Web calculator was used. Using the Web calculator, p (H0 proportion) = 1.5%; a difference (H1-H0) 'Δ' = 4.53% can be detected at α = 5% and power = 80% with N = 110. RESULTS: Samples were collected from 110 volunteers. Seven samples were positive for MRSA, resulting in a prevalence of 7/110 or 6.4% (95% CI, 1.8%-11%; P < .0003) compared with a 1.5% prevalence of MRSA colonization among the general population. CONCLUSION: There is evidence that EMS personnel have a higher prevalence of MRSA colonization than the general population. This can be a risk to patients and can be recognized as an occupational hazard.

Transportation-related injuries and fatalities among emergency medical technicians and paramedics.

INTRODUCTION: This is the first study using national data to evaluate transportation risks among emergency medical technicians (EMTs) and paramedics (to be referred to hereafter as "EMTs") in the United States. HYPOTHESIS: This epidemiological study compares the transportation risks for EMTs to the transportation risks for all workers in the US. METHODS: The rates, relative risks, and proportions associated with the 1,050 injury cases with lost work days, and 30 fatalities resulting from transportation incidents occurring to EMTs in the US between 2006 and 2008 are described. RESULTS: The risk of transportation-related injury for EMTs in the US is about five times higher than the national average. Females were the victims in 53% of the cases yet females only accounted for about 27% of employment in this occupation. Twenty percent of cases resulted in 31 or more lost work days. There were 30 transportation related fatalities. CONCLUSIONS: The US national EMS system is built on the premise of having an unlimited supply of 20 year olds interested in, and dedicated to, the provision of EMS care. Not only do we not have an unlimited supply of 20 year olds, we may be rapidly losing our current workforce through clearly preventable risks such as transportation incidents.Emergency medical services workers face a rate of occupational injury that is much higher than the national average and transportation-related events are a significant component of that risk. Resources must be devoted to further research, and to the development and evaluation of interventions designed to mitigate these transportation-related hazards.

Epidemic and bioterrorism preparation among emergency medical services systems.

INTRODUCTION: The purpose of this research was to determine the preparedness of emergency medical services (EMS) agencies in one US state to cope with a massive epidemic event. METHODS: Data were collected primarily through telephone interviews with EMS officials throughout the State. To provide a comparison, nine out-of-state emergency services agencies were invited to participate. RESULTS: Emergency medical services agencies from nine of the 23 counties (39%) provided responses to some or all of the questions in the telephone survey. Seven of the nine out-of-state agencies provided responses to the survey. Most of the EMS agencies do not have broad, formal plans for response to large-scale bio-terrorist or pandemic events. CONCLUSIONS: The findings indicate that EMS agencies in this state fundamentally are unprepared for a large-scale bioterrorism or pandemic event. The few existing plans rely heavily on mutual aid from agencies that may be incapable of providing such aid. Therefore, EMS agencies must be prepared to manage a response to these incidents without assistance from any agencies outside of their local community. In order to accomplish this, they must begin planning and develop close working relationships with public health, healthcare, and elected officials within their local communities.

Occupational injuries among emergency medical services personnel.

BACKGROUND: Emergency medical services (EMS) personnel treat 22 million patients a year in the United States, yet little is known of their injury risks. OBJECTIVES: To describe the epidemiology of occupational injuries among EMS personnel, calculate injury rates, and compare the findings with those for other occupational groups. METHODS: This was a retrospective review of injury records kept by two urban agencies. The agencies submitted all 617 case reports for three periods between January 1, 1998, and July 15, 2002. The agency personnel worked an estimated 2,829,906 hours during the study periods. Cases were coded according to U.S. Department of Labor (DOL) criteria. RESULTS: Four hundred eighty-nine cases met the DOL inclusion criteria. The overall injury rate was 34.6 per 100 full-time (FT) workers per year (95% confidence interval [CI] 31.5-37.6). "Sprains, strains, and tears" was the leading category of injury; the back was the body part most often injured. Of the 489 cases, 277 (57%) resulted in lost workdays, resulting in a rate of 19.6 (95% CI 17.3-21.9) per 100 FT workers; in comparison, the relative risks for EMS workers were 1.5 (95% CI 1.35-1.72) compared with firefighters, 5.8 (95% CI 5.12-6.49) compared with health services personnel, and 7.0 (95% CI 6.22-7.87) compared with the national average. CONCLUSIONS: The injury rates for EMS workers are higher than rates reported by DOL for any industry in 2000. Funding and additional research are critical to further defining the high risks to EMS workers and developing interventions to mitigate this serious problem.