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A review of infectious disease epidemiology in emergency medical service clinicians

Published:December 09, 2022DOI:https://doi.org/10.1016/j.ajic.2022.12.001

      Highlights

      • There is limited available evidence on EMS providers’ exposure and infection.
      • COVID-19 is the most common infectious disease studied among EMS providers.
      • Few studies showed infection differences between age, race, gender, or work characteristics.

      Abstract

      Background

      The emergency medical service (EMS) workforce is at high risk of occupationally-acquired infections. This review synthesized existing literature on the prevalence, incidence, and severity of infections in the EMS workforce.

      Methods

      We searched PubMed, Embase, CINAHL, and SCOPUS from January 1, 2006 to March 15, 2022 for studies in the US that involved EMS clinician or firefighter populations and reported 1 or more health outcomes related to occupationally-acquired infections.

      Results

      Of the 25 studies that met the inclusion criteria, most focused on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with prevalence rates ranging from 1.1% to 36.2% (median 6.7%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in 4 studies ranged from 1.9% to 6.4%, and the prevalence of Hepatitis C in 1 study was 1.3%. Few studies reported incidence rates. The prevalence or incidence of these infections generally did not differ by age or gender, but 4 studies reported differences by race or ethnicity. In the 4 studies that compared infection rates between EMS clinicians and firefighters, EMS clinicians had a higher chance of hospitalization or death from SAR-CoV-2 (odds ratio 4.23), a higher prevalence of Hepatitis C in another study (odds ratio 1.74), and no significant difference in MRSA colonization in a separate study.

      Conclusions

      More research is needed to better characterize the incidence and severity of occupationally-acquired infections in the EMS workforce.

      Key Words

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      References

        • Roline CE
        • Crumpecker C
        • Dunn TM.
        Can methicillin-resistant Staphylococcus aureus be found in an ambulance fleet?.
        Prehosp Emerg Care. 2007; 11: 241-244
        • Brown R
        • Minnon J
        • Schneider S
        • Vaughn J.
        Prevalence of methicillin-resistant Staphylococcus aureus in ambulances in southern Maine.
        Prehosp Emerg Care. 2010; 14: 176-181
        • Bledsoe BE
        • Sweeney RJ
        • Berkeley RP
        • Cole KT
        • Forred WJ
        • Johnson LD.
        EMS provider compliance with infection control recommendations is suboptimal.
        Prehosp Emerg Care. 2014; 18: 290-294
        • Teter J
        • Millin MG
        • Bissell R.
        Hand hygiene in emergency medical services.
        Prehosp Emerg Care. 2015; 19: 313-319
        • Bitely C
        • Miller B
        • Glauser J.
        EMS disease exposure, transmission, and prevention: a review article.
        Curr Emerg Hosp Med Rep. 2019; 7: 135-140
      1. Jenkins JL, Hsu EB, Russell A, Zhang A, Wilson LM, Bass EB. Infection Prevention and Control for the Emergency Medical Services and 911 Workforce. [Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 75Q80120D00003.] Rockville, MD: Agency for Healthcare Research and Quality; In Press.

        • Thomas BH
        • Ciliska D
        • Dobbins M
        • Micucci S.
        A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions.
        Worldviews Evid Based nurs. 2004; 1: 176-184
        • Newcombe RG.
        Two-sided confidence intervals for the single proportion: comparison of seven methods.
        Stat Med. 1998; 17: 857-872
        • Akinbami LJ
        • Vuong N
        • Petersen LR
        • et al.
        SARS-CoV-2 seroprevalence among healthcare, first response, and public safety personnel, detroit metropolitan area, michigan, USA, May-June 2020.
        Emerg Infect Dis. 2020; 26: 2863-2871
        • Al Amiry A
        • Bissell RA
        • Maguire BJ
        • Alves DW
        Methicillin-resistant staphylococcus aureus nasal colonization prevalence among emergency medical services personnel.
        Prehosp Disaster Med. 2013; 28: 348-352
        • Caban-Martinez AJ
        • Schaefer-Solle N
        • Santiago K
        • et al.
        Epidemiology of SARS-CoV-2 antibodies among firefighters/paramedics of a US fire department: a cross-sectional study.
        Occup Environ Med. 2020; 77: 857-861
      2. Caban-Martinez AJ, Gaglani M, Olsho LEW, et al. High burden of COVID-19 among unvaccinated law enforcement officers and firefighters. 2021. Accessed December 21, 2022. https://www.medrxiv.org/content/10.1101/2021.11.24.21266396v2

        • El Sayed M
        • Kue R
        • McNeil C
        • Dyer KS
        A descriptive analysis of occupational health exposures in an urban emergency medical services system: 2007-2009.
        Prehosp Emerg Care. 2011; 15: 506-510
        • Elie-Turenne MC
        • Fernandes H
        • Mediavilla JR
        • et al.
        Prevalence and characteristics of Staphylococcus aureus colonization among healthcare professionals in an urban teaching hospital.
        Infect Control Hosp Epidemiol. 2010; 31: 574-580
        • Ellingson KD
        • Gerald JK
        • Xiaoxiao S
        • et al.
        Incidence of SARS-CoV-2 infection among health care personnel, first responders, and other essential workers during a prevaccination COVID-19 surge in Arizona.
        JAMA Health Forum. 2021; 2: 1-10
        • Firew T
        • Sano ED
        • Lee JW
        • et al.
        Protecting the front line: a cross-sectional survey analysis of the occupational factors contributing to healthcare workers' infection and psychological distress during the COVID-19 pandemic in the USA.
        BMJ Open. 2020; 10e042752
        • Grant M
        • Harrison R
        • Nuñez A
        • et al.
        Seroprevalence of SARS-CoV-2 among firefighters/paramedics in San Francisco, CA.
        J Occup Environ Med. 2021; 63: e807-ee12
        • Harris SA
        • Nicolai LA.
        Occupational exposures in emergency medical service providers and knowledge of and compliance with universal precautions.
        Am J Infect Control. 2010; 38: 86-94
        • McGuire SS
        • Klassen AB
        • Heywood J
        • Sztajnkrycer MD.
        Prevalence of COVID-19 IgG antibodies in a cohort of municipal first responders.
        Prehosp Disaster Med. 2021; 36: 131-134
        • Mohanty S
        • Lakkireddy D
        • Trivedi C
        • et al.
        Creating a safe workplace by universal testing of SARS-CoV-2 infection in asymptomatic patients and healthcare workers in the electrophysiology units: a multi-center experience.
        J Interv Card Electrophysiol. 2021; 62: 171-176
        • Montague BT
        • Wipperman MF
        • Hooper AT
        • et al.
        Anti-SARS-CoV-2 IgA identifies asymptomatic infection in first responders.
        J Infect Dis. 2022; 225: 578-586
        • Mulligan K
        • Berg AH
        • Eckstein M
        • et al.
        SARS-CoV-2 seroprevalence among firefighters in Los Angeles, California.
        Occup Environ Med. 2022; 79: 315-318
        • Murphy DL
        • Barnard LM
        • Drucker CJ
        • et al.
        Occupational exposures and programmatic response to COVID-19 pandemic: an emergency medical services experience.
        Emerg Med J: EMJ. 2020; 37: 707-713
      3. Newberry JA, Gautreau M, Staats K, et al. SARS-CoV-2 IgG seropositivity and acute asymptomatic infection rate among firefighter first responders in an early outbreak county in california. Prehosp Emerg Care. Published online May 6, 2021. https://doi.org/10.1080/10903127.2021.1912227.

        • Orellana RC
        • Hoet AE
        • Bell C
        • et al.
        Methicillin-resistant Staphylococcus aureus in Ohio EMS Providers: a statewide cross-sectional study.
        Prehosp Emerg Care. 2016; 20: 184-190
        • Prezant DJ
        • Zeig-Owens R
        • Schwartz T
        • et al.
        Medical leave associated with COVID-19 among emergency medical system responders and firefighters in New York City.
        JAMA Network Open. 2020; 3e2016094
        • Sami S
        • Akinbami LJ
        • Petersen LR
        • et al.
        Prevalence of SARS-CoV-2 antibodies in first responders and public safety personnel, New York City, New York, USA, May-July 2020.
        Emerg Infect Dis. 2021; 27: 796-804
        • Shukla V
        • Lau CSM
        • Towns M
        • et al.
        COVID-19 exposure among first responders in Arizona.
        J Occup Environ Med. 2020; 62: 981-985
        • Shukla V
        • Johns J
        • Lau CSM
        • et al.
        Prevalence of COVID-19 amongst Arizona first responders.
        Biomesip. 2021; 12940 (LNCS): 371-379
        • Tarabichi Y
        • Watts B
        • Collins T
        • et al.
        SARS-CoV-2 infection among serially tested emergency medical services workers.
        Prehosp Emerg Care. 2021; 25: 39-45
        • Vieira V
        • Tang IW
        • Bartell S
        • Zahn M
        • Fedoruk MJ.
        SARS-CoV-2 antibody seroprevalence among firefighters in Orange County, California.
        Occup Environ Med. 2021; 78: 789-792
        • Webber MP
        • Liu Y
        • Cohen HW
        • et al.
        Incidence and prevalence of antibody to hepatitis C virus in FDNY first responders before and after work at the World Trade Center disaster site.
        Am J Ind Med. 2018; 61: 733-740
        • Weiden MD
        • Zeig-Owens R
        • Singh A
        • et al.
        Pre-COVID-19 lung function and other risk factors for severe COVID-19 in first responders.
        ERJ Open Res. 2021; 7: 00610-02020
      4. 2020 National Emergency Medical Services Assessment.
        National Association of State EMS Officials, Falls Church, VA2020