Emergency medical service (EMS) providers are on the front lines during disasters and public health emergencies. They are the emergency medical technicians (EMTs) and paramedics that provide medical and trauma care to patients in their homes, businesses and broader society, and those who whisk us to the hospital when the need arises.

As a community, we rely on them as a portal to the larger health care system.

But, do EMS providers ever hesitate to report to work?

University of Delaware Associate Professor Joseph Trainor and alumnus Mahmoud T. Alwidyan have co-written a paper in Disaster Medicine and Public Health Preparedness on the attitudes of EMS providers about working during pandemic disasters.

Trainor is an affiliated researcher with UD’s Disaster Research Center (DRC), the oldest center in the world focused on the social and management aspects of disaster. He also directs the disaster science and management degree program, a specialty degree within the Joseph R. Biden School of Public Policy and Administration and delivered in partnership with the DRC  and other departments on campus to train the future workforce in this area.

The paper’s lead author, Alwidyan earned his doctorate in disaster science and management at UD in 2017, and now is an assistant professor of applied medical sciences at Jordan University of Science and Technology (JUST) in Irbid, Jordan. Alaa Oteir, also an assistant professor of applied medical sciences at JUST and adjunct lecturer in the Department of Paramedicine at Monash University in Melbourne, Australia, also is a co-author.

In 2018, the research team surveyed EMS providers in Jordan to assess their attitudes about reporting to work during a disease outbreak and factors that affected their decisions.

The study — based on a hypothetical scenario — found Jordanian EMS providers were most willing to come to work when they felt confident that employers would provide adequate personal protective equipment, and when they had the necessary knowledge and training for disease outbreaks.

The most important barrier against going to work was family safety.

Hypothetical scenario

Survey participants were given a hypothetical disease outbreak scenario — eerily similar to the coronavirus (COVID-19) pandemic— indicating that a disease outbreak was unfolding in a country outside of Jordan. Limited information was available beyond early reports that the outbreak was an airborne disease with flu-like symptoms that were associated with high mortality.

Of the Jordanian EMS providers surveyed, 71.1% reported that they were willing to come to work during disease outbreaks despite any concerns for their individual or family’s safety. Over two-thirds of respondents were confident that their employer would do their job to keep the workers safe. Jordan’s EMS system is managed by the Jordanian Civil Defense, a quasi-military system.

Interestingly, when it came to what EMS providers prioritized during a disease outbreak, the study showed that work obligation came first (45.3%), followed by family safety (29.2%) and their personal safety (25.5%). That said, those who were confident that their employers would provide PPE were four times more likely to report to work than those who were not confident.

“Concerns for family safety and a shortage in PPE were found to be the major barriers for fulfilling their duties,” said Alwidyan.

The current study grew out of Alwidyan’s dissertation work at UD, which focused on EMS response during pandemic, and was grounded in a 2011 report titled “Reporting for Duty,” by Trainor and a team of graduate students in UD’s disaster science and management degree program that studied factors that influence if critical workers would consider abandoning their posts during crises.

The researchers noted at the time that their data was limited, and that the study results should be considered with caution, since a simple case scenario cannot account for coincidental situations that might occur in real disease outbreaks.

Two years later, in 2019, the team published a separate study comparing natural disasters and pandemic. In that study EMS workers showed willingness and even excitement to be on the frontlines during natural disasters. But when asked about working during pandemic, EMS workers show hesitancy and uncertainty, reflecting similar concerns for the health and safety of their families.

“This is really important,” said Trainor. “Up until the COVID-19 event, there have been a limited number of real-life, large-scale, virulent, uncertain events in which to study this phenomenon. A lot of what’s been done have been surveys asking people to imagine a scenario that, up until about three months ago, was a lot harder to see as a real thing.”

During the current COVID-19 pandemic, Trainor said it is important to note that people are reporting to work. And as his previous research suggested a decade ago, communicating with employees in advance about expectations and providing proper equipment (PPE) and training are key. This aligns with what has been reported in the mainstream news media during the current pandemic.

For Trainor, it was the 2009 H1N1 virus, known early on as the swine flu, that brought home the need for advanced preparation and planning. UD was among the first universities in 2009 to be affected by H1N1 and, as such, worked closely with Delaware’s Emergency Management Agency and the Centers for Disease Control to create an approach for managing H1N1 on campuses that has informed the way we think about university settings and disease outbreaks.

On April 1, 2020, Alwidyan replicated the 2018 study through an online survey of EMS providers, nurses and physicians, to capture data during the COVID-19 pandemic. While he’s still analyzing the data, early indications suggest that while a majority of health care workers would report to work, there may be differences between willingness to work and willingness to work directly with affected patients.

“This is definitely a new wrinkle to the science. It will be interesting to consider the implications of this,” said Trainor.

Challenges ahead

One issue unique to EMS providers is that in the field, the environment is constantly changing and hard to control. Remember, emergency medical technicians (EMTs), paramedics and other field providers go into the public, to people’s homes and businesses, to deliver care and transport patients back to health care facilities. Keeping workers safe is both important and challenging.

Alwidyan recalled the 2003 example of Canadian paramedics in Toronto who were exposed to severe acute respiratory syndrome, better known as SARS, after providing care in the community during an outbreak.

“More than 50% of the paramedics had been exposed and needed to be quarantined for two weeks, effectively knocking out over half of the paramedic workforce,” said Alwidyan.