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Infection Prevention and Control for the Emergency Medical Services and 911 Workforce

Technical Brief Nov 1, 2022
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  • Emergency medical service (EMS) workers appear to be at higher risk of infection when compared to firefighters and other frontline emergency personnel.
  • Little research exists on infectious diseases in 911 dispatchers and telecommunicators.
  • Research studies on infectious diseases in the EMS and 911 workforce have increased significantly since the beginning of the coronavirus disease 2019 (COVID-19) pandemic.
  • Most research since 2006 has concentrated on the epidemiology of infections and infection risk.
  • Research into the field effectiveness of N95 respirator and surgical face mask personal protective equipment (PPE) is limited, especially in the arena of airborne diseases.
  • Regular hand hygiene decreases the spread of methicillin-resistant Staphylococcus aureus (MRSA).
  • Standard precautions, such as gloves, decrease the chance of needlestick exposures.
  • Vaccine uptake increases with the application of on-site directed clinics in the workforce, especially when combined with an active, targeted educational program with supervisor and peer support.
  • Mandatory influenza vaccine programs increase the likelihood of vaccine uptake.
  • Research into EMS and 911 infectious disease issues would be strengthened by a national research agenda including improved data uniformity, use of appropriate comparison groups, and comparable outcome measures.

Objectives. To summarize current evidence on exposures to infectious pathogens in the emergency medical services (EMS) and 911 workforce, and on practices for preventing, recognizing, and controlling occupationally acquired infectious diseases and related exposures in that workforce.

Review methods. We obtained advice on how to answer four Guiding Questions by recruiting a panel of external experts on EMS clinicians, State-level EMS leadership, and programs relevant to EMS personnel, and by engaging representatives of professional societies in infectious diseases and emergency medicine. We searched PubMed®, Embase®, CINAHL®, and SCOPUS from January 2006 to March 2022 for relevant studies. We also searched for reports from State and Federal Government agencies or nongovernmental organizations interested in infection prevention and control in the EMS and 911 workforce.

Results. Twenty-five observational studies reported on the epidemiology of infections in the EMS and 911 workforce. They did not report demographic differences except for a higher risk of hepatitis C in older workers and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in minorities. EMS clinicians certified/licensed in Advanced Life Support have a high risk for blood and fluid exposure, and EMS clinicians had a higher risk of hospitalization or death from SARS-CoV-2 than firefighters whose roles were not primarily related to medical care. Eleven observational studies reported on infection prevention and control practices (IPC), providing some evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Research on IPC in EMS and 911 workers has increased significantly since the SARS-CoV-2 pandemic.

Conclusions. Moderate evidence exists on the epidemiology of infections and effectiveness of IPC practices in EMS and 911 workers, including hand hygiene, standard precautions, mandatory vaccine policies, and vaccine clinics. Most evidence is observational, with widely varying methods, outcomes, and reporting. More research is needed on personal protective equipment effectiveness and vaccine acceptance, and better guidance is needed for research methods in the EMS and 911 worker setting.

Jenkins JL, Hsu EB, Zhang A, et al. Current evidence for infection prevention and control interventions in emergency medical services: a scoping review. Prehosp Disaster Med. 2023 Mar 29:1-7. [Epub ahead of print.] PMID: 36987848. doi: 10.1017/S1049023X23000389.

Russell A, Jenkins JL, Zhang A, et al. A review of infectious disease epidemiology in emergency medical service clinicians. Am J Infect Control. 2022 Dec 10: S0196-6553(22)00846-X. [Epub ahead of print.] PMID: 36509183. doi: 10.1016/j.ajic.2022.12.001.

Jenkins JL, Hsu EB, Russell A, Zhang A, Wilson LM, Bass EB. Infection Prevention and Control for the Emergency Medical Services and 911 Workforce. Technical Brief No. 42. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 75Q80120D00003.) AHRQ Publication No. 22(23)-EHC039. Rockville, MD: Agency for Healthcare Research and Quality; November 2022. DOI: https://doi.org/10.23970/AHRQEPCTB42. Posted final reports are located on the Effective Health Care Program search page.

Project Timeline

EMS/911 Workforce Infection Control

Sep 15, 2021
Topic Initiated
Nov 23, 2021
Nov 1, 2022
Technical Brief
Page last reviewed April 2023
Page originally created November 2022

Internet Citation: Technical Brief: Infection Prevention and Control for the Emergency Medical Services and 911 Workforce. Content last reviewed April 2023. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.

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