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In the USA, terrorist threats captured government attention following 11 September 2001. Cities remain the most likely setting for terrorist incidents. Many cities, building on a successful federal program begun in 1997, have developed metropolitan medical response systems (MMRS) to address the consequences of terrorist incidents. The basic system design has been tested both through drills and incidents – including the attacks on the World Trade Center – and appears to function well. This paper describes the philosophy and elements of the MMRS model. The model has considerable value as a readily exportable strategy for responding to municipal terrorist incidents.

A very limited number of studies have explored factors related to emergency medical services (EMS) workers leaving their jobs and the profession. This paper aims to investigate the correlates of intent to leave EMS jobs and the profession and compared two types of workers: emergency medical technicians (EMTs) and paramedics.

A national sample of 308 EMTs and 625 paramedics responded to a cross‐sectional survey. Independent variables were personal, job related, and work attitudes (job satisfaction). Outcomes were intent to leave job and profession. Analytic methods included factor analysis, t‐tests, correlation, and hierarchical regression.

Factor analysis identified a five‐item intrinsic job satisfaction measure and a four‐item extrinsic job satisfaction measure across both samples. Contrary to what hypothesis one predicted, paramedics had lower extrinsic job satisfaction than EMTs. There was no difference between these two groups on intrinsic job satisfaction. Consistent with the second hypothesis, after controlling for personal and job‐related perceptions, extrinsic job satisfaction was negatively related to intent to leave job and profession for both EMTs and paramedics. However, intrinsic job satisfaction was negatively related only to intent to leave the profession for paramedics.

Future research efforts might utilize stronger measures and incorporate longitudinal methodologies to further explore the career intention of EMS workers and similar occupational groups.

This paper examines job satisfaction and job and career intentions in a rarely studied occupation that provides critical prehospital emergency care to the population.

This paper's aim is to study a neglected relationship: testing the impact of emotional labor on the work exhaustion for samples of emergency medical service (EMS) professionals.

Three distinct samples of EMS professionals, i.e. emergency medical technician (EMT) – basic, EMT – intermediate, and paramedic, were surveyed to test the impact of three variable sets, personal (e.g. gender, age, health), work‐related (e.g. years of service, job satisfaction), and emotional labor (i.e. surface acting, deep acting) on work exhaustion.

Results across the three samples consistently showed that surface acting had a significantly stronger positive impact than deep acting on work exhaustion. In addition it was found that surface acting had a significantly stronger negative relationship to job satisfaction than deep acting. Surface acting also had a significant negative relationship to perceived health. Years of service were positively related to work exhaustion across all samples, while job satisfaction was negatively related.

Work exhaustion is an occupational risk for EMS professionals. Individuals considering EMS as a career must have realistic expectations and information about the rewards as well as challenges facing them. To help buffer the impact of emotional labor on work exhaustion and related outcomes, EMS stakeholders should consider facilitating mentor and/or peer support group programs to enhance the development of stronger camaraderie in different EMS‐based organizations (e.g. hospitals, fire services).

Prior research has not tested for the impact of emotional labor on work exhaustion for EMS professionals. Even after controlling for personal and work‐related variables, surface acting maintained a stronger positive impact than deep acting on work exhaustion. Key demographics for each of the three samples (type of work, community size, gender) indicate representativeness to previous cohort samples of nationally certified EMS professionals.

The research is an administrative case study based on an extensive review of Hawaii government documents and interviews with key personnel of the Hawaii Emergency Preparedness Committee, civil defense and other relevant officials. Describes the interagency coordination at the federal, state, county, and community level to improve capability. Also described and critically evaluated are the roles of interagency emergency preparedness training, disaster drills, and coordination and partnership with the private sector, such as medical centers and the Federal Emergency Management Agency’s designated “disaster resistant communities” in Maui and Hawaii County. Recommends that more frequent interagency drills, increased funding for family emergency preparedness and local community response teams, and continuous training by emergency response coordinators could improve state and county disaster preparedness and concludes that, overall, Hawaii is adequately prepared in emergency response capability, particularly in the areas of medical services and interagency coordination.

The uniqueness of the pre-hospital setting and the need for quick decision-making confronts pre-hospital emergency personnel with various moral conflicts that can lead to moral distress (MD) in them. This study aimed to design a valid scale for the assessment of MD in emergency medical service (EMS) staff.

This exploratory mixed-method study was conducted among the EMS provider's community. In the qualitative section, data were gathered and analyzed with semi-structured interviews and conventional content analysis, respectively. The initial pool of items was formed and the primary scale was designed. In the quantitative section, a methodological study was carried out to determine the psychometric properties of the scale including qualitative-quantitative face validity, qualitative-quantitative content validity with content validity ratio and index (CVR/CVI), construct validity by exploratory factor analysis (EFA), and convergent validity, internal consistency (Cronbach's alpha/ Omega McDonald's/ floor and ceiling effect) and stability with intra-class correlation (ICC).

After interviews with 14 emergency technicians, the initial scale was designed with 60 items. Of the total items, 17 poor items were dropped during face and qualitative content validity. In the content validity phase, the items with CVR > 0.62, modified Kappa > 0.74 were retained, which eliminated 23 items. EFA was conducted with 20 items and lead to the 5 factors. The floor and ceiling effect for the whole scale was zero. Finally, the reliability of the scale was confirmed (a = 0.83, O = 0.86, ICC = 0.95).

The developed 20-item scale is a valid and reliable scale for the assessment of the MD in EMS providers.

Simple Triage and Rapid Treatment (START) is a unique triage system used by prehospital providers during disasters to quickly categorize and prioritize patient care according to severity. This study aims at evaluating knowledge about the START triage system among field emergency medical service (EMS) personnel working at the Saudi Red Crescent Authority (SRCA) in the stations of the city of Riyadh.

This is a cross-sectional study that examined data collected from August 2019 to January 2020. The statistical population is from all field EMS personnel working in the SRCA located in Riyadh, Saudi Arabia. Using simple random sampling, 239 field EMS personnel were assessed, and 235 completed the study (98.3% response rate). Data were collected electronically using demographics and 15 multiple choice emergency scenarios based on the START protocol.

The mean correct score is 8.21 ± 3.36 out of 15 questions of triage knowledge (score of 0–15 points), indicating that those respondents have moderate knowledge levels on the START triage tool. Physicians and paramedics have higher mean scores (10.13 ± 3.42 and 9.07 ± 3.22, respectively), which are significantly higher than emergency medical technicians and nurses (7.25 ± 3.15 and 5.63 ± 2.72, respectively; p < 0.05). The providers who attended the training course had higher mean scores (p < 0.05).

Based on the results of the study, field EMS personnel did not reflect full knowledge of START triage tool. An interdisciplinary approach that adopts reinforcement education and periodical training courses is highly recommended to improve the respondents' performance and productivity. Moreover, there was a noticeable correlation between performance of respondents on the one hand and their education levels and prior training on the other hand.

Most rescue squad members, both in the city and in rural areas, serve on a volunteer (unpaid) basis. It has been widely reported and observed that the number of Emergency Medical Technician (EMT) volunteers is falling in communities across the USA. Meanwhile, internationally, the need for emergency services volunteers is increasing as government support dwindles in these uncertain economic times. The purpose of this paper is to determine how to keep EMT volunteerism at desired levels and provide recommendations for increasing recruitment and retention.

The paper examines what motivates people and why people volunteer in general, beginning with a discussion of citizenship participation and international EMS, then reviewing general and volunteer motivation theories, and finally focusing on volunteer EMT motivation/retention theories in particular. Research studies in two diverse locations (one urban, one rural) are then implemented to survey volunteer EMT motivations and priorities, to find what stimulates EMTs to join and continue to participate in rescue squad operations.

Theoretical explanations and research results are analyzed to determine the implications for both recruitment and retention of volunteer EMTs.

Based on these findings, the remainder of the article is dedicated to the practical application of strategies which are easily implemented and cost‐effective for any volunteer EMT organization, regardless of locale or country of origin. Utilization of these strategies is both timely and relevant, because few communities' operational budgets can absorb the costs of hiring additional professional EMTs.

This study was designed to examine burnout in US emergency medical services (EMS) providers. It examined burnout scores measured using the Maslach Burnout Inventory (MBI) on a convince sample of US EMS providers as well individual variables associated of burnout in this population.

This study used a convince sample, recruited using social media, of EMTs and paramedics and engaged them in an online survey to obtain information on burnout in this population. The responses were analyzed using stand statistical approached in order to determine MBI burnout scores, as well as which individual variables were influential in contributing to burnout in EMS.

This study found that most EMS providers had high levels of depersonalization and medium levels of personal accomplishment and emotional exhaustion. Gender differences were found as they were differences based on agency type and response area.

The main limitation is the nature of sample recruitment. The use of social media for the recruitment of this type of study has not been done before. Furthermore, it is a convince sample. This issue has limited impact on the results and the ability to apply them more generally because despite the convince nature of this sample, the sample is similar to those used in other studies as well as reflect that national statistics on the make of this population. The second major limitation of this study is that it does not include job specific and organization specific factors that may contribute to burnout. The findings for the variables used in this study suggest that future works should encompass these variables as well.

This study sets a clear foundation for further examination of US EMS providers and burnout. It helps to establish key ideas that can be followed up. Difference and key issues among US EMS providers need to be understood on a more comprehensive level before the assertion that they are similar to EMS providers worldwide. Ultimately, there is a need to develop better screening tools to assess burnout in EMS as well as to develop prevention and intervention programs based on clear empirical data.

Burnout EMS provides are a harm to themselves as well as the organization that employ them. The cost of burnout EMS provider crosses over to patient care and provision of care.

This study is one of the first to examine such a large US-based sample of EMS providers using the MBI. Other studies have used smaller sample or other tools to assess burnout in providers

The purpose of this paper is to examine emergency medical service (EMS) personnel’s perceptions and experiences of managing underground mining injury incidents.

In total, 13 EMS personnel were interviewed according to a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using qualitative content analysis.

An underground mining environment was described as unfamiliar and unsafe and, with no guidelines for operational actions in an extreme environment, such as underground mines, the EMS personnel were uncertain of their role. They therefore became passive and relied on the rescue service and mining company during a major incident. However, the medical care was not considered to be different from any other prehospital care, although a mining environment would make the situation more difficult and it would take longer for the mine workers to be placed under definitive care.

This study complements earlier studies by examining the EMS personnel’s perceptions and experiences of major incidents.