This project sought to develop evidence-based guidelines for the administration of analgesics for moderate to severe pain by Emergency Medical Services (EMS) clinicians based on a separate, previously published, systematic review of the comparative effectiveness of analgesics in the prehospital setting prepared by the University of Connecticut Evidence-Based Practice Center for the Agency for Healthcare Research and Quality (AHRQ). A technical expert panel (TEP) was assembled consisting of subject matter experts in prehospital and emergency care, and the development of evidence-based guidelines and patient care guidelines. A series of nine “patient/population-intervention-comparison-outcome” (PICO) questions were developed based on the Key Questions identified in the AHRQ systematic review, and an additional PICO question was developed to specifically address analgesia in pediatric patients. The panel made a strong recommendation for the use of intranasal fentanyl over intravenous (IV) opioids for pediatric patients without intravenous access given the supporting evidence, its effectiveness, ease of administration, and acceptance by patients and providers. The panel made a conditional recommendation for the use of IV non-steroidal anti-inflammatory drugs (NSAIDs) over IV acetaminophen (APAP). The panel made conditional recommendations for the use of either IV ketamine or IV opioids; for either IV NSAIDs or IV opioids; for either IV fentanyl or IV morphine; and for either IV ketamine or IV NSAIDs. A conditional recommendation was made for IV APAP over IV opioids. The panel made a conditional recommendation against the use of weight-based IV ketamine in combination with weight-based IV opioids versus weight–based IV opioids alone. The panel considered the use of oral analgesics and a conditional recommendation was made for either oral APAP or oral NSAIDs when the oral route of administration was preferred. Given the lack of a supporting evidence base, the panel was unable to make recommendations for the use of nitrous oxide versus IV opioids, or for IV ketamine in combination with IV opioids versus IV ketamine alone. Taken together, the recommendations emphasize that EMS medical directors and EMS clinicians have a variety of effective options for the management of moderate to severe pain in addition to opioids when designing patient care guidelines and caring for patients suffering from acute pain.

Background: Immunizations for emergency medical services (EMS) professionals during pandemics are an important tool to increase the safety of the workforce as well as their patients. The purpose of this study was to better understand EMS professionals’ decisions to receive or decline a COVID-19 vaccine. Methods: We conducted a cross-sectional analysis of nationally certified EMS professionals (18–85 years) in April 2021. Participants received an electronic survey asking whether they received a vaccine, why or why not, and their associated beliefs using three validated scales: perceived risk of COVID-19, medical mistrust, and confidence in the COVID-19 vaccine. Data were merged with National Registry dataset demographics. Analyses included descriptive analysis and multivariable logistic regression (OR, 95% CI). Multivariate imputation by chained equations was used for missingness. Results: A total of 2,584 respondents satisfied inclusion criteria (response rate = 14%). Overall, 70% of EMS professionals were vaccinated. Common reasons for vaccination among vaccinated respondents were to protect oneself (76%) and others (73%). Common reasons for non-vaccination among non-vaccinated respondents included concerns about vaccine safety (53%) and beliefs that vaccination was not necessary (39%). Most who had not received the vaccine did not plan to get it in the future (84%). Hesitation was most frequently related to wanting to see how the vaccine was working for others (55%). Odds of COVID-19 vaccination were associated with demographics including age (referent 51 years: 2.22, 1.64–3.01), male sex (1.26, 1.01–1.58), residing in an urban/suburban area (referent rural; 1.36, 1.08–1.70), advanced education (referent GED/high school and below; bachelor’s and above: 1.72, 1.19–2.47), and working at a hospital (referent fire-based agency; 1.53, 1.04–2.24). Additionally, vaccination odds were significantly higher with greater perceived risk of COVID-19 (2.05, 1.68–2.50), and higher vaccine confidence (2.84, 2.40–3.36). Odds of vaccination were significantly lower with higher medical mistrust (0.54, 0.46–0.63). Conclusion: Despite vaccine availability, not all EMS professionals had been vaccinated. The decision to receive a COVID-19 vaccine was associated with demographics, beliefs regarding COVID-19 and the vaccine, and medical mistrust. Efforts to increase COVID-19 vaccination rates should emphasize the safety and efficacy of vaccines.

The adaptive immune response requires waves of T-cell clonal expansion on contact with pathogen and elimination after clearance of the source of antigen. However, lifelong persistent infections with common viruses cause chronic antigenic stimulation which takes its toll on adaptive immunity in late life. Chronic antigenic stress results in deregulation of the T-cell response and accumulation of anergic cells. Longitudinal studies of the elderly show that this impacts on survival. Identifying the nature of the defects in chronically-stimulated T-cells and protein bio-markers of these dysfunctional cells would help to understand age-associated compromised T-cell function (immunosenescence) and facilitate the development of targeted intervention strategies. The purpose of this work was to use surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS) to analyse proteins associated with T-cell senescence in order to identify potential bio-markers. Clonal populations of T-cells isolated from elderly octogenarian and centenarian donors were grown in vitro until senescence, and early passage and late passage (pre-senescent) cells were analysed using SELDI-TOF-MS ProteinChip arrays. Discriminant analysis identified several protein or peptide peaks in the region of 14.5–16.5 kDa that were associated with T-cell clone senescence. Human profilin-1, a ubiquitous protein associated with actin remodelling and cellular motility was unambiguously identified. Altered expression of profilin-1 in senescent T-cell clones was confirmed by Western blot analysis. Due to the proposed roles of profilin-1 in cellular survival, cytoskeleton remodelling, motility, and proliferation, it is hypothesised that differential expression of profilin-1 in ageing may contribute directly to immunosenescence.

Limited recent national data exist measuring burnout levels among emergency medical services (EMS) clinicians and the potential impact of burnout on workforce strength and stability. We aimed to measure current EMS burnout and its association with workforce-reducing factors. In April 2022, a random sample of nationally certified EMS clinicians was sent a survey that included the Copenhagen Burnout Inventory (CBI) to assess for burnout in 3 dimensions: personal, work-related, and patient-related. Descriptive statistics (count and percentage) and multivariable logistic regression (odds ratio [OR] and 95% CI) were used to identify and measure each domain of burnout and the relationship between these domains and workforce-reducing factors. From 1838 survey responses (9% response rate), prevalence of EMS burnout was high in the personal (52%), work-related (49%), and patient-related (23%) domains. Burnout was higher for paramedics than for emergency medical technicians across all domains. Higher odds of reporting 10 or more sick days was observed for those with personal (OR, 2.66; 95% CI, 1.70-4.15), work-related (OR, 1.99; 95% CI, 1.31-3.01), or patient-related burnout (OR, 1.85; 95% CI, 1.20-2.86). Higher odds of reporting likelihood to leave the EMS profession was observed for those with personal (OR, 3.06; 95% CI, 2.16-4.33), work-related (OR, 3.34; 95% CI, 2.35-4.74), or patient-related burnout (OR, 3.42; 95% CI, 2.39-4.90). Nationally certified EMS clinicians demonstrated high burnout in 2022. Combined with increased absenteeism and intent to leave the profession associated with these high levels of burnout, these findings suggest that a renewed and deliberate focus on EMS clinician well-being is needed to ensure job satisfaction and workforce stability.