Coping with difficulties faced in pre-hospital healthcare amid pandemics

EMS (Call number: 112 in Turkey) encompasses services provided by professional healthcare teams in case of diseases and injuries emerging acutely, accessed expediently following the event, using specialized equipment as necessary. The main purpose of this study is to determine the difficulties faced by 112 pre-hospital healthcare workers (HCWs) in the transfer of patients to hospital, during the COVID-19 pandemic period, and to examine ways to cope with these difficulties, with a case study method that examines unique cases. The study group of the research consists of Emergency Medical Technicians (EMTs) (n = 15; 30.6%), paramedics (n = 19; 38.8%) and doctors (n = 15; 30.6%). The forty-nine participants who comprise the study group were selected from ‘HCWs who worked in the ambulance service during the transportation of patients with COVID-19 to hospital’. Based on the narratives of the participants, two main themes were determined as difficulties experienced and strategies of coping with these difficulties. Under the theme of difficulties experienced, three subthemes and a total of thirty-one codes were created as problems originating from society, the system and the employee himself. The theme of the strategies used to cope with the difficulties experienced was determined under three subthemes; professional equipment and personal precautions, professional measures and system support. A total of twelve codes were created. The pandemic period has been a time when boundaries and durability have been questioned. The experience obtained during this period is a great knowledge base for future global and mass epidemics, attacks and disasters.

Pre-hospital; Healthcare workers; COVID-19; Difficulties; Coping strategy

[1] Boudreaux E, Mandry C. Sources of Stress among Emergency Med-ical Technicians (Part I): what does the Research Say? Prehospital and Disaster Medicine. 1996; 11: 296–301.

[2] Chen Q, Liang M, Li Y, Guo J, Fei D, Wang L, et al. Mental health care for medical staff in China during the COVID-19 outbreak. The Lancet Psychiatry. 2020; 7: e15–e16.

[3] Maguire BJ, O’Meara P, O’Neill BJ, Brightwell R. Violence against emergency medical services personnel: a systematic review of the literature. American Journal of Industrial Medicine. 2018; 61: 167–180.

[4] Bakanlığı S. 112 Acil Ambulans Sisteminin 25. yılı kutlandı [Internet] 2019. Available at: https://www.saglik.gov. tr/tr,59151/112-acil-ambulans-sisteminin-25-yilikutlandi.html (Accessed: 1 November 2020)

[5] Cresswell JW. Qualitative inquiry and research design: Choosing among five approaches. Sage: Thousand Oaks, CA. 2007.

[6] Yıldırım A, Şimşek H. Sosyal bilimlerde nitel araştırma yöntemleri. Seçkin Yayıncılık: Ankara. 2016. (In Turkish)

[7] Miles MB, Huberman AM. Qualitative data analysis: An expanded Sourcebook. 2nd edn. Sage: Thousand Oaks, CA. 1994.

[8] Goyal M, Ospel JM, Southerland AM, Wira C, Amin-Hanjani S, Fraser JF, et al. Prehospital Triage of Acute Stroke Patients during the COVID-19 Pandemic. Stroke. 2020; 51: 2263–2267.

[9] Hartmann S, Rubin Z, Sato H, OYong K, Terashita D, Balter S. Coronavirus 2019 (COVID-19) Infections Among Healthcare Workers, Los Angeles County, February - May 2020. Clinical Infectious Diseases. 2020. (in press)

[10] Pan American Health Organization. Epidemiological Alert COVID-19 Among Healthcare Workers 31 August 2020. 2020. Available at: https://www.paho.org/en/documents/epidemiological-alert-covid-19-among-health-workers-31-august-2020 (Accessed: 1 November 2020).

[11] Montesó-Curto P, Sánchez-Montesó L, Maramao FS, Toussaint L. Coping with the COVID-19 Pandemic in Italy and Spain: Lessons in Response Urgency. Journal of Global Health. 2020; 10: 020326

[12] Yıldız MS. Violence against healthcare professionals in turkey: A research in Ankara. Hacettepe Journal of Health Administration, 2019; 22: 135–156.

[13] Doğan M. Physical, Psychosocial, Occupational Problems and Protection Behaviors Experienced by Pre-Hospital Emergency Healthcare Professionals During The COVID-19 Pandemic. Journal of Contemporary Medical Sciences. 2021; 11: 174–179.

[14] Daily Sabah. Emergency calls surge in Istanbul with coronavirus outbreak. 2020. Available at: https://www.dailysabah. com/turkey/istanbul/emergency-calls-surge-in-istanbulwith-coronavirus-outbreak?gallery_image= undefined#big (Accessed: 2 February 2021).

[15] Menon S. COVID-19 lockdown leads to rise in demand for ambulances. ETRise, Business News. 2020Available at: https://economictimes.indiatimes.com/smallbiz/startups/newsbuzz/covid-19lockdown-leads-to-rise-in-demand-forambulances/articleshow/75022540.cms (Accessed: 1 May 2021).

[16] Luxmoore M. All The Hospitals Are Full’: Russia’s Health-Care System Scrambles As COVID-19 Cases Rise. RFE/RL: Free Media In Unfree Societies. 2020 Available at: https://www.rferl.org/a/all-the-hospitals-are-full-russia-s-health-care-system-scrambles-ascovid-19-cases-rise/30563990.html (Accessed: 12 May 2021).

[17] Yamaguchi M, Kageyama Y. Thejapantimes News: New wave of coronavirus infections threatens Japan’s hospitals as emergency care collapses. 2020 Available at: https: //www.japantimes.co.jp/news/2020/04/18/national/coronavirus-japanhospitals/#.XqAChMgzZPY (Accessed: 2 May 2021).

[18] Mahase E. Coronavirus: home testing pilot launched in London to cut hospital visits and ambulance use. British Medical Journal. 2020; 368: m621.

[19] Ebadi A, Froutan R. Positive Coping: a Unique Characteristic to Pre-Hospital Emergency Personnel. Electronic Physician. 2017; 9: 3575–3583.

[20] Zhu F, Guan X, Li Y, Huang J, Jiang T, Hou L, et al. Immunogenicity and safety of a recombinant adenovirus type-5-vectored COVID-19 vaccine in healthy adults aged 18 years or older: a randomised, double-blind, placebo-controlled, phase 2 trial. The Lancet. 2020; 396: 479–488.

[21] Lee SM, Kang WS, Cho A, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Comprehensive Psychiatry. 2018; 87: 123–127.

[22] Li L, Ai H, Gao L, Zhou H, Liu X, Zhang Z, et al. Moderating effects of coping on work stress and job performance for nurses in tertiary hospitals: a cross-sectional survey in China. BMC Health Services Research. 2017; 17: 401.

[23] Li Z, Ge J, Yang M, Feng J, Qiao M, Jiang R, et al. Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain, Behavior, and Immunity. 2020; 88: 916–919.

[24] Munawar K, Choudhry FR. Exploring stress coping strategies of frontline emergency health workers dealing COVID-19 in Pakistan: a qualitative inquiry. American Journal of Infection Control. 2021; 49: 286–292.

[25] Yan Y, Chen H, Chen L, Cheng B, Diao P, Dong L, et al. Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against coronavirus disease 2019. Dermatologic Therapy. 2020; 33: e13310.

[26] Isaacs D, Britton P, Howard-Jones A, Kesson A, Khatami A, Marais B, et al. Do facemasks protect against COVID-19? Journal of Paediatrics and Child Health. 2020; 56: 976–977.

[27] Murphy DL, Barnard LM, Drucker CJ, Yang BY, Emert JM, Schwarcz L, et al. Occupational exposures and programmatic response to COVID-19 pandemic: an emergency medical services experience. Emergency Medicine Journal. 2020; 37: 707–713.

[28] Mohammadi F, Tehranineshat B, Bijani M, Khaleghi AA. Manage-ment of COVID-19-related challenges faced by EMS personnel: a qualitative study. BMC Emergency Medicine. 2021; 21: 95.

[29] Klein TA, Irizarry L. EMS Disaster Response. StatPearls Publishing: Treasure Island (FL). 2020.