Factors Influencing Use of Personal Protective Equipment Among Emergency Medical Services Responders During the COVID-19 Pandemic: A Retrospective Chart Review

Abstract

Introduction: The use of personal protective equipment (PPE) is a salient component of reducing occupational risk in many fields. Emergency medical services (EMS) personnel use PPE to reduce risk of exposure and defend against various pathogens they come in contact with while providing patient care. Currently, the understanding of factors that predict the use of PPE by an EMS responder during a pandemic is limited. In this study our objective was to identify factors that influenced PPE use by EMS responders during the coronavirus disease 2019 (COVID-19) pandemic, which may guide future planning for responders in similar austere or personal risk situations. Methods: We conducted a retrospective chart review among all EMS encounters across an EMS agency affiliated with a large New York health system from March 16–June 30, 2020. All adult, emergency encounters with available prehospital record data were analyzed. We assessed patient- and EMS encounter-level data as possible factors that influence PPE utilization. The use of PPE was defined and guided by the literature as being either full or partial PPE, or “not documented.” We used multinomial logistic regression to identify factors that influence PPE use among EMS responders. Results: We identified 28,693 eligible EMS encounters during the study period; 54.2% of patients were male, the median patient age was 58 years, and 66.9% of patients had at least one chronic medical condition. The use of PPE was documented in 92.8% of encounters, with full PPE used in 17.8% of these encounters. Full PPE utilization, relative to partial, was most strongly influenced by dispatch codes indicative of “breathing problems” (odds ratio [OR] 4.89; 95% confidence interval [CI]: 4.40, 5.46) and “cardiac/respiratory arrest” (OR 3.82; 95% CI: 2.99, 4.88), in addition to a patient’s positive screening for COVID-19 on 9-1-1 dispatch (OR 3.97; 95% CI: 3.66, 4.32). Conclusion: Emergency medical services responders more frequently used full PPE for calls with dispatch codes indicative of respiratory distress or cardiac arrest. Understanding factors that influence PPE use among EMS personnel, particularly during times of public health emergencies, is essential to mitigate exposure and ensure the safety of frontline responders.