Editing

Complete the corrections based on the 

EMS responders to pandemic influenza

EMS responders to pandemic influenza (Red Crescent) in Saudi

A

rabia

Emergency service providers and agencies alike participate in life-saving activities every day. Workers in these agencies provide assistance in daily emergency situations, transporting and treating patients in various situations. Their input in the medical process is incontrovertible as they ensure the welfare of the patient.

The healthcare sector is exposed to varying infections despite the availability of multiple disinfection procedures. Contamination remains a significant issue to the EMS responders as ambulances become a constant source of various pathogenic bacteria as a result of transporting patients from emergency scenes to the medical facilities. The transportation procedure creates a situation where the paramedics as well as the patient are exposed to the pathogens, a majority of which may be infectious (Reed, et al., 1993). Although there are various safeguards and disposable equipment which reduce the risk to the medical staff, the transportation process remains susceptible to contamination from blood and infectious substance. The result of these infections on the EMS in Saudi Arabia specifically is significant, as estimated 35 to 45 medical providers have been infected .

The ambulance service managed by the Red Crescent is the source of focus for this project for its lack of policy and guidelines on the pre-hospital process. Precautions such as disinfection and sterilization are not accompanied by corresponding infection control procedures. Currently in the Kingdom, there are over 5, 000 EMS staff using approximately 1,400 ambulances, and they are all at risk (Reed, et al., 1993). To ensure effective control of possible infections, a significantly holistic approach is required; one which is evidence-based and also cost-effective. Comment by Steve Parrillo: How do you know this? Comment by Microsoft Office User: Look at the year of this reference – is it the same in 2018 as it was in 1993 – I think not

Problem Statement

Inadequate policies and interventions or personal failures of the emergency medical services team are a facilitator for infections among the healthcare workers. Comment by Steve Parrillo: How do you plan to apply this to disasters and MCIs? Comment by Microsoft Office User: expand

Description of the Problem

The requirement for disaster medicine is more crucial than ever before with diseases such as MERS affecting areas deemed disaster-prone. Medical workers and emergency service providers at large require the evidence as a stepping stone to new decisions and measures involving medical care for health workers. EMS in Saudi Arabia has faced its fair share of challenges, with a number of its employees contracting the deadly virus MERS. EMS plans to use this information in creating effective influenza plans which will enhance its existing operational protocols. Comment by Microsoft Office User: ref and supporting details? Comment by Steve Parrillo: Reference? Comment by Microsoft Office User: Who is doing this? EMS means who -?

In particular, influenza plans will require thorough assessment carried out, which will benefit all parties involved. According to Costa et al. (2015), interventions should be prioritized before travel to ensure that volunteers and medical professionals going on a mission abroad are adequately considered in regards to their health. The assessment will use observation as the tool. Information will be derived by working with the EMS employees and observing them to assess their response to the issues of workplace infections. The study will get permission from the Red Crescent to speak to its employees on how the gap can be bridged. The study once carried out will be useful to both the authority and the employees. The employees will have proper medical care, while the authority will benefit from the job security provided by the employees. The organizational structures will also support the humanitarian aspect while securing the fair decisions in the daily operations of the workers. Comment by Microsoft Office User: This paragraph is confusing – are you only looking at flu? Comment by Microsoft Office User: Flow is off – what assessment? Of flu plans? I think you mean your project but this paragraph needs to be re-worked. Did you submit for IR

B

?? Comment by Microsoft Office User: REMEMBER – this is not a proposal or future tense – it is real time the assessment uses, information is derived etc. Comment by Steve Parrillo: Make sure you include comment about approval from IRB to do this. Comment by Steve Parrillo: I believe you already did this, correct?

Literature Review

The importance of adequate policy guidelines in preventing infection of healthcare workers is inarguable, with benefits such as better individual health. Costa et al. (2015) focused on reviewing existing information on the delivering interventions before the workers were deployed to their missions. They aimed to understand the benefits of the intervention. Majority of the identified results contended that workplace health is crucial to the success of the lifesaving efforts of the employees. Just as in the case of the EMS from Red Crescent, the policies did not place emphasis on the workplace assessments. The study discovered that the workers were exposed to high-risk infections which included TB, influenza, HIV, and other hazardous infections (Costa, et al. 2015). These infections depended on the region, but the results are a clear indication that the pre-mission assessment policy should be mandatory. The importance of having a clear policy by authorities is clear in this study. Comment by Steve Parrillo: ??

Effective policy is significant in identifying and managing the risk posed by these diseases to the workers. For any health care worker, especially those in humanitarian crises, blood-borne pathogens may be transmitted through exposure to the infected patients. It could either be percutaneous or mucosal, with the risk of exposure ranging between 0.3% to 30 % in cases where the worker is exposed to HIV and HBV respectively. According to Beltrami, Williams, Shapiro, and Chamberland (2010), only a sustained obligation to the health care workers will provide the prerequisite protection they require. Due to the risky aspect of their occupations, the threat of exposure is ever present (Beltrami et al., 2010). The authors call for adherence to disease control regulations on dealing with the threats of infectious diseases by providing vaccines, creating exposure control plans, and ensuring frequent training of their employees. Hence, the need arises to ensure continuous improvement of definitions of exposure, the effectiveness of the preventive procedures, as well as sustained commitment to the overall health of medical workers.

Recent rises in the number of infectious diseases in humanitarian crises led to an unwillingness by workers to take part in risky missions. One of the hazardous infections which have caused the apathy among emergency services workers is MERS. The infectious disease has broken in some of the areas which already face limited healthcare infrastructure. In their study, Haggman, Kenkre, and Wallace (2016) focus on reviewing the impact of Ebola in regards to the overall willingness of healthcare workers to move to areas such as Liberia and Sierra Leone which are some of the most affected such diseases. Comment by Steve Parrillo: Ref? Comment by Steve Parrillo: Word choice. Comment by Steve Parrillo: What were the results?

Figures in recent studies show that in 2015, only two cases of Ebola were reported, but in the following 1 ½ years, more than 11,000 people died, including 400 medical workers. Their study also focused on Red Cross and Red Crescent employees and their issues with deployment to such regions (Haggman et al., 2016). The workers raised concerns about their overall welfare in such countries, while also highlighting the apprehensions cited by their close relatives. A major aspect underlining the issues they raised was the lack of adequate operating procedures to guarantee their quality of life. There was also no guarantee of their safety. This study highlights the changes posed by infectious diseases and why it is critical for service providers to enhance the health conditions of their workers. In addition to health, safety was also highlighted as a precondition for ensuring the occupational health of the professionals in these situations (Haggman et al., 2016). Hence, the need arose to create policies which will guarantee the two aspects highlighted by the healthcare workers.

Various methods of managing infectious diseases by the health workers have been discussed. Koenig (2014a) stresses various approaches to be utilized by EMS to limit their exposure. A critical policy proposed is the identity, isolate, and inform policy. The emergency services workers already have training on the signs of an infectious disease, which should be applied in this instance. They should then isolate the risk, which will reduce their exposure and others to the deadly infections. The last step involves using the protocol in place to provide the information to fellow workers and relevant authorities (Koenig, 2014a). Due to the direct threat posed by the infections, the author provides these screening methods to service providers to protect themselves, while also protecting the patients. The methods applied in this study stress the fact workers should also take the initiative to protect themselves (Koenig, 2014b). Due to the bureaucratic nature of this step, the EMS should ensure they put the details in their policies to ensure notifications of infectious diseases are dealt with before they affect the first responders. Comment by Steve Parrillo: Is this acceptable APA format for a ref? There are two Koenig refs, but I don’t think a and b are proper.
Yes if the following are true it is correct:
Two or More Works by the Same Author in the Same Year: If you have two sources by the same author in the same year, use lower-case letters (a, b, c) with the year to order the entries in the reference list. Use the lower-case letters with the year in the in-text citation.
Research by Berndt (1981a) illustrated that…
Jean

The articles by various authors have raised the same concerns ― the risks posed by infectious diseases to the humanitarian workers. The consensus is that EMS should do more to protect the workers from infection, by the implementation of various policy decisions. Despite the dangers posed by these diseases, the responsibility still lies with the Red Crescent and its workers. Hence, disaster disease management should include protecting the employees to ensure a better quality of life and overall satisfaction.

Description
of the Project Comment by Microsoft Office User: Methods section is where I am focusing this week – Please build out a specific methds section that describes the process for doing the project. This includes details on how you created the observation tool and validated it – IRB etc.

The project will lay its foundation on the question of whether authorities, specifically, the EMS, play a part in the workers contracting infectious diseases. Red Crescent’s guidelines and procedures will be assessed to note the specific impact they have on addressing risks faced by their employees. The research will be carried out in 2018 between January and May. The participants of the study will include employees of The EMS, Saudi Arabia. The authority is an emergency services provider whose employees are exposed to infectious diseases during treatment and transport of victims. The employees in the study will include field officers as well as office workers of various ranks. The assumption is that they are all exposed to infectious diseases or have been in contact with a fellow employee who was infected. Diversity in the respondents will be a consideration, to ensure different views on each observation made.

The study devised the observation technique as an effective tool in gathering information. This technique will be useful in measuring the impacts of risky exposure to a worker’s general demeanor. The study will minimize the impact of interference, since the workers may provide information which is incorrect, by changing their behavior. Saudi Arabia is home to victims of various infectious diseases such as MERS. Consequently, these victims may expose other people to these infections. The reaction during transport and treatment of patients deemed risky will be crucial when collecting the data. Although the respondents will be informed of the study, during the data collection, there will be no interference on the worker’s assignments through questioning or coercion. The Red Crescent will also need to provide permission to gather the data. Information on the respondents will not be shared with any other party, as names will be used.

The data collected will be collated in regards to various types of behaviors observed. The patterns will be identified in comparison to treatment of normal patients. Risk related behavior such as withdrawal from patients or willingness to treat patients is one of the expected behaviors. Behavior that does not align with the transport and treatment of infectious patients will be disregarded. The data will be processed, classified, and tabulated, reducing it in terms of specificity. A graphical analysis will be included to help me understand the observation data collected. The new information will then be shared with the relevant parties, including the Red Crescent.

The data collected from this study is susceptible to various challenges, including workers who do not show their behavior publicly. In addition, the idea of being watched may force the respondents to change their behavior, as such leading to false data being collected. Despite the challenges, the study will provide an opportunity for the EMS authority and the medical field at large to learn important lessons. Lessons will be on how to improve the quality of care of workers as well as any policies which require improvement in the treatment process.

Conclusion

It is the responsibility of Red Crescent to realize the danger posed by exposure to infectious diseases. Despite their contribution to society, the medical and trauma workers also require consummate medical health. This proposal provides a guideline for collecting data which will be used to prove the impact of infectious diseases on their willingness to treat patients. authorities such as Red crescent will, consequently, use this information to enhance their policies which will then enhance the quality of life and work for healthcare workers.

Observation:

The current guideline and procedures for EMS (Red crescent) workers in Saudi Arabian do not adequately address potential risk associated with treating patients who suffer from infection disease. Since 2012, a few EMS workers have contracted to MERS. This research intends to investigate whether infection in responders is a result from Inadequate policy and guidelines or EMS personal failing to follow the guideline. The results are intended to provide guidance to EMS agencies in Saudi Arabia in their pandemic influenza plans and operational protocols. The audience for this subject is EMS agencies (Red Crescent).

Use observation Technique as tool. And use randomly time assignments to reach most of the EMS workers.

Red Crescent (EMS)

Hail City, Saudi Arabia

EMS station 1

(36 paramedics)

EMS station 2

(24 paramedics)

EMS station 3

(24 paramedics)

A

2 paramedics

2 paramedics

2 paramedics

2 paramedics

3 days on + 3 days off

EMS station 1

EMS station 2

EMS station 3

8:00 – 20:00

4 paramedics

2 paramedics

20:00 – 8:00

B

3 days on + 3 days off

EMS station 1

EMS station 2

EMS station 3

8:00 – 20:00

4 paramedics

2 paramedics

2 paramedics

20:00 – 8:00

2 paramedics

2 paramedics

2 paramedics

(EMS) providers play an important role in the prevention and control of infections. EMS providers are at the front line of medical care and have a high risk of exposure to patients with known or unknown infectious diseases.

Concentration on seven key strategies as infection control measures in the EMS:

· Use of personal protective equipment, e.g. gowns, gloves, eye, face and respiratory protection

· Hand hygiene

· Environmental cleaning and disinfection

· Source control measures aimed at containing the patient’s secretions

· Limiting contact with patients

· Ambulance cleaning and disinfection.

· Knowledge of EMS workers about infection prevention and control standards

Comment by Steve Parrillo: Did you create these tables? If not, cite your source.

References

Bekefi, T., Epstein M. J., & Yuthas, K. (2008). Managing opportunities and risks. Ottawa: The Society of Management Accountants of Canada.

Beltrami, E. M., Williams, I. T., Shapiro, C. N., & Chamberland, M. E. (2000). Risk and management of blood-borne infections in health care workers. Clinical Microbiology Reviews, 13(3), 385-407. doi:10.1128/cmr.13.3.385-407.2000

Costa, M., Oberholzer-Riss, M., Hatz, C., Steffen, R., Puhan, M., & Schlagenhauf, P. (2015). Pre-travel health advice guidelines for humanitarian workers: A systematic review. Travel Medicine and Infectious Disease, 13(6), 449-465. doi:10.1016/j.tmaid.2015.11.006

Gushulak, B. D. (2017, May 31). Humanitarian aid workers. Retrieved from https://wwwnc.cdc.gov/travel/yellowbook/2018/advising-travelers-with-specific-needs/humanitarian-aid-workers

Haggman, H., Kenkre, J., & Wallace, C. (2016). Occupational health for humanitarian aid workers in an Ebola outbreak. Journal of Research in Nursing, 21(1), 22-36. doi:10.1177/1744987116630578

Koenig, K. L. (2014a). Identify, isolate, inform: A 3-pronged approach to management of public health emergencies. Disaster Medicine and Public Health Preparedness, 9(1), 86-87. doi:10.1017/dmp.2014.125

Koenig, K. L. (2014b). Ebola triage screening and public health: The new “Vital Sign Zero”. Disaster Medicine and Public Health Preparedness, 9(1), 57-58. doi:10.1017/dmp.2014.120

Reed, E., .daya, M. R., Jui, J., Grellman, K., Gerber, L., & Loveless, M. O. (1993). Occupational infectious disease exposures in EMS personnel. The Journal of Emergency Medicine, 11(1), 9-16. doi:10.1016/0736-4679(93)90003-p