Page 62 - JSOM Summer 2023

Maladaptive Cognitions in EMS Professionals
as a Function of the COVID-19 Pandemic

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Ginny K. Renkiewicz, PhD, MHS, Paramedic, FAEMS *; Michael W. Hubble, PhD, MBA, NRP ;
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Sandy L. Hunter, PhD, NRP ; Randy D. Kearns, DHA 4

ABSTRACT
Introduction: The coronavirus disease pandemic has pro- campaigns causing vaccine and treatment hesitancy have taken
foundly affected emergency medical services (EMS) profes- their toll on frontline healthcare workers, including EMS pro-
sionals, but the emotional impact is unknown. Methods: This fessionals. As such, it is possible that EMS professionals on
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was a cross-sectional survey of North Carolina EMS profes- the frontlines of the COVID-19 pandemic have maladaptive
sionals from April to May 2021. EMS professionals on an ac- cognitions of psychotraumatological origin that may predis-
tive roster were included. With pandemic-related perceptions, pose them to moral injuries and posttraumatic stress injury
the 15-item Posttraumatic Maladaptive Beliefs Scale (PMBS) (PTSI). The austerity of this practice environment for the civil-
was used to quantify the severity of maladaptive cognition. ian EMS force is akin to the environment often experienced by
Significant univariate variables were used to create a hier- tactical Operators and Special Forces, who are often activated
archical linear regression to assess the potential impact of and deployed during times of disaster. As such, this study pro-
pandemic-related factors on maladaptive cognition scores. vides important insight into the initial psychotraumatology of
Results: Overall, 811 respondents were included; of those, front-line medical personnel during a disaster, irrespective of
33.3% were female, 6.7% were minorities, and 3.2% were military, tactical, or civilian affiliation. Such experiences may
8,9
Latinx; the mean age was 41.11 ± 12.42 years. Mean scores elicit changes in individuals’ beliefs about themselves, their
on the PMBS were 37.12 ± 13.06 and ranged from 15 to 93. worldviews, and others.
PMBS scores were 4.62, 3.57, and 3.99 points higher, respec-
tively, in those with increased anxiety, those who trusted their Military and civilian EMS professionals faced the same con-
sources of information, and those who reported to work de- cerns as other healthcare workers as the pandemic raged;
spite being symptomatic. Pandemic-specific factors accounted however, additional issues specific to EMS may have put these
for 10.6% of the variance in PMBS total scores (ΔR = 0.106, frontline workers at particular risk, especially during the early
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ΔF[9, 792]; p < .001). Psychopathological factors accounted stages and peaks of the pandemic. In these moments, EMS
for an additional 4.7% of the variance in PMBS total scores personnel were reusing tattered personal protective equipment
(ΔR = 0.047, ΔF[3, 789]; p < .001). Conclusion: Given that and using it long past its recommended usage, forced to refuse
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10.6% of the difference in PMBS scores can be explained by transport to lower acuity patients, and, in some cases, with-
pandemic- related factors, maladaptive cognitions in EMS are holding potentially life-saving care in the interest of personal
a considerable concern and could lead to the development of and public safety. 10-12 Additionally, EMS professionals have
significant psychopathology post-trauma. been experiencing sharp fluxes in call volume coupled with
hospitals that are running at several times their peak capac-
Keywords: paramedic; EMS; maladaptive cognition; COVID-19; ity, resulting in call stacking, prolonged emergency department
pandemic; stress; PTSI offload times, and a confused and angry public. 12–15 Con-
versely, some patients who need medical care for acute illnesses
or injuries have been refusing transport because of the fear
of contracting COVID-19 while hospitalized. The impact to
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Introduction
the overall workforce has been potentially devastating as EMS
The coronavirus disease 19 (COVID-19) pandemic has been professionals faced exposure-related quarantine, infection,
one of the transformative events of our time, resulting in more line-of-duty death, and sustained fatigue, which has resulted
than 760 million cases globally and more than 103 million in in a 33% average reduction in the workforce nationwide. 14,15
the United States. Of the more than 103 million US cases,
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1,2
there have been just over 1.1 million deaths. As of August Military or civilian EMS professionals may have acute trau-
2022, the pandemic first classified by the World Health Or- matization resulting from isolation, perilous workforce condi-
ganization in March 2020 has been ongoing for nearly 2.5 tions, or perceived severity or transmissibility of the virus, such
years. Irrespective of substantial case and mortality counts, that existing belief structures have been overwhelmed and
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shortages of personal protective equipment, lack of trust in the must be adapted—a construct known as moral injury. 8,9,16 This
government’s handling of the pandemic, and misinformation psychological response is initiated by primary emotions that
*Correspondence to grenkiewicz@methodist.edu
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1 Dr Ginny K. Renkiewicz is affiliated with the Department of Healthcare Administration, Methodist University, Fayetteville, NC. Dr Michael W.
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Hubble is affiliated with the Department of Emergency Medical Science, Wake Technical Community College, Raleigh, NC. Dr Sandy L. Hunter
is affiliated with the Department of Emergency Medical Science, Wake Technical Community College, Raleigh. Randy D. Kearns is affiliated
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with the Department of Management and Marketing, College of Business Administration, The University of New Orleans, New Orleans, LA.
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