Page 63 - JSOM Summer 2023

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result from reaction to the event itself, followed by second- with Cronbach’s alpha values ranging from 0.74 to 0.93.
ary emotions, which are a consequence of the interpretation of Additionally, the PMBS has been shown in previous reports
16
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the event. Moral injuries and PTSI result from dangers that to have good content, convergent, and discriminant validity.
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challenge their moral and physiological safety, respectively. A Each question on the PMBS uses a 7-point Likert scale, where
common tactic used by EMS professionals during their daily 1 is Not True and 7 is Completely True. Scoring on the PMBS
work is emotional dissociation, which may be a self-protective ranges from 15 to 105, with higher scores indicating increas-
mechanism to avoid such intrusive situations. 16–18 Dissociation ingly maladaptive cognitions. Subscale scores range from 5 to
in the presence of trauma or an acute stress reaction may lead 35. The PMBS was selected because it is an instrument specif-
to maladaptive cognitions, poor coping strategies, and psycho- ically crafted for generalized trauma exposure and not expo-
somatic illness, which are then maintained by increased levels sure to specific events.
of baseline cortisol or inflammatory cytokines. This vicious
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cycle will continue until healthier coping strategies are realized. The survey was piloted with a core group of EMS experts, and
modifications based on feedback were made accordingly. The
In the presence of increasing levels of hopelessness, stress, anx- time from informed consent to survey completion was esti-
iety, depression, and emotional overload, EMS professionals mated to be an average of 10 minutes.
may experience maladaptive cognitions to remain present and
grounded. This indicates that health behaviors may be defined Statistical Analysis
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by the individuated experiences of the healthcare workers who Data from Qualtrics were downloaded to Excel (Microsoft ,
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have been exposed to trauma and have found any way they https://www.microsoft.com/en-us/) for coding and then up-
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can to cope with it, even if such cognitions are maladaptive loaded to SPSS Statistics Microsoft (IBM , https://www.ibm.
or harmful. 16,20 Furthermore, prior studies have shown that com/products/spss-statistics) for Windows, Version 28.0. Al-
maladaptive cognitions may catalyze the development of anx- pha was established at 0.05.
iety, depression, substance abuse, and suicidal ideation and
attempts. 21–24 Descriptive statistics were calculated to analyze the sample.
Univariate analyses using t-tests or ANOVA were performed
This study sought to investigate the impact the COVID-19 for all normally distributed variables, while nonparametric
pandemic has made on the EMS workforce and to identify testing, such as Mann-Whitney U tests and Pearson correla-
specific variables within the occupational environment during tions, were used where appropriate for non-normally distrib-
the COVID-19 pandemic that affect maladaptive cognitions in uted variables.
EMS professionals.
Variables identified as significant in the univariate analysis
were used to construct a hierarchical linear regression model
Methods
using total PMBS scores to determine the predictive utility of
Institutional review board approval was obtained from the the COVID-19 pandemic on maladaptive cognitions in EMS
University of New Orleans for a cross-sectional survey study. professionals. Binary dummy variables were created for all
Anonymous electronic data were collected from late April to statistically significant categorical variables identified in the
early May 2021 for 21 calendar days. The web-based electronic univariate analysis. Squared semi-partial correlations deter-
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survey was created using Qualtrics (Provo, UT; https://www. mined the unique criterion validity of specific factors related
qualtrics.com/). The survey was sent to all EMS professionals to the COVID-19 pandemic. Collinearity diagnostics, namely
in North Carolina who were actively on the roster of an EMS the Variance Inflation Factor (VIF) and Tolerance value, were
agency (n = 25,474). Emergency medical technicians (EMTs), assessed to detect multicollinearity in the model. Histograms,
advanced EMTs (AEMTs), and paramedics were included. Be- residual plots, and scatter plots were used to assess the assump-
cause of the desire to understand the impact of the COVID-19 tions of normality, linearity, and homoscedasticity, respectively.
pandemic on EMS clinical professionals, credentialed EMS
instructors and those unlikely to transport COVID-19 pa- Results
tients as a primary occupational function, such as emergency
medical responders, were excluded. Each respondent provided Demographic Factors
informed consent prior to participation in the study, and no Overall, 811 EMS professionals responded to the survey; of
incentives were provided. Because this was a statewide study, those, the majority were male (66.5%), Caucasian (93.3%),
military medical personnel were not included because these advanced life support (ALS) providers (73.7%), and primarily
personnel were more likely to be deployed to areas of highest employed by an EMS agency (75.1%). The average age was
burden during peak times of the pandemic. Additionally, those 41.11 ± 12.42 years, with an average of 15.42 ± 10.98 years
who may have deployed to North Carolina were likely sta- of EMS service. A total of 26 (3.2%) identified as Latinx. The
tioned at local hospitals, not augmenting EMS response. majority of respondents (86.6%) were in a direct patient care
role; the remaining 13.4% were listed on the roster but may
The Survey Instrument have been in another role, such as training, operations, or
The 71-question survey consisted of 12 demographic ques- leadership.
tions, 44 items related to perceptions and mindsets surrounding
the COVID-19 pandemic, and the 15-question Posttraumatic Univariate analysis revealed statistically significant differences
Maladaptive Beliefs Scale (PMBS). The PMBS is designed to in PMBS total scores between at least two groups for sex and
measure maladaptive cognition through a total score and three race. An independent samples t-test showed a statistically sig-
subscales: Reliability and Trustworthiness of Others (RTO), nificant difference in PMBS total scores in those who were
Threat of Harm (TH), and Self-Worth and Judgment (SWJ). Latinx compared with those who were not (53.8 ± 18.1 vs.
The instrument shows good to excellent internal consistency, 35.6 ± 12.6; p < .01).

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