ObjectivesThe purpose of this study was twofold: (1) establish the prevalence of safety threats and workplace violence (WPV) experienced by emergency medical technicians (EMTs) in a low/middle-income country with a new prehospital care system, India and (2) understand which EMTs are at particularly high risk for these experiences.SettingEMTs from four Indian states (Gujarat, Karnataka, Tamil Nadu and Telangana) were eligible to participate during the study period from July through November 2017.MethodsCross-sectional survey study.Participants386 practicing EMTs from four Indian states.ResultsThe overall prevalence of any WPV was 67.9% (95% CI 63.0% to 72.5%). The prevalence of physical assault was 58% (95% CI 52.5% to 63.4%) and verbal assault was 59.8% (95% CI 54.5% to 65%). Of physical assault victims, 21.7% were injured and 30.2% sought medical attention after the incident. Further, 57.3% (n=216) of respondents reported they were ‘somewhat worried’ and 28.4% (n=107) reported they were ‘very worried’ about their safety at work.ConclusionWPV and safety fears were found to be common among EMTs in India. Focused initiatives to counter WPV in countries developing prehospital care systems are necessary to build a healthy and sustainable prehospital healthcare workforce.

Introduction: Emergency Departments are inundated by patients with respiratory illness during the winter months. Emergency physicians are required to quickly identify critically ill patients among the large volume of patients with mild upper respiratory illness. Among these life-threatening conditions is acute epiglottitis. Case Presentation: We report a rare series of four adult patients who presented to our Emergency Department during a period of only one week in April 2015 and were ultimately diagnosed with acute epiglottitis. Three of the patients improved with conservative measures and were observed in the intensive care unit. One patient required an emergent tracheostomy. Discussion: This series of patients is unique in that all four patients presented to a single Emergency Department within a few days of each other and, despite a myriad of presenting chief complaints, the patients were eventually found to have the same potentially life-threatening diagnosis. These cases reinforce the variability of presenting symptoms and physical examination findings that can occur in patients with epiglottitis. They also highlight clinical findings and adjunctive testing that can help identify patients who would most benefit from intervention.

Non‐exertional heat stroke is a life‐threatening condition characterized by passive exposure to high ambient heat, a core body temperature of 40°C (104°F) or greater, and central nervous system dysfunction. Rapid cooling is imperative to minimize mortality and morbidity. Although evaporative and convective measures are often used for cooling heat stroke patients, cold water immersion produces the fastest cooling. However, logistical difficulties make cold water immersion challenging to implement in the emergency department. To our knowledge, there is no documented case utilizing a body bag (ie, human remains pouch) as a cold water immersion tank for rapid resuscitation of heat stroke. During a regional heat wave an elderly woman was found unconscious in a parking lot with an oral temperature of 40°C (104°F) and altered mental status. She was cooled to 38.4°C (101.1°F) in 10 minutes by immersion in an ice‐ and water‐filled body bag. The patient rapidly regained normal mentation and was discharged home from the ED. This case highlights a novel method for efficient and convenient cold water immersion for heat stroke treatment in the emergency department.

Introduction Professional wellness is critical to developing and maintaining a health care workforce. Previous work has identified burnout as a significant challenge to professional wellness facing emergency medical technicians (EMTs) in many countries worldwide. Our study fills a critical gap by assessing the prevalence of burnout among emergency medical technicians (EMTs) in India. Methods This was a cross-sectional survey of EMTs within the largest prehospital care organization in India. We used the Maslach Burnout Inventory (MBI) to measure wellness. All EMTs presenting for continuing medical education between July-November 2017 from the states of Gujarat, Karnataka, and Telangana were eligible. Trained, independent staff administered anonymous MBI-Medical Personnel Surveys in local languages. Results Of the 327 EMTs eligible, 314 (96%) consented to participate, and 296 (94%) surveys were scorable. The prevalence of burnout was 28.7%. Compared to EMTs in other countries, Indian EMTs had higher levels of personal accomplishment but also higher levels of emotional exhaustion and moderate levels of depersonalization. In multivariate regression, determinants of burnout included younger age, perceived lack of respect from colleagues and administrators, and a sense of physical risk. EMTs who experienced burnout were four times as likely to plan to quit their jobs within one year.

Background: Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice, nations leverage cellular phones and call centers for real-time online medical direction. However, there exist several barriers to adequate communication that impact the provision of emergency care. We sought to identify obstacles in the cellular communication process among GVK Emergency Management and Research Institute (GVK EMRI) EMTs in Gujarat, India.Methods: A convenience sample of practicing EMTs in Gujarat, India were surveyed regarding the barriers to call initiation and completion.Results: 108 EMTs completed the survey. Overall, ninety-seven (89.8%) EMTs responded that the most common reason they did not initiate a call with the call center physician was insufficient time. Forty-six (42%) EMTs reported that they were unable to call the physician one or more times during a typical workweek (approximately 5-6 twelve-hour shifts/week) due to their hands being occupied performing direct patient care. Fifty-eight (54%) EMTs reported that they were unable to reach the call center physician, despite attempts, at least once a week.Conclusion: This study identified multiple barriers to communication, including insufficient time to call for advice and inability to reach call center physicians. Identification of simple interventions and best practices may improve communication and ensure timely and appropriate prehospital care.