This study aimed to investigate available resources, Personal Protective Equipment (PPE) availability, sanitation practices, institutional policies, and opinions among EMS professionals in the United States amid the COVID-19 pandemic using a self-report survey questionnaire. Methods: An online 42-question multiple choice survey was randomly distributed between April 1, 2020, and April 16, 2020 to various active Emergency Medical Services (EMS) paid personnel in all 50 U.S. states including the District of Columbia (n ¼ 192). We approximate a 95% confidence interval (AE0.07). Results: An overwhelming number of EMS providers report having limited access to N95 respirators, receiving little or no benefits from COVID-19 related work, and report no institutional policy on social distancing practices despite CDC recommendations. For providers who do have access to N95 respirators, 31% report having to use the same mask for 1 week or longer. Approximately 1 / 3 of the surveyed participants were unsure of when a COVID-19 patient is infectious. The data suggests regular decontamination of EMS equipment after each patient contact is not a regular practice. Discussion: Current practices to educate EMS providers on appropriate response to the novel coronavirus may not be sufficient, and future patients may benefit from a nationally established COVID-19 EMS response protocol. Further investigation on whether current EMS practices are contributing to the spread of infection is warranted. The data reveals concerning deficits in COVID-19 related education and administrative protocols which pose as a serious public health concern that should be urgently addressed. Key MessagesWhat is already known on this subject COVID-19 presents as a national emergency in the United States, and all efforts to mitigate the spread of disease should be considered Emergency Medical Services personnel play a pivotal role in patient outcomes and are often the first healthcare providers to make contact with COVID-19 patients The CDC has provided an Interim guidance for EMS professionals amid the COVID-19 pandemic What this study addsDue to inconsistent decontamination practices and administrative protocols that are non-compliant with CDC recommendations, EMS providers may inadvertently contribute to the spread of infection Due to varied knowledge and opinions of EMS providers on COVID-19, current pandemic education approaches may need to be revisited

ObjectivesThe primary purpose of this study was to determine if methicillin-resistant Staphylococcus aureus (MRSA) was present on the surface of oxygen cylinders and regulators used in the prehospital setting and secondarily to assess other surfaces for MRSA within the ambulance compartment, as a comparison.MethodsOn 17 March 2018, the surface of oxygen cylinders and regulators located in ambulances at an emergency medical services (EMS) station in North Alabama (n=9) and at an offsite oxygen cylinder storage area (n=70) were swabbed using sterile cotton-tipped applicators saturated in an 0.9% NaCl solution. These cotton-tipped applicators were then streaked across the surface of HardyCHROM MRSA plates, followed by incubation at 36°C for 24 hours. The growth of pink or magenta colonies was considered a positive indication for the presence of MRSA. The motivation for assessing oxygen cylinders at the offsite storage area was to outline the persistence of MRSA on stored oxygen cylinders.ResultsOf nine oxygen cylinders tested in the ambulances, nine had MRSA colonisation (100%). MRSA was also present on 67 of 70 oxygen cylinders (96%) tested at the offsite oxygen cylinder storage area.ConclusionOxygen cylinders appear to act as a fomite for MRSA. The development of universal disinfection protocols for oxygen equipment could help reduce the risk of patient infection due to cross-contamination.

This study aimed to investigate available resources, Personal Protective Equipment (PPE) availability, sanitation practices, institutional policies, and opinions among EMS professionals in the United States amid the COVID-19 pandemic using a self-report survey questionnaire. METHODS An online 42-question multiple choice survey was randomly distributed between April 1, 2020, and April 12, 2020 to various active Emergency Medical Services (EMS) paid personnel in all 50 U.S. states including the District of Columbia (n=165). We approximate a 95% confidence interval (+/- 0.0755). RESULTS An overwhelming number of EMS providers report having limited access to N95 respirators, receiving little or no benefits from COVID-19 related work, and report no institutional policy on social distancing practices despite CDC recommendations. For providers who do have access to N95 respirators, 31% report having to use the same mask for 1 week or longer. Approximately ⅓ of the surveyed participants were unsure of when a COVID-19 patient is infectious. The data suggests regular decontamination of EMS equipment after each patient contact is not a regular practice. DISCUSSION Current practices to educate EMS providers on appropriate response to the novel coronavirus may not be sufficient, and future patients may benefit from a nationally established COVID-19 EMS response protocol. Further investigation on whether current EMS practices are contributing to the spread of infection is warranted. The data reveals concerning deficits in COVID-19 related education and administrative protocols which pose as a serious public health concern that should be urgently addressed.

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This paper describes pilot test results from a round-robin conducted in support of the standard ASTM E2760, Standard Test Method for Creep-Fatigue Crack Growth Testing, on creep-fatigue crack growth testing. Results from the pilot study are recommended to participants to develop their individual experimental testing. This round-robin is an international effort with 10 participants from five countries from Asia, North America, and Europe. All participants are testing compact type (C(T)) specimens according to the procedure described in the standard. A few participants are evaluating the Kb-bar (surface crack) specimen configuration. The test material is Inconel-718 (IN718) nickel-based alloy, which is a creep-brittle alloy. Pilot creep-fatigue crack growth tests were conducted at 600°C using C(T) specimens under constant load amplitude conditions. The tests were conducted at hold times of 0, 60, and 600 s. Creep-fatigue crack growth rates were analyzed using the methods proposed and included in the test standard. It was found that the procedures followed throughout the pilot test program were sufficient in generating the desired outcomes. As a result, it is proposed that the various participants follow the procedures and test matrix as close as possible and document any deviations. This will allow data from the various participants to be assessed and determine the levels of precision and bias in creep-fatigue crack growth data obtained using the ASTM standard.