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Study Objective:Our objective was to assess the prevalence of cardiac risk factors in a sample of urban paramedics and emergency department (ED) nurses.Methods:We asked 175 paramedics and ED nurses working at a busy, urban ED to complete a cardiovascular risk assessment. The survey asked subjects to report smoking history, diet, exercise habits, weight, stress levels, medication use, history of hypertension or cardiac disease, family history of cardiovascular disease (CVD), and cholesterol level (if known)Results:129 of 175 surveys were returned (74% return rate) by 85 paramedics and 44 nurses. The percentages of paramedics and nurses at high or very high risk for cardiac disease were 48% and 41%, respectively. Forty-one percent of female respondents and 46% of male respondents were at high or very high risk. Cigarette smoking was reported in 19% of the paramedics and 14% of the nurses. The percentages of paramedics and nurses who reported hypertension were 13% and 11%, respectively. High cholesterol was reported in 31% of paramedics and 16% of nurses.Conclusions:Forty-eight percent of paramedics and 41% of ED nurses at this center are at high or very high risk for cardiovascular disease, by self-report. Efforts should be made to better educate and intervene in this population of health-care providers in order to reduce their cardiac risk.

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cost of health care translates into the clinical setting for emergency providers and the quality of care delivered. Additionally, little is known about if and how health care spending is incorporated into emergency medicine (EM) resident education. This study aims to evaluate emergency providers' perceptions on cost of care including care delivery as well as resident education.Methods: The study population was four classes of emergency medicine residents at George Washington University; 24 residents were surveyed. We employed a 9-item questionnaire with a combination of open-and closed-ended questions, including utilization of a Likert 5-point scale (1 being not important at all; 3 being neutral; 5 being very important). Surveying was conducted solely by the first author, an EM senior resident trained by the second author, an attending emergency physician with expertise in narrative interview. Data were analyzed using grounded theory methodology, with 100% agreement between the authors.Results: One-third of EM residents have never discussed out of pocket costs with a patient. Nearly two thirds of residents (63%) considered the costs of tests, procedures, and medications at least once per shift; they discussed it with their patients only 21% of the time. The most common reasons why residents considered costs included the potential financial burden on the patient, patient compliance, diagnostic utility and medical necessity, and a feeling of personal responsibility for overall health care costs. In addition, 50% of the time providers learned that a patient was non-compliant secondary to financial reasons from a return emergency visit for the same complaint. Although residents agreed it is important to consider cost of care when making medical decisions (3.8/5), they disagreed (1.8/5) that they know the costs of tests and treatments when ordering them. Finally, the majority of residents (91%) felt they receive too little education on medical costs, with half having received no type of education. Residents felt that the most common ways to educate them on costs of care are through lectures, Grand Rounds presentations, and providing hospital-based price sheets.Conclusion: The majority of EM residents take cost into consideration when ordering tests and treatments for their patients; commonly cited reasons include financial burden on the patient, patient compliance, and diagnostic utility-all aspects that affect quality of care. Despite an expanding focus on the link between cost of medical care and quality of care, residents feel that they lack knowledge and receive too little, if any, education in regards to the cost of the care they deliver. Incorporating targeted educational tools such as lectures, presentations, and price sheets into resident education may help narrow the gap between the rising costs of care delivered by the provider and the quality of care received by patients. Future studies will investigate the perceptions of trainees in other medical specialties as well as the impact of these educational inter...

Industries worldwide have faced continuous burdens since the beginning of the COVID-19 pandemic, while adjusting to rapidly changing rules and regulations. Industries need to be prepared to remain operational and productive in the face of current and emergent pathogens. While several businesses could remain functional through remote work, critical industries faced closings, worker shortages, and loss of productivity. Pharmaceutical industries were blessed with an increase in the stock market and creation of new jobs, but faced serious severe challenges due to shortage of medicines and drugs. Critical infrastructures such as healthcare, food and agriculture, manufacturing, construction, transportation, retail, waterworks, and waste management took a significant hit during the pandemic, and are still suffering from worker shortages to function optimally. Above all odds, companies were able to maintain the necessities by implementing strict safety protocols such as thorough and repeated cleaning, use of hand sanitizer/disinfectants, wearing face masks and personal protective equipment, and maintaining social distancing. This article addresses how COVID-19 disrupted normal operations on a large scale, and how essential businesses have learned to assess the impact, handle situations effectively, and become resilient for future crises. Best practices were tailored to each industry sector to prepare for and address the pandemic.