Emergency medical service (EMS) professionals have a stressful vocation, inarguably worsened by the COVID-19 pandemic, which affects their mental health and makes them a vulnerable population warranting further study. However, to date, no published research has compared non-treatment and treatment-seeking EMS professionals in the same greater metropolitan area. In this study, we examined differences and similarities among the non-treatment-seeking EMS professionals (<em>n </em>= 57) from a local EMS agency and treatment-seeking EMS personnel (<em>n </em>= 53) from a non-profit community treatment center on six assessment instruments that measure attachment avoidance, attachment anxiety, resilience, depression, generalized anxiety, posttraumatic stress disorder (PTSD), and suicidality. The Mann-Whitney U test revealed attachment avoidance, attachment anxiety, depression, generalized anxiety, and posttraumatic stress disorder (PTSD) were significantly higher in the treatment-seeking sample compared to the non-treatment-seeking group. Resilience and suicide did not significantly differ. Correlational analyses revealed that the most consistent findings for both samples were PTSD, depression, and generalized anxiety. Findings suggest that negative affect may underlie these three constructs, regardless of whether the individual is treatment-seeking or not. These findings are conceptualized through three different theoretical frameworks: attachment, resilience, and negative affect. We also make recommendations for EMS agencies and suggest future scholarship based on these preliminary findings.

OBJECTIVECSF shunt placement is the primary therapy for hydrocephalus; however, shunt malfunctions remain common and lead to neurological deficits if missed. There is a lack of literature characterizing the epidemiology of children with possible shunt malfunctions presenting to United States emergency departments (EDs).METHODSA retrospective study was conducted of the 2006–2017 National Emergency Department Sample. The data were queried using an exhaustive list of Current Procedural Terminology and International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes representing children with hydrocephalus diagnoses, diagnostic imaging for shunt malfunctions, and shunt-related surgical revision procedures.RESULTSIn 2017, there were an estimated 16,376 ED visits for suspected shunt malfunction. Children were more commonly male (57.9%), ages 0–4 years (42.2%), and publicly insured (55.8%). Many did not undergo diagnostic imaging (37.2%), and of those who did, most underwent head CT scans (43.7%). Between 2006 and 2017, pediatric ED visits for suspected shunt malfunction increased 18% (95% CI 12.1–23.8). The use of MRI increased substantially (178.0%, 95% CI 176.9–179.2). Visits resulting in discharge home from the ED increased by 76.3% (95% CI 73.1–79.4), and those involving no surgical intervention increased by 32.9% (95% CI 29.2–36.6).CONCLUSIONSBetween 2006 and 2017, ED visits for children to rule out shunt malfunction increased, yet there was a decline in surgical intervention and an increase in discharges home from the ED. Possible contributing factors include improved clinical criteria for shunt evaluation, alternative CSF diversion techniques, changing indications for shunt placement, and increased use of advanced imaging in the ED.

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