INTRODUCTION:Periods of civil unrest pose significant operational and security challenges to those seeking to provide emergency care to patients. For emergency departments (EDs) and their staff, effectively operating in this potentially hostile environment requires careful planning. Understanding the challenges posed during periods of civil unrest is paramount for emergency medicine staff and emergency planners to ensure continuity of care. OBJECTIVE:To provide ED and hospital staff with an understanding of the challenges faced during periods of civil unrest and to offer recommendations to maintain safety and operational viability. DISCUSSION:Preplanning before any anticipated civil unrest is essential to a well-coordinated response. During the period of civil unrest, maintaining effective communication between command elements and clinicians in the ED is vital to ensure bidirectional sharing of information. Deviations from normal operating procedures should be expected and relayed to clinicians as quickly as possible. Similarly, staff may need to shelter in place or relocate to a more secure area within the hospital. Civil unrest is highly dynamic, and hospital leadership must follow developments closely to protect staff and facilities. CONCLUSION:This review provides ED and hospital staff with an understanding of the significant challenges during periods of civil unrest.

Mass gatherings entail unique crowd behavioral, health and safety risks for participants; however, risk perception can vary widely, and factors that influence perception of risk are not completely understood. Mass gathering organizers must take into consideration recognition, mitigation, monitoring, and communication of risk. This scoping review aims to (1) examine key factors affecting public perceptions of risk in mass gatherings and; (2) identify contemporary risk communication strategies specific to these events. We conducted a scoping review of articles indexed in MEDLINE, Embase, Scopus, CINAHL, and PsycINFO published between 1990 and 2024. Eligible articles included peer-reviewed original research (qualitative and quantitative), case studies, commentaries, reviews, and book chapters that discussed either factors influencing public risk perception of mass gatherings or strategies for mass gathering risk communication. Title and abstract screening, full article review, and data extraction were performed independently by team members. Final article inclusion was determined by team consensus, and findings were analyzed using thematic content analysis. A total of 29 articles were included. Of these, four articles addressed factors shaping public risk perception of mass gatherings, 14 articles addressed risk communication strategies, and 11 articles addressed both. Factors influencing risk perception include mass gathering risk education, nature of the crowd, overcrowding, as well as event and venue specific characteristics. Risk communication strategies for mass gatherings thematically highlighted- communications flow, timing and content of messaging and differing modalities such as digital media, physical media and in-person communication. Understanding factors affecting risk perception of mass gatherings can inform risk communication strategies tailored for different target participants. While a variety of risk communication approaches have been employed in differing contexts, gaps remain in determining effectiveness of the wide range of risk communication strategies used for mass gatherings and suggest future directions for risk communication research.

BACKGROUND:As frontline health care workers, Emergency Medical Service (EMS) clinicians are subject to stressful conditions. These conditions contribute to burnout, stress, and moral injury. OBJECTIVE:The objectives of this systematic review were to 1) evaluate the incidence, prevalence, and severity of adverse occupationally related mental health conditions, including burnout, stress, and moral injury among EMS clinicians; and 2) to identify any modifying factors associated with those conditions. METHODS:We searched MEDLINE, Embase®, Cochrane Register of Clinical Trials, PsycINFO®, and Cumulative Index to the Nursing and Allied Health Literature from January 1, 2001 through June 30, 2024. We also searched websites, the ClinicalTrials.gov registry, and journals not indexed in Medline. To increase applicability to the U.S. decision-making context, we restricted to studies of EMS clinicians in high-income countries. We used standard methods to assess the risk of bias and evaluate the strength of evidence. RESULTS:We included 92 studies (88 cross-sectional studies and 4 cohort studies). During routine practice, the mean levels of organizational job stress were mild to moderate, burnout and general stress were mild to severe, and secondary traumatic stress was mild (moderate strength of evidence for each). There was considerable heterogeneity in prevalence and severity by country, setting, population, context, and outcome measurement instruments and scoring methodology or threshold. No study reported on incidence. Some modifying factors (e.g., more trauma exposure, more hours per week, more burnout, higher call volumes) may be associated with poor outcomes. CONCLUSIONS:Despite considerable variation, the stress issues in the EMS workforce are substantial enough to merit greater attention by health systems. Addressing these challenges will require evidence-based comprehensive strategies that consider the modifying factors associated with poor outcomes.

BACKGROUND:Emergency Medical Services (EMS) clinicians are the first line of care for the public in emergency medical situations. The prevalence and severity of mental health diagnoses among EMS clinicians are unclear. OBJECTIVES:To systematically review the incidence, prevalence, and severity of depression, anxiety, posttraumatic stress disorder (PTSD), suicidality, and substance use among EMS clinicians. METHODS:We searched Medline, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, journals, and websites for studies published from January 1, 2001 through June 30, 2024. We conducted duplicate screening of abstracts followed by full-text articles. We included studies from high-income countries that enrolled at least 100 EMS clinicians. We assessed the risk of bias, conducted meta-analyses, and evaluated strength of evidence (SoE) using standard methods. RESULTS:We included 85 studies, of which 11 studies had high risk of bias, 66 moderate risk, and eight low risk. No study reported on incidence of any outcome. During routine practice, prevalence estimates were: suicidal ideation 33%, suicide plans 8.7-10.9%, and suicide attempts 2.8-5.6% (moderate SoE). During routine clinical practice and after critical incidents, depression, anxiety, and PTSD prevalence each varied considerably (low SoE). During routine practice, the mean severity of depressive symptoms was minimal-to-mild, anxiety was mild-to-moderate, PTSD was mild, and alcohol usage was of low risk (each moderate SoE). The Suicide Behaviors Questionnaire-Revised mean score was 4.92 (95% confidence interval 2.44-7.39; ≥ 7 indicates at risk of suicide; moderate SoE). After critical incidents, depressive symptoms were minimal-to-mild, and anxiety was mild-to-moderate (moderate SoE for each). CONCLUSIONS:More research is needed because of the marked heterogeneity of studies and lack of consistency in the epidemiologic methods used.

Introduction: Violence in healthcare settings, particularly directed toward healthcare workers, has received increasing attention in the United States (US). However, there is limited evidence on trends in hospital-based gun violence. We aimed to better understand the characteristics of US hospital-based shootings over two decades. Methods: A search of Nexis Uni was conducted for newspaper articles, newswires, web news articles, or magazines mentioning hospital-based shootings during the period from 2000 to 2019. Articles were screened for relevance, and data were subsequently extracted and categorized by two independent reviewers. Results: From 2000 to 2019, we identified 148 hospital-based shootings with 241 victims. Mean number of shootings increased from 3.4/year during 2000-2004 to 8.4/year during 2005-2009 (rate ratio [RR]: 2.5, 95 percent confidence interval [CI]: 1.4, 4.3), to 11.2/year during 2010-2014 (RR: 1.3, 95 percent CI: 0.9, 2.0) but decreased to 6.6/year during 2015-2019 (RR: 0.6, 95 percent CI: 0.4, 0.9). An overwhelming majority (91 percent) of shooters were male with a median age of 46. The most frequent motive was the spillover of social violence (22 percent). The majority (59 percent) of events involved a single victim, although 14 percent had three or more victims. Discussion: Hospital-based shootings remain a persistent threat, with the 2010-2014 period representing increased risk. While motives were varied, spillover of social violence was the most frequent. These findings can potentially inform prevention and mitigation strategies for hospital-based gun violence.

ObjectivesTo systematically review the (1) incidence, prevalence, and severity of mental health issues and occupational stress issues among emergency telecommunicators, and (2) effectiveness and harms of interventions to promote resistance and resilience regarding these issues.MethodsWe searched Medline, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, journals, and websites from January 1, 2001, through June 30, 2024. We conducted duplicate screening of titles and abstracts followed by full texts of potentially relevant records. We included studies of telecommunicators in high-income countries that reported the incidence/prevalence/severity of mental health issues and occupational stress issues or evaluated interventions targeting resistance/resilience regarding these issues. We excluded studies of telecommunicators in training during the study. We assessed the risk of bias using study design-specific tools, conducted meta-analyses using random-effects models, and evaluated strength of evidence (SoE) per Agency for Healthcare Research and Quality methods. We registered the systematic review prospectively in PROSPERO (CRD42023465325).ResultsWe included 31 studies (29 cross-sectional studies, 1 pre-post study, and 1 randomized controlled trial) that evaluated a total of 6,621 participants. Research Question 1 (30 studies): No study reported on incidence of any outcome. During routine practice, prevalence estimates were: any depression 15.5%, suicidal ideation 12.4%, suicide plans 5.7%, suicide attempts 0.7%, alcohol abuse 15.5%, high/extreme peri-traumatic distress 5%, high secondary traumatic stress 16.3%, and acute stress disorder 17% (low SoE for each). In terms of severity, on average, depressive symptoms and stress were mild/low to moderate, burnout was mild to severe (moderate SoE); peri-traumatic distress was moderate, and secondary traumatic stress was mild (low SoE). After critical incidents, the prevalence of high and medium general stress was 39.7% and 28.2%, respectively (low SoE). In terms of severity, on average, burnout and general stress were moderate (low SoE). Research Question 2 (2 studies): The evidence was insufficient regarding the impacts of interventions on anxiety, depression, posttraumatic stress disorder, and alcohol use.ConclusionsThe prevalence and severity of mental health and occupational stress issues in the emergency telecommunicator workforce merits greater attention. Much more research is needed regarding the effectiveness of interventions for strengthening the resistance and resilience of the workforce.

OBJECTIVES:To systematically review the effectiveness and harms of interventions to promote resistance and resilience regarding mental health and occupational stress issues among emergency medical service (EMS) clinicians. METHODS:We registered the systematic review prospectively on PROSPERO (CRD42023465325). We searched Medline, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, journals, and websites for studies published from January 1, 2001, through June 30, 2024. We conducted duplicate screening of titles and abstracts followed by full texts of potentially relevant abstracts. We included studies of EMS clinicians in high-income countries that evaluated interventions targeting resistance or resilience regarding mental health or occupational stress issues. We assessed the risk of bias and evaluated strength of evidence (SoE) using standard methods. RESULTS:We included seven studies (one randomized controlled trial, one controlled trial with a waitlist control, four pre-post studies, and one prospective cohort [single group] study) that evaluated a total of 425 EMS clinicians. We deemed five of the seven studies to have high risk of bias, one moderate risk, and one low risk. No meta-analysis was feasible because of heterogeneity in the interventions evaluated across studies. Mindfulness-building interventions targeting resistance and resilience among EMS clinicians were associated with reduced burnout at up to 6 months of follow-up (low SoE). The evidence was insufficient regarding the impacts of interventions targeting both resistance and resilience on anxiety and depression. No conclusions are possible for resistance-only or resilience-only interventions. No studies reported on the effectiveness of any interventions in reducing hospitalizations, post-traumatic stress disorder, substance use, suicidality, or withdrawals from the workforce. No studies reported on unintended harms of interventions. CONCLUSIONS:Given the sparse evidence identified in this systematic review, evidence-based options to improve mental health outcomes for EMS clinicians are very limited. Future research is urgently needed to inform strategies to address the many mental health and occupational stress issues that face the EMS clinician workforce.

The 2013–2016 West African Ebola virus outbreak was the longest and largest Ebola outbreak to date. High levels of stress and isolation experienced by frontline workers (FWs) during the Ebola outbreak highlight the importance of recognizing mental health and well-being (MHW). This study aimed to summarize and synthesize the MHW dimensions and interventions among FWs during the Ebola outbreak. A scoping review was conducted for English- and French-language articles indexed in PubMed and the Global Health Library, published from 2013 up to March 2025. Quantitative and qualitative studies reporting on the epidemiology and interventions for MHW among FWs, including healthcare personnel and ancillary health staff, during the Ebola outbreak were eligible for inclusion. A total of 22 articles were included in this review. Of these, 14 articles addressed the epidemiology of MHW for FWs, 3 addressed MHW interventions for FWs, and 5 addressed both topics. Studies interviewing FWs offered a glimpse into the unique psychological burden of responding to the outbreak, highlighting themes of stress, anxiety, social isolation, fear, and guilt. Intervention-based studies identified resources that could provide psychological support and/or relevant education. Recommendations aimed at the local, national, and international levels are proposed. Studies that address MHW among FWs during the Ebola outbreak are scarce, with even fewer describing interventions that address these issues. Demands on FWs remain an essential consideration during any emergent response, and further examination of impacts and interventions is needed.

Background: Direct-acting antiviral agents (DAAs) have significantly reduced Hepatitis C Virus (HCV) transmission and improved health outcomes since their FDA approval in 2011. Despite these advances, over 70 million people remain untreated globally, with a disproportionately high burden in low- and middle-income countries (LMICs). Methods: Through a structured search of open access informational sources and an informal peer-reviewed literature review, HCV treatment barriers were identified, compiled, and analyzed. Current challenges to HCV treatment were organized by themes and summarized as recommendations for LMICs. Results: Key obstacles to HCV treatment in LMICs are identified, with the underdiagnosis and undertreatment of the disease linked to inadequate funding and healthcare infrastructure for screening and testing, poor awareness among healthcare providers, and the misinformation and stigmatization of HCV disease. Discussion: Recommendations for LMICs to attenuate treatment obstacles include distributing educational media, implementing mobile clinics, and fostering international partnerships. The successful implementation of these interventions has been demonstrated in developed countries. Conclusions: To achieve the WHO’s goal of eliminating HCV as a public health threat by 2030, concerted efforts are needed by LMICs to reduce gaps in care and ensure that all patients are afforded access to testing and treatment.

In absence of a "gold standard", a standardized clinical adjudication process was developed for a registrational trial of a transcriptomic host response (HR) test. Two physicians independently reviewed clinical data to adjudicate presence and source of bacterial and viral infections in emergency department patients. Discordant cases were resolved by a third physician. Agreement among 955 cases was 74.1% (708/955) for bacterial, 75.6% (722/955) for viral infections, and 71.2% (680/955) overall. Most discordances were minor (85.2%; 409/480) versus moderate (11.7%; 56/480) or complete (3.3%; 16/480). Concordance levels were lowest for bacterial skin and soft tissue infections (8.2%) and for viral respiratory tract infections (4.5%). This robust adjudication process can be used to evaluate HR tests and other diagnostics by regulatory agencies and for educating clinicians, laboratorians, and clinical researchers. Clinicaltrials.gov NCT04094818. SUMMARY: Without a gold standard for evaluating host response tests, clinical adjudication is a robust reference standard that is essential to determine the true infection status in diagnostic registrational clinical studies.

Abstract The emergence of SARS-CoV-2 has unleashed a global health crisis, demanding advanced research into its genomic mutations and their consequences. Our study combines computational models and empirical validation to predict the effects of these mutations, aiming to understand their impact on the virus's behaviour, including its transmissibility and immune escape mechanisms. Utilising advanced prediction tools, we analysed mutations across the virus's genome, focusing on changes to both structural and non-structural proteins. This approach identified key mutations likely to influence protein functionality and the virus's evolution. Our findings, integrating computational predictions with real-world data, offer insights into SARS-CoV-2's evolutionary path and its implications for developing vaccines and therapies. We highlight the necessity of ongoing genomic surveillance and the combined use of computational and empirical methods to stay ahead of viral mutations. This study not only deepens our understanding of SARS-CoV-2 but also lays groundwork for future research on viral evolution and pandemic response strategies, emphasizing our approach's potential to inform public health decisions and research priorities.

Objective: To determine the incidence and characteristics of hospital-based gun violence from 2000-2019. Methods: A keyword-based search of the Nexis Uni database was conducted to identify hospital based shootings (("shooting" w/5 " healthcare " ) OR ("shooting" w/5 " health care") OR ("shooting" w/5 " hospital " ) OR ("shooting" w/5 " emergency room") OR ("shooting" w/5 " ER " ). Hospital based shootings were defined as any firearms discharge that occurred on hospital grounds in which at least one person was injured. Specialty hospitals and other healthcare facilities were excluded. Demographic, motive, and outcome data from news articles were abstracted by 2 independent reviewers with discrepancies resolved by a third reviewer. Motives were categorized according to a previously published classification schema. Results: We identified 146 hospital-based shootings. 88 shootings have occurred since 2010. 133 of the shooters were male (91%), with a median age of 46. 77 (53%) shooters were killed, 49 from suicide (34%). Shootings were most frequently motivated by social violence (n=32, 22%). Conclusions: Hospital-based shootings are not a rare occurrence, with middle-aged male shooters as the most common perpetrators. These events appear to be increasing over time and evidence-based mitigation strategies should be investigated.

The recent Halloween crowd crush incident in Itaewon, Seoul, Korea, highlights a woeful inadequacy in our collective knowledge about crowd disasters. Underscored is a lack of detailed information on the causes of death and the injuries sustained. While traumatic asphyxiation has been widely implicated as the primary cause of death, the wider spectrum of injury patterns and their causative mechanisms remain poorly identified. Challenges to advancing our understanding of crowd disasters include limited and restricted access to official reports, incomplete documentation, and reliance on unofficial sources for information. There is a need for targeted research to better understand crowd dynamics that lead to injuries. Future directions should prioritize better interdisciplinary collaboration, improved data sharing, and computer simulations to model real-world events. Further inquiry into human stampedes and crowd crushes, such as the Itaewon incident, is urgently needed to prevent similar tragedies; focusing on the types and mechanisms of injuries is a crucial first step to enhancing emergency preparedness and disaster response.

Introduction: The COVID-19 pandemic has not only put a strain on the health care system throughout the world but has had an extreme impact on health care workers caring for these patients on a daily basis. These workers have been isolated from their families and experienced significant stress and loss at work and home. Some health care workers experienced rationing of care, inadequate personal protective equipment, and found themselves without the resources needed to care for patients. This paper reports on a systematic review of wellness and stress interventions targeting healthcare workers during the COVID-19 pandemic. Method: A systematic review of Pubmed and SCOPUS articles published between January 1, 2020 and November 1, 2022 was conducted using the terms “healthcare worker”, “nurse”, “doctor”, “paramedic”, ”emergency medical technician”, “mental health”, “resilience”, “wellness”, “stress”, “sleep” , “intervention”, “Covid-19”, “coronavirus”, and “pandemic.” These results were imported into Covidence. Inclusion criteria were studies on interventions of healthcare workers. Exclusion criteria were papers not describing health care workers, papers not describing interventions, health care workers not caring for COVID19 patients, and papers not written in English. Results: A total of 26 papers were included in the analysis after the final screen. These papers were examined and sorted into groups based on the types of interventions on health care workers. The groups of interventions included 1. Psychological interventions, 2. Wellness or well-being interventions, 3. Work-related interventions, and 4. Pharmacologic interventions. Two studies were longitudinal in nature. The most common intervention was psychological (10), followed by work-related interventions (6). Conclusion: Psychological interventions were the most commonly deployed and included hotline establishment or speaking with a therapist. This was followed by wellness interventions such as exercise, sleep regulation, breathing exercises, and healthy eating. Fewer interventions were included in the work-related or pharmacologic categories. Data regarding effectiveness and feasibility of interventions was heterogenous.

The emergence of viruses and their variants has made virus taxonomy more important than ever before in controlling the spread of diseases. The creation of efficient treatments and cures that target particular virus properties can be aided by understanding virus taxonomy. Alignment-based methods are commonly used for this task, but are computationally expensive and time-consuming, especially when dealing with large datasets or when detecting new virus variants is time sensitive. An alternative approach, the encoded method, has been developed that does not require prior sequence alignment and provides faster results. However, each encoded method has its own claimed accuracy. Therefore, careful evaluation and comparison of the performance of different encoded methods are essential to identify the most accurate and reliable approach for virus taxonomy classification. This study aims to address this issue by providing a comprehensive and comparative analysis of the potential of encoded methods for virus classification and phylogenetics. We compared the vectors generated for each encoded method using distance metrics to determine their similarity to alignment-based methods. The results and their validation show that K-merNV followed by CgrDft encoded methods, perform similarly to state-of-the-art multi-sequence alignment methods. This is the first study to incorporate and compare encoded methods that will facilitate future research in making more informed decisions regarding selection of a suitable method for virus taxonomy.

Objective:Emergency medical (EM) response systems require extensive coordination, particularly during mass casualty incidents (MCIs). The recognition of preparedness gaps and contextual priorities to MCI response capacity in low- and middle-income countries (LMICs) can be better understood through the components of EM reponse systems. This study aims to delineate essential components and provide a framework for effective emergency medical response to MCIs. Methods:A scoping review was conducted using 4 databases. Title and abstract screening was followed by full-text review. Thematic analysis was conducted to identify themes pertaining to the essential components and integration of EM response systems. Results:Of 20,456 screened citations, 181 articles were included in the analysis. Seven major and 40 sub-themes emerged from the content analysis as the essential components and supportive elements of MCI medical response. The essential components of MCI response were integrated into a framework demonstrating interrelated connections between essential and supportive elements. Conclusions:Definitions of essential components of EM response to MCIs vary considerably. Most literature pertaining to MCI response originates from high income countries with far fewer reports from LMICs. Integration of essential components is needed in different geopolitical and economic contexts to ensure an effective MCI emergency medical response.

Objectives:The aim of this review was to summarize current evidence from the United States on the effectiveness of practices and interventions for preventing, recognizing, and controlling occupationally acquired infectious diseases in Emergency Medical Service (EMS) clinicians. Report and Methods:PubMed, Embase, CINAHL, and SCOPUS were searched from January 1, 2006 through March 15, 2022 for studies in the United States that involved EMS clinicians and firefighters, reported on one or more workplace practices or interventions that prevented or controlled infectious diseases, and included outcome measures. Eleven (11) observational studies reported on infection prevention and control (IPC) practices providing evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Less frequent handwashing (survey-weight adjusted odds ratio [OR] 4.20; 95% confidence interval [CI], 1.02 to 17.27) and less frequent hand hygiene after glove use (survey-weight adjusted OR 10.51; 95% CI, 2.54 to 43.45) were positively correlated with nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA). Lack of personal protective equipment (PPE) or PPE breach were correlated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity (unadjusted risk ratio [RR] 4.2; 95% CI, 1.03 to 17.22). Workers were more likely to be vaccinated against influenza if their employer offered the vaccine (unadjusted OR 3.3; 95% CI, 1.3 to 8.3). Active, targeted education modules for H1N1 influenza were effective at increasing vaccination rates and the success of on-site vaccine clinics. Conclusions:Evidence from the United States exists on the effectiveness of IPC practices in EMS clinicians, including hand hygiene, standard precautions, mandatory vaccine policies, and vaccine clinics. More research is needed on the effectiveness of PPE and vaccine acceptance.

Estimation of crowd size for large gatherings is an indispensable metric for event planners, local authorities, and emergency management. Currently, most crowd counting relies on dated methods such as people counters, entrance sensors, and ticket sales. Over the past decade, there has been rapid development in crowd counting techniques and related technology. Despite progress, theoretical advances in crowd counting technology have outpaced practical applications. The emergence of the vast array of crowd counting techniques has added to the challenge of determining those advances that can be most readily implemented. This article aims to provide an overview of promising crowd counting strategies and recent developments applied within the disaster medicine context along with the best use cases and limitations.

Objectives. To summarize current evidence on exposures to infectious pathogens in the emergency medical services (EMS) and 911 workforce, and on practices for preventing, recognizing, and controlling occupationally acquired infectious diseases and related exposures in that workforce. Review methods. We obtained advice on how to answer four Guiding Questions by recruiting a panel of external experts on EMS clinicians, State-level EMS leadership, and programs relevant to EMS personnel, and by engaging representatives of professional societies in infectious diseases and emergency medicine. We searched PubMed®, Embase®, CINAHL®, and SCOPUS from January 2006 to March 2022 for relevant studies. We also searched for reports from State and Federal Government agencies or nongovernmental organizations interested in infection prevention and control in the EMS and 911 workforce. Results. Twenty-five observational studies reported on the epidemiology of infections in the EMS and 911 workforce. They did not report demographic differences except for a higher risk of hepatitis C in older workers and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in minorities. EMS clinicians certified/licensed in Advanced Life Support have a high risk for blood and fluid exposure, and EMS clinicians had a higher risk of hospitalization or death from SARS-CoV-2 than firefighters whose roles were not primarily related to medical care. Eleven observational studies reported on infection prevention and control practices (IPC), providing some evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Research on IPC in EMS and 911 workers has increased significantly since the SARS-CoV-2 pandemic. Conclusions. Moderate evidence exists on the epidemiology of infections and effectiveness of IPC practices in EMS and 911 workers, including hand hygiene, standard precautions, mandatory vaccine policies, and vaccine clinics. Most evidence is observational, with widely varying methods, outcomes, and reporting. More research is needed on personal protective equipment effectiveness and vaccine acceptance, and better guidance is needed for research methods in the EMS and 911 worker setting.