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Engagement in regular physical activity is one of the best strategies for older adults to remain healthy. Unfortunately, only 35% of older adults meet guidelines for muscle strengthening activities. Eliciting participant preferences is one possible way to improve physical activity engagement. However, other sources of participant input to improve uptake and maintenance remain uninvestigated. This study compared preferences to self-efficacy ratings for two strength training programs. We conducted a national cross-sectional survey of 611 US adults over age 65. We compared two participant evaluations (the preferred program and the program for which they had higher barrier self-efficacy) of two hypothetical strength training programs (45 minutes performed three times per week (traditional) and 5 minutes performed daily (brief)). Most participants (68%) preferred the brief strength training program. The difference in self-efficacy ratings was an average of 1.2 (SD = 0.92). One in five participants preferred a strength training program for which they had less self-efficacy; nearly all of these participants (92%) preferred the traditional strength training program but had more self-efficacy for the brief strength training program. Older adults reported preferring and having more self-efficacy for a brief compared to a traditional strength training program. Differences in self-efficacy ratings between the two strength training programs were large. Preferences were often not congruent with ratings of self-efficacy. Preferences for strength training programming may not always reflect the program most likely to be maintained. Future investigations should evaluate differences in behavioral uptake, maintenance, and outcomes from two comparative strength training interventions using preferences and self-efficacy.

Resistance training (RT) improves strength and physical function; however, only 35% of older adults meet national guidelines for muscle strengthening activities. Though time is often noted as a barrier to physical activity participation, little is known about the interest of older adults in brief RT programs. This study compared preferences for brief, more frequent vs longer, less frequent RT programs. A nationwide survey was conducted among 611 US adults aged 65 and over. Preference for either (1) a traditional (45 minutes per session, three days per week) RT program or (2) a short (5 minutes per session, daily) RT program was compared. Overall, 2.2 times as many older adults preferred the daily 5-minute RT program versus the traditional RT program (68.4% v. 31.6%). Preference for the brief, daily RT program was 5.3 times higher among adults with difficulty walking (84.2% v. 15.8%) than for the traditional RT program. Preference for a daily 5-minute RT program is significantly higher than for traditional 45-minute, three times weekly programs. This difference is larger in older adults who have serious difficulty walking or climbing stairs. Brief daily RT options may help engage older adults in RT at a population level, particularly those with poorer health and mobility disability. Future investigations should evaluate differences in uptake, adherence, and outcomes from two RT programs of varying durations and frequencies.

There is growing concern with the strength and stability of the emergency medical services (EMS) workforce with reports of workforce challenges in many communities in the United States. Our objective was to estimate changes in the EMS workforce by evaluating the number of clinicians who enter, stay, and leave. A 4‐year retrospective cohort evaluation of all certified EMS clinicians at the emergency medical technician (EMT) level or higher was conducted for 9 states that require national EMS certification to obtain and maintain EMS licensure. The study spanned 2 recertification cycles (2017–2021) for 2 workforce populations: the certified workforce (all EMS clinicians certified to practice) and the patient care workforce (the subset who reported providing patient care). Descriptive statistics were calculated and classified into 1 of 3 categories: EMS clinicians who entered, stayed in, or left each respective workforce population. There were 62,061 certified EMS clinicians in the 9 included states during the study period, and 52,269 reported providing patient care. For the certified workforce, 80%–82% stayed in and 18%–20% entered the workforce. For the patient care workforce, 74%–77% stayed and 29%–30% entered. State‐level rates of leaving each workforce ranged from 16% to 19% (certified) and 19% to 33% (patient care). From 2017 to 2020, there was a net growth of both the certified (8.8%) and patient care workforces (7.6%). This was a comprehensive evaluation of both the certified and patient care EMS workforce dynamics in 9 states. This population‐level evaluation serves as the first step for more detailed analyses to better understand workforce dynamics in EMS.

Recent concerns for the strength and stability of the emergency medical services (EMS) workforce have fueled interest in enhancing the entry of EMS clinicians into the workforce. However, the educational challenges associated with workforce entry remain unclear. Our objective was to evaluate the educational pathway of entry into the EMS workforce and to identify factors that lead to the loss of potential EMS clinicians. This is a cross‐sectional evaluation of all US paramedic educational programs, with enrolled students, in the 2019 Committee on Accreditation of Educational Programs for the EMS Professions annual report survey. This data set includes detailed program characteristics and metrics including program attrition rate (leaving before completion), and certifying exam pass rates. Descriptive statistics were calculated, and multivariable logistic regression analysis was conducted to evaluate the association between high program attrition rates (>30%) and program specific characteristics. In 2019, 640 accredited programs met inclusion with 17,457 students enrolled in paramedic educational programs. Of these, 13,884 students successfully graduated (lost to attrition, 3,573/17,457 [21%]) and 12,002 passed the certifying exam on the third attempt (lost to unable to certify, 1,882/17,457 [11%]). High program attrition rates were associated with longer programs (>12 months), small class sizes (<12 students), and regional locations. Nearly 1 in 3 paramedic students were lost from the potentially available workforce either owing to attrition during the educational program or failure to certify after course completion. Attrition represented the largest loss, providing an avenue for future targeted research and interventions to improve EMS workforce stability.

Introduction/Objectives: One in four older adults in the United States (US) reports being socially isolated or lonely, leading to increases in the odds of having heart disease, a stroke, and dementia. Physical activity (PA) has many benefits in this population, both physical and psychological. One such type of PA growing in popularity is pickleball. Our objective was to understand the relationship of pickleball participation with perceived loneliness and social isolation among older adults in the US. Methods: We conducted a national cross-sectional survey of 825 US adults over age 50 years. We compared the effect of 3 levels of pickleball play history (never played (NP); played previously, not currently (PP); and currently play (CP)) on loneliness and social isolation. Results: Most participants (65%) who had ever played pickleball were still currently playing. Over half of the sample (57%) reported being lonely. The adjusted odds of being lonely were greater for NP (adjusted odds ratio 95% CI = 1.53, 1.04-2.23), and PP (1.95, 1.24-3.05) groups. Compared to NP, PP, and CP groups were found to be associated with having made more social connections and reporting a greater number of social engagements, thus appearing to experience less social isolation. Conclusion: Older adults who participate in pickleball had an associated decreased perceived loneliness and reduced risk of social isolation. Further research is needed to determine if recommendations for those able to physically participate in pickleball might result in similar changes to loneliness and social isolation.

Objective As the COVID‐19 pandemic began, there were significant concerns for the strength and stability of the emergency medical services (EMS) workforce. These concerns were heightened with the closure of examination centers and the cessation of certification examinations. The impact of this interruption on the EMS workforce is unclear. Our objective was to evaluate the impact of COVID‐19 on initial EMS certification in the United States. In addition, we evaluated mitigation measures taken to address these interruptions. Methods This study was a cross‐sectional evaluation of the National Certification Cognitive Examination administration and results for emergency medical technician (EMT) and paramedic candidates. We compared the number of examinations administered and first‐attempt pass rates in 2020 (pandemic) to 2019 (control). Descriptive statistics and 2 one‐sided tests of equivalence were used to assess if there was a relevant difference of ±5 percentage points. Results Total number of examinations administered decreased by 15% (EMT, 14%; paramedic, 7%). Without the addition of EMT remote proctoring, the EMT reduction would have been 35%. First‐time pass rates were similar in both EMT (−0.9%) and paramedic (−1.9%) candidates, which did not meet our threshold of a relevant difference. Conclusion COVID‐19 has had a measurable impact on examination administration for both levels of certification. First‐time pass rates remained unaffected. EMT remote proctoring mitigated some of the impact of COVID‐19 on examination administration, although a comparison with mitigation was not assessed. These reductions indicate a potential decrease in the newly certified workforce, but future evaluations will be necessary to assess the presence and magnitude of this impact.

ObjectiveEmergency medical services (EMS) clinicians operate in environments that predispose them to occupational hazards. Our objective was to evaluate the frequency of occupational hazards and associations with mitigation strategies in a national dataset.MethodsWe performed a cross-sectional analysis of currently working, nationally certified civilian EMS clinicians aged 18–85 in the USA. After recertifying their National EMS Certification, respondents were invited to complete a survey with questions regarding demographics, work experience and occupational hazards. Three multivariable logistic regression models (OR, 95% CI) were used to describe associations between these hazards and demographics, work characteristics and mitigation strategies. Models were adjusted for age, sex, minority status, years of experience, EMS agency type, service type and EMS role.ResultsA total of 13 218 respondents met inclusion criteria (response rate=12%). A high percentage of EMS clinicians reported occupational injuries (27%), exposures (38%) and violence (64%) in the past 12 months. Odds of injury were lower with the presence of a lifting policy (0.73, 0.67–0.80), lift training (0.74, 0.67–0.81) and always using a powered stretcher (0.87, 0.78–0.97). Odds of exposure decreased with chemical, biological and nuclear exposure protection training (0.75, 0.69–0.80). Training in de-escalation techniques was associated with lower odds of experiencing violence (0.87, 0.79–0.96).ConclusionsOccupational hazards are commonly experienced among EMS clinicians. Common mitigation efforts are associated with lower odds of reporting these hazards. Mitigation strategies were not widespread and associated with lower odds of occupational hazards. These findings may present actionable items to reduce occupational hazards for EMS clinicians.

Although COVID-19 vaccines are widely available in the U.S. and much of the world, many have chosen to forgo this vaccination. Emergency medical services (EMS) professionals, despite their role on the frontlines and interactions with COVID-positive patients, are not immune to vaccine hesitancy. Via a survey conducted in April 2021, we investigated the extent to which first responders in the U.S. trusted various information sources to provide reliable information about COVID-19 vaccines. Those vaccinated generally trusted healthcare providers as a source of information, but unvaccinated first responders had fairly low trust in this information source—a group to which they, themselves, belong. Additionally, regardless of vaccination status, trust in all levels of government, employers, and their community as sources of information was low. Free-response explanations provided some context to these findings, such as preference for other COVID-19 management options, including drugs proven ineffective. A trusted source of COVID-19 vaccination information is not readily apparent. Individuals expressed a strong desire for the autonomy to make vaccination decisions for themselves, as opposed to mandates. Potential reasons for low trust, possible solutions to address them, generalizability to the broader public, and implications of low trust in official institutions are discussed.

Recently, there have been annual increases in emergency medical service (EMS) demand with concurrent clinician shortages. Understanding the diverse number of EMS clinicians available for emergent roles is vital for planning and resource management. Our study aims to understand the roles and environments of US EMS clinicians. This cross-sectional study analyzed nationally certified civilian US EMS clinicians recertifying from October 2021 to April 2022, ages 18-85, with at least one EMS job. Respondents answered questions regarding their primary and secondary EMS roles, including emergent response (with/without 9-1-1), medical transport (non-emergent), clinical services, mobile integrated health (MIH), or none of the above. Next, respondents were asked about the number of jobs needed to make ends meet. All responses were combined with self-reported National Registry profile data (e.g., age, sex). Descriptive statistics were performed. The study included 33,335 EMS clinicians (response rate: 34.0%). The primary role reported was emergent response with 25,086 (75.3%), including ground ambulance and non-ambulance response. Clinical service roles were reported by 2,427 (7.3%), including settings such as the emergency department and outpatient clinics. Medical transport roles accounted for 2,346 (7.0%), including ground interfacility and critical ground care. Educators and administrators made up 1,453 (4.4%). Overall, roles varied by sex, and 48.8% of respondents reported needing more than one job to make ends meet. Our evaluation highlights various US EMS clinician roles. These findings suggest the need for continued focus and attention on EMS roles, compensation structures, and sex distributions to ensure a resilient, diverse, and adequately supported EMS workforce.