A review of infectious disease epidemiology in emergency medical service clinicians

Am J Infect Control. 2023 Aug;51(8):931-937. doi: 10.1016/j.ajic.2022.12.001. Epub 2022 Dec 10.


Background: The emergency medical service (EMS) workforce is at high risk of occupationally-acquired infections. This review synthesized existing literature on the prevalence, incidence, and severity of infections in the EMS workforce.

Methods: We searched PubMed, Embase, CINAHL, and SCOPUS from January 1, 2006 to March 15, 2022 for studies in the US that involved EMS clinician or firefighter populations and reported 1 or more health outcomes related to occupationally-acquired infections.

Results: Of the 25 studies that met the inclusion criteria, most focused on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with prevalence rates ranging from 1.1% to 36.2% (median 6.7%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in 4 studies ranged from 1.9% to 6.4%, and the prevalence of Hepatitis C in 1 study was 1.3%. Few studies reported incidence rates. The prevalence or incidence of these infections generally did not differ by age or gender, but 4 studies reported differences by race or ethnicity. In the 4 studies that compared infection rates between EMS clinicians and firefighters, EMS clinicians had a higher chance of hospitalization or death from SAR-CoV-2 (odds ratio 4.23), a higher prevalence of Hepatitis C in another study (odds ratio 1.74), and no significant difference in MRSA colonization in a separate study.

Conclusions: More research is needed to better characterize the incidence and severity of occupationally-acquired infections in the EMS workforce.

Keywords: Firefighters; Occupationally-acquired infections; Prehospital; Systematic review.

Publication types

  • Review
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • COVID-19* / epidemiology
  • Communicable Diseases*
  • Emergency Medical Services*
  • Hepatitis C*
  • Humans
  • Methicillin-Resistant Staphylococcus aureus*
  • SARS-CoV-2
  • Staphylococcal Infections* / epidemiology