• Megan E Gregory, Jonathan R Powell, Sarah R MacEwan, Jordan D Kurth, Eben Kenah, Ashish R Panchal, and Ann Scheck McAlearney.
• Received August 24, 2021; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio (MEG, ASM); The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio (MEG, SRM, ARP, ASM); National Registry of Emergency Medical Technicians, Columbus, Ohio (JRP, JDK, ARP); Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio (JRP, ARP); Division of Biostatistics, The Ohio State University College of Public Health, Columbus, Ohio (EK); Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (ARP); Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio (ASM). Revision received October 8, 2021; accepted for publication October 11, 2021.
• Prehosp Emerg Care. 2022 Sep 1; 26 (5): 632-640.

AbstractBackground: Immunizations for emergency medical services (EMS) professionals during pandemics are an important tool to increase the safety of the workforce as well as their patients. The purpose of this study was to better understand EMS professionals' decisions to receive or decline a COVID-19 vaccine.Methods: We conducted a cross-sectional analysis of nationally certified EMS professionals (18-85 years) in April 2021. Participants received an electronic survey asking whether they received a vaccine, why or why not, and their associated beliefs using three validated scales: perceived risk of COVID-19, medical mistrust, and confidence in the COVID-19 vaccine. Data were merged with National Registry dataset demographics. Analyses included descriptive analysis and multivariable logistic regression (OR, 95% CI). Multivariate imputation by chained equations was used for missingness.Results: A total of 2,584 respondents satisfied inclusion criteria (response rate = 14%). Overall, 70% of EMS professionals were vaccinated. Common reasons for vaccination among vaccinated respondents were to protect oneself (76%) and others (73%). Common reasons for non-vaccination among non-vaccinated respondents included concerns about vaccine safety (53%) and beliefs that vaccination was not necessary (39%). Most who had not received the vaccine did not plan to get it in the future (84%). Hesitation was most frequently related to wanting to see how the vaccine was working for others (55%). Odds of COVID-19 vaccination were associated with demographics including age (referent <28 years; 39-50 years: 1.56, 1.17-2.08; >51 years: 2.22, 1.64-3.01), male sex (1.26, 1.01-1.58), residing in an urban/suburban area (referent rural; 1.36, 1.08-1.70), advanced education (referent GED/high school and below; bachelor's and above: 1.72, 1.19-2.47), and working at a hospital (referent fire-based agency; 1.53, 1.04-2.24). Additionally, vaccination odds were significantly higher with greater perceived risk of COVID-19 (2.05, 1.68-2.50), and higher vaccine confidence (2.84, 2.40-3.36). Odds of vaccination were significantly lower with higher medical mistrust (0.54, 0.46-0.63).Conclusion: Despite vaccine availability, not all EMS professionals had been vaccinated. The decision to receive a COVID-19 vaccine was associated with demographics, beliefs regarding COVID-19 and the vaccine, and medical mistrust. Efforts to increase COVID-19 vaccination rates should emphasize the safety and efficacy of vaccines.

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