Role of Knowledge, Skills and Peer Support for Early Recovery of COVID-19 Positive Rescuers

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Introduction
The World Health Organization (WHO) declared Coronavirus disease 2019(COVID-19) as a pandemic on 11 th March, 2020 which was started from Wuhan City, China in December, 2019 (Novel, 2020). In majority of cases, it has been observed that the infection starts from mild illness and turned toward severe pneumonia that leads to acute respiratory disorder which is fatal for health. The pandemic of Coronavirus infected more than 6.7 million people of the world also having 0.4 million deaths globally till date. The first couple of cases of Coronavirus were confirmed in Karachi and Islamabad on 26 th February, 2020 (Ali, Shah, & Siddiqui, 2020). Upcoming 15 days confirmed 20 more cases that are found 14 in Sindh, 5 in Gilgit and 01 in Baluchistan. The major cause of infection was foreign traveling history as the patients were recently visiting back from Iran, Syria and London. The Health Authorities conduct 471 samples having 20 (4.25%) confirmed positive cases till 12 th March, 2020(MALIK & Javed, 2020. As the Punjab Emergency Service, Rescue 1122 took initiative to shift the infected patients from homes to hospitals and quarantine centers. Meanwhile, in this process some of the operational and administration individuals of the service also got infected from the pandemic and become sick due to the disease. However, it has been observed that the healing period of these individuals was rapid as compare to the other people.

Rationale of the Study
Rescue 1122 is an outstanding service that is providing lifesaving services to the people of Punjab. As the whole world was suffering due to the coronavirus disease and there was a sever life threat not only to the lives of the general public but also to the paramedics who were performing their professional duties during this pandemic. The operational staff (rescuers) of the Punjab Emergency Service, like the rest of the world, were also infected during their shifting of the patients but it has been observed that their healing process and period was rapid, as compare to the general public. The aim of this study is to know the facts and techniques that the rescuers used during the period of their disease as how they rapidly overcome on this disease.

Methodology
This survey study was conducted through random sampling and a specific Performa that was designed and emailed to them also informed them about the purpose of the study through telephonic communication, to know the experience of the employees of Punjab Emergency Service, Rescue 1122 operational staff who were performing their duties during the pandemic and got affected through this life-threatening virus. Initially, this study is conducted between the field staff only who were performing duties on ambulances and are in close contact with the suspected or probable COVID-19 cases and felt fever, cough or sore throat during their professional duties. Later on, the staff from control room and administration sections were also involved in this study. The staff was enlisted to do the Coronavirus test during their quarantine period, usually after 14 days of their quarantine period to know about their current health status, as they are recovered from the COVID-19 or they need more care and treatment.

Results
Present study explores the socio economic impact of Coronavirus diseases on the healthcare workers of Punjab Emergency Service during the performing of their professional duties and shifting of the infected patients into hospitals and quarantine centers in district Punjab. The results from the data are as under.
The results have shown that Highest Temperature (75%), Sore Throat (75%), Cough (68%) and Muscle Pain (68%) were the prominent symptoms that the rescuers had faced during the time of their disease and they all successfully recover from this life threatening disease by adopting various other strategies that make the healing process fast and no life-loss has been observed from all the infected rescuers. As there is no authentic medicine has yet been discovered by the WHO or other Healthcare Institutions so the single dependency on medicine is not the only way out. Therefore, various techniques/therapies have been practiced by the patients. Same is happened in Punjab Emergency Service and it has been observed that these simple techniques are beneficial for the Corona patients. The most important technique is Positive Behavior (95%) that keep the nervous system of the patient at normal level which helps them to stay away from anxiety and negativity. The second technique is Skills (85%) that the rescuers use during their professional duties to provide the pre-hospital care to the victims. Also the Professional Knowledge (82.5) that they learned during their training period at Emergency Services Academy also helped them to overcome the disease. Peer Support (70%) is also of parimportance, as it helps the patient from psychological shut-down and provide encourage and support for quick recovery. A total 40 coronavirus affected rescuers of the Punjab Emergency Service had participated in this study who were randomly selected from the total number of rescuers. The main proportion of the reported coronavirus patients (27%) were the drivers LTV who had performed transportation duties during the pandemic, also there were other designations like RSO, SI, FDI, EMT, CTWO, etc.    Table-2 has shown the experience of the infected rescuers from coronavirus i.e. 01-03 Years (7.5%), 4-6 Years (20.0%), 7-10 Years (37.5%), and above 10 Years (35.0%).
The main proportion reflects that the rescuers having 7-10 Years professional experience were the most infected during this pandemic as they prefer to step forward due to their field knowledge and performed exemplary duties in front of the newly joined rescuers. Table-3: As the results shows that the majority of the participants (85%) were married and only (15%) were the single.    Table 6: Mental and Psychological stress bound to come during the self-quarantine of any patients and the victims feel a lot of stress while the rescuers cope this stress through their positive behavior and 95% rescuers are agree that positive behavior plays a vital role in healing from COVID-19.

What kind of positive behavior you adopt?
Percentage Exercise 27.5 Prayer 57.5 Book Reading 5.0 Social Media 10.0 Total 100.0 Table 7: Various rescuers adopt various techniques of positive behaviors during their selfquarantine. As 57.5% rescuers do prayers, 27.5% do various exercises, 10% use social medial and only 05% do book reading to practice the positive behavior.

Discussion
As the first two cases were confirmed on 25 th February, 2020 in Pakistan, the Punjab Emergency Service, took the initiative to start a coronavirus patient shifting service from home to hospital. The first step in this regard was the establishment of Corona Rescue Helpline (1190) to provide the free of cost services to the public who were in a state of threat and terror. The staff of Punjab Emergency Service, Rescue 1122 started its services after adopting all the precautionary measures/standard PPE including gloves, face mask, gown, shoe cover, head cover and goggles etc. but unfortunately still the life threat was on. The first SARS-CoV-2 positive case among the healthcare professionals of Punjab Emergency Service, Rescue 1122 was found on 25 th February, 2020 and from there 40 number of employees were infected out of approximately more than 13thousand employees who were performing their professional duties at pandemic. The healthcare professionals around the world are performing exemplary services during this outbreak. Overall, the infection rate in healthcare professional was 1.1% in a study at Wuhan. However, another study states the rate of infection among the paramedical staff at a high level of 3.8% (Yasmin et al., 2020). This study shows that the overall median age of the employees of Punjab Emergency Service is 26-35 years. There is a similarity in the age groups of health professionals between Rescue 1122 and the rest of the world as they are from the younger age groups that is also evident from several studies performed in China (Bi et al., 2020;Liu et al., 2020;Ran et al., 2020). And another study that was performed in Washington but the results were the same. While the paramedical staff of United States was at 42 years of median age when they were infected by the COVID-19 outbreak (McMichael et al., 2020). Majority of the Rescue 1122 employees had not any other pre-existing comorbidities i.e. kidney pain (2.5%), cardiac disease (0%), diabetes(0%), lungs disease (0%)etc (Hughes, 2020). The same level of health between healthcare professionals are the world. After their quarantine period the majority of the infected employees had various kind of experiences/views as they are of the view that separated quarantine (98%) was the leading cause in the healing process, while positive behavior (95%) was also very important during their healing process (Chou et al., 2020). The professional knowledge (82.5%) and skills (85%) about coronavirus disease, learned at Punjab Emergency Services also helps the rescuers to recover quickly. Also the peer's support (70%) is the fourth leading cause in view of the rescuers that is essential to get motivational approach. The current trend is may be due to the younger mean age of the employees which again shows the identical observation of recent corona infection trends among the healthcare professionals. High Fever/Temperature (75%), Sore Throat (75%), Cough (68%), and Muscle Pain 68% etc, were the common symptoms among the employees of Rescue 1122. This study also found that majority of the employees 39 (97.5%), had no previous fatal medical history (Chou et al., 2020).

Conclusion
The study identifies socio-economic aspects that the positive behavior, separate selfquarantine, peers support, same eating & sleeping habits, professional knowledge & skills were the key factors in the rapid healing process of the rescuers.