Introduction
Emergency Medical Services (EMS) personnel are often the first to provide healthcare services to a patient in different situations outside the hospital. The most important part of the pre-hospital EMS is the useful and practical manpower that can manage various injuries and diseases using equipment in ambulance [1]. Knowledge of ambulance equipment have a great impact on their performance [2]. In order to improve the performance of EMS personnel, the first step is to assess their knowledge of ambulance equipment. This study aims to investigate the knowledge of ambulance equipment in pre-hospital EMS personnel of Rasht city, Iran.
 Methods
This cross-sectional analytical study, was conducted on 84 EMS personnel of 17 medical centers in Rasht, Iran in 2020. The sample size was determined based on Holmberg’s study [3]. Sampling was done using a convenience sampling method. Inclusion criteria were a relevant higher education and one year of experience. The assessment tool was a two-part questionnaire: The first part surveys demographic characteristics (age, gender, work experience, type of employment, education, field of study, history of retraining courses) and the second part assesses the knowledge level of ambulance equipment according to the Pre-hospital Emergency Medicine/Equipment User Manual of Iranian Ministry of Health and Medical Education (fourth edition), which has 91 items. The total score is 91, where a score of 0-45 shows poor knowledge, a score of 46-63 shows moderate knowledge, and a score of 64-91 shows good knowledge. The collected data were analyzed in IBM SPSS Statistics software version 22, and the significance level was set at 0.05.  
Results
The mean age of participants was 35.21±7.79 years and most of them were male and had formal contract and a bachelor’s degree in nursing or emergency medicine. Their mean work experience was 9.84±6.41 years, and most of them had a history of participating in retraining courses. Based on the findings, their mean knowledge score was 86.02±2.84 which was at a good level. Their knowledge of ambulance equipment had a significant relationship with their type of employment (P<0.001), where that the score of those with a formal contract was higher (Table 1).


Discussion
In this study, the knowledge level of pre-hospital EMS personnel in Rasht city about ambulance equipment was assessed. One third of personnel had a formal contract. In studies by Heydari et al. and Sharifi et al., a few of EMS personnel were official employees [4, 5]. Employment status is in fact a sign of job security and can be effective in motivating staff and improving their performance. According to the results of this study, the knowledge of most of participants was at good level. This finding is consistent with the results of other studies in which the knowledge level of most EMS staff was reported to be above average [3] and good [4]. Familiarity with ambulance equipment through specialized training, practical work with experienced staff [6], simulation and continuous training can increase knowledge and create a sense of security and full use of equipment [7]. The sensitivity of prehospital emergency service delivery work requires the personnel to have full knowledge of ambulance equipment. In this study, the type of employment was significantly related to the knowledge about ambulance equipment. Those with a formal contract had more knowledge which increases service delivery. It seems that holding appropriate training courses can improve the knowledge of EMS personnel in Rasht city about ambulance equipment.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of the Guilan University of Medical Sciences (Code: IR.GUMS.REC.1399.481). 

Funding
The present study was funded by the Deputy for Research and Technology of Guilan University of Medical Sciences.

Authors' contributions
Conceptualization and design: Payman Asadi, Nazanin Noori Roodsari; Data acquisition, analysis and interpretation: Payman Asadi, Nazanin Noori Roodsari, Habib Eslami Kenarsari, Mohammadreza Darabinia; initial draft preparation: Payman Asadi. Critical review of the content: Habib Eslami Kenarsari and Majid Pourshaikhian; Project administration and technical support: Payman Asadi; supervision: Payman Asadi, Nazanin Noori Roodsari. 

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgements
The authors would like to thank the Vice-Chancellor for Research and Technology of Guilan University of Medical Sciences and the participants for their cooperation.


References

1. Mistovich JJ, Karren KJ, Hafen B. Prehospital emergency care. London: Pearson; 2014. https://www.google.com/books/edition/Prehospital_Emergency_Care/s5TtmAEACAAJ?hl=en
2. Haghani F, Sadeghi N. [Training in pre-hospital emergency: Needs and truths (Persian)]. Iranian Journal of Medical Education. 2011; 10(5):1273-80. http://ijme.mui.ac.ir/article-1-1636-en.html
3. Pourshaikhian M, Jahangiri K, Kazemnejhad E, Vatankhah S. [Hospital emergency medical services: The analysis of EMS ambulances equipment in Rasht city (Persian)]. Scientific Journal of Rescue and Relief. 2014; 6(1):55-65. https://www.sid.ir/en/journal/ViewPaper.aspx?ID=464435
4. Heidari M, Shahbazi S. [Assessment of emergency medical services (EMS) staff’s knowledge and practice about principles and equipment used for patient handling in EMS centers of Isfahan province (Persian)]. Journal of Research Development in Nursing & Midwifery. 2015; 12(1):111-7. http://nmj.goums.ac.ir/article-1-719-en.html
5. Yadollahi S. [Evaluation of prehospital emergency performance services in Shahrekord city in 2016 (Persian)]. Scientific Journal of Rescue and Relief. 2018; 9(4):100-11. https://www.sid.ir/en/journal/ViewPaper.aspx?id=667767
6. Rad M, Saburie O, Saburie E. [The comparison of Sabzevar’s pre-hospital emergency conditions and existing standards in, 2014-2015 (Persian)]. Iranian Journal of Emergency Care. 2017; 1(2):19-28. https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=597866
7. Sabouri E, Naderi MM, Saburie O, Mohammadi Y, Tavakkoli F. [The evaluation of prehospital emergency performance indicators in Birjand, 2015 (Persian)]. Iranian Journal of Emergency. 2017; 1(1):61-8. https://www.sid.ir/en/journal/ViewPaper.aspx?id=568129
8. Holmberg M, Fagerberg I, Wahlberg AC. The knowledge desired by emergency medical service managers of their ambulance clinicians-A modified Delphi study. International Emergency Nursing. 2017; 34:23-8. [DOI:10.1016/j.ienj.2017.03.007] [PMID]
9. Moradian MJ, Peiravi MR, Ettehadi R, Pourmohammadi K. [Response time to emergency cases in Shiraz (Persian)]. Journal of Rescue and Relief. 2013; 5(2):30-9. https://www.sid.ir/en/journal/ViewPaper.aspx?ID=646295
10. Lyng J, Adelgais K, Alter R, Beal J, Chung B, Gross T, et al. Recommended essential equipment for basic life support and advanced life support ground ambulances 2020: A joint position statement. Pediatrics. 2021; 147(6):e2021051508. [DOI:10.1542/peds.2021-051508] [PMID]
11. Jeon WC, Kim HJ, Park J, Kim KH, Shin DW, Park JM, et al. The importance of preliminary evaluation in developing ambulance staff training curriculum for developing countries: A survey in Uzbekistan. Turkish Journal of Trauma and Emergency Surgery. 2020; 26(1):9-14. [DOI:10.14744/tjtes.2019.79595] [PMID]
12. Sharifi Y, Nikravan Mofard M, Jamsahar M, Nasiri M, Safari M. Knowledge, attitude, and practice of emergency medical services staff in bleeding control of trauma patients; a cross sectional study. Archives of Academic Emergency Medicine. 2020; 8(1):e11. [PMID]
13. Abelsson A, Lindwall L. The Prehospital assessment of severe trauma patients performed by the specialist ambulance nurse in Sweden-a phenomenographic study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2012; 20:67. [DOI:10.1186/1757-7241-20-67] [PMID] [PMCID]
14. Maurin Söderholm H, Andersson H, Andersson Hagiwara M, Backlund P, Bergman J, Lundberg L, et al. Research challenges in prehospital care: The need for a simulation-based prehospital research laboratory. Advances in Simulation. 2019; 4:3. [DOI:10.1186/s41077-019-0090-0] [PMID] [PMCID]
15. Guldiken B, Rémi J, Noachtar S. Cardiovascular adverse effects of phenytoin. Journal of Neurology. 2016; 263(5):861-70. [DOI:10.1007/s00415-015-7967-1] [PMID]