Ethical Challenges Among Hellenic National Center of Emergency Care (EKAB) Prehospital Emergency Personnel During the Financial Crisis and COVID-19

Objective Τo assess the knowledge, attitudes, and practices of the Hellenic National Center of Emergency Care (EKAB) prehospital emergency personnel regarding ethical and legal issues in their professional practice and to identify the underlying dimensions of ethical perception. Methods A validated 32-item structured anonymous online questionnaire was administered to the EKAB prehospital emergency personnel directly involved in patient care. The first part included items on sociodemographic and professional characteristics, while the second part assessed perceptions regarding ethics and deontology in prehospital care. Data collection took place during the later phase of the Greek financial crisis and amidst the COVID-19 pandemic. Results A total of 273 participants (50.2% men; mean age range 41-50 years) completed the survey. Exploratory factor analysis (EFA) yielded four factors: (i) autonomy and consent, (ii) resource allocation and triage, (iii) confidentiality vs public health, and (iv) duty and reciprocity. This explained 60.9% of total variance (Kaiser-Meyer-Olkin (KMO) test=0.75; Bartlett’s χ²=1656.44, degrees of freedom (df)=300, p<0.001; α=0.70-0.85). Higher autonomy and consent scores were observed among university-educated staff (p=0.030), and higher duty and reciprocity scores among those >50 years (p=0.022). Significant positive correlations were found between Autonomy and Consent and Confidentiality vs Public Health (ρ=0.522, p<0.01) and between Duty and Reciprocity and Resource Allocation and Triage (ρ=0.465, p<0.01). Conclusions EKAB prehospital emergency personnel demonstrate strong ethical commitments across four key domains despite working under dual crisis conditions (economic crisis and the COVID-19 pandemic). These findings provide a framework for targeted ethics education, policy development, and institutional support to strengthen ethical decision-making in prehospital care.