Study design and setting

The present cross-sectional survey was performed in April–May 2019 among volunteer members of ten local committees of the Red Cross in Salerno, Campania, Southern Italy, which is the second most populous city in Campania region (Total area 4,954.16 km²; with 1,092,779 inhabitants according to 2019 census), with a total of around 2,500 FAVs active at the time of the survey (2019).

The Italian Red Cross (in Italian: Croce Rossa Italiana; CRI) is among the original founding members of the International Committee of the Red Cross in 1919 and includes around 11,590 no profit associations for over 400,000 volunteers⁴⁶⁾. Service as FAVs is deeply grounded within the Italian healthcare system. In facts, while the International Committee of the Red Cross mainly ensures humanitarian protection and assistance for victims of war and other situations of violence, CRI alongside other organizations for voluntary assistance (in Italian: Pubblica Assistenza or Misericordia), supports the Italian National Health Service also for daily medical emergencies, including ambulance services and first aid activities.

Despite their non-medical status, FAVs of the Italian Red Cross are medically trained personnel. Their training path is known as MTAR (Medical Transport and Ambulance Rescue) with the following basic requirements: a) being ≥18 yr-old; b) having completed a training course including cardiopulmonary resuscitation (CPR) and First Aid rules; c) having received a formal formation course on health and safety in the workplace according to Italian National Law (i.e. Legislative Decree No. 81 of April 9th, 2008); and d) fulfilling psycho-physical requirements for ambulance service, as assessed by a special commission of medical and psychologist specialists. Formal and professional requirements of FAVs are periodically updated, as qualification as FAVs requires a periodical retraining. Even though FAVs do not receive a formal salary from CRI and/or Italian National Health Service, they have to guarantee from 2 to 20 shifts of work per month. Even though personal working shifts depend on the type of service provided, they usually face long-hours and tiring shift work⁴⁷⁾.