## 4 Discussion
### Heart Rate Comparison between the Gown and Coverall Protocols
#### 4.3.3 Safety Perceptions  
Studies show that the safety perceptions of medical personnel affect the quality of medical treatment [17,20]. Low safety perceptions affect caregivers' mental well-being metrics [21], and, subsequently, can affect the quality of care provided to patients [18]. As the protective items of the coverall protocol cover a wider surface area of the caregiver's body compared to the gown protocol, we hypothesized that safety perceptions would be higher when medical personnel felt less exposed during treatment. However, this hypothesis was not confirmed, as, for both protocols, the safety perception rating was high, with no statistically significant difference. These results do not match the existing knowledge in the literature--that feelings of safety are higher when using protective equipment that covers a larger body area [22].  
Even though we found a relationship between safety and comfort perceptions, it is difficult to draw any conclusion because the correlation coefficient was very low, which indicates a very weak relationship between the variables. Another relationship was found between safety perceptions and the difficulty in providing medical treatment. Here, a weak positive relationship was also found; therefore, it is also difficult to draw a conclusion in this case as well.  
This study was designed in the first year of the COVID-19 pandemic when knowledge about the form of the virus spread and the methods of infection were fundamentally different compared to the knowledge that exists today. At the outbreak of the COVID-19 pandemic, it was thought that the virus was transmitted by micro-droplet transmission (aerosol) [23] and by encountering a contaminated surface due to the virus' ability to survive on surfaces for several days [24]. Based on these beliefs, protection and work protocols were adapted for medical personnel working in hospital and pre-hospital settings. It is now known that the virus is transmitted mainly by droplet transmission, meaning it cannot survive for a long period of time on surfaces and contaminate them [24]. This knowledge changes the need for various protection methods and work protocols. However, in the pre-hospital setting in Israel and in the framework of Magen-David-Adom, the current accepted PPE wearing protocol is still the overall protocol.  
Although no statistically significant difference was found in safety perceptions using the two protocols examined in the study, and relationships with weak correlation coefficients were found for background variables, the existing knowledge in the literature supports that safety perceptions affect many aspects of the quality of patient care. It is likely that the safety perceptions using PPE when treating patients positive for COVID-19 have changed since the time this study was conducted due to changes in our existing knowledge about possible paths of infection. For these reasons, further research on the subject is needed.  
As this study was conducted only under simulated conditions, we recommend conducting a follow-up study to examine the effectiveness of using the gown protocol in field conditions and as part of the work of medical personnel. This would shed light on additional conditions that might affect the medical response given to patients in pre-hospital settings.