The findings of the current research, which investigated the role of predictive death anxiety in the job satisfaction of pre-hospital emergency personnel during the spread of the COVID-19 disease, showed that the level of job satisfaction of the staffs is average and their death anxiety is high. Although death anxiety and job satisfaction in the study samples during the COVID-19 Pandemic have a low inverse linear relation but have no significant correlation.
In the study of Kojaei et al. in Iran , the average death anxiety score of emergency personnel was 5.68, which is lower compared to the average death anxiety in the present study. In other words, the results differed from this study. However, both studies were done during the COVID-19 Pandemic. Pre-hospital emergency staffs has faced various challenges with the outbreak of COVID-19 and they experience significant stress because they are the first staffs to attend the bedside of COVID-19 patients . It seems that the pre-hospital emergency personnel of Qazvin is more impacted by the COVID -19 pandemic than the personnel mentioned above. According to this study, the level of death anxiety of pre-hospital emergency personnel was higher than average in the study by Esadi et al. . It appears that the completion of both studies during the COVID-19 Pandemic is a common reason for the high level of death anxiety in the samples from both studies. In the meta-analysis study of Sahebi et al. , which investigated post-traumatic stress disorder (PTSD) among health service workers during the COVID-19 Pandemic, the prevalence of PTSD among these workers was reported to be high (13.52%). Although the variables of the above study are different from the variables of the present study, considering that PTSD and death anxiety has somewhat similar concepts, it can be said that the results of the above study are somewhat consistent with the results of the present study. In addition, Adibi et al.'s study  also reported a relatively high prevalence (30.5%) of anxiety disorders among health service workers during the COVID-19 Pandemic. Although the above study was conducted by meta-analysis method, in the present study, the level of death anxiety of the personnel was high, which shows that the results of the two studies are in line with each other.
Kasraei et al.'s study before the outbreak of COVID-19 Pandemic showed that job satisfaction has no significant relation to death anxiety , which is in line with the findings of the present study. Although the relation was not significant, there was an inverse correlation between the two variables, and that opposite relation seems logical. According to Aydin et al. , it has been found that death anxiety negatively affects life satisfaction. Although the above study did not consider job satisfaction, in the sense that death anxiety has a relation to job satisfaction, it is somewhat consistent with the results of the present study.
The results of the study by Kamil et al.  showed that there is an inverse and low-significance relationship between death anxiety and life satisfaction. Although unlike the present study, the relationship between the two variables is significant, in line with the results of the present study, it shows that death anxiety and the concept of satisfaction have an inverse relationship. The results of Özmen et al.'s study  showed that there is an inverse and weak relationship between the fear of Covid-19 and life satisfaction. Although the population of the above study was not healthcare personnel and did not consider job satisfaction, in principle, the inverse relationship between death anxiety and the life satisfaction variable is somewhat in line with the results of the present study. In general, it should be said that most studies have addressed the factors that cause death anxiety, but the consequences of death anxiety such as job satisfaction have not been attentioned.
In the research by Kajaei et al. , the level of death anxiety was found to be higher among females than males, consistent with the results of this study. Differences in mental health among males and females can be attributed to gender differences that are embedded in genetics, anatomy, and physiology . As a result, given these differences between males and females, the increase in death anxiety scores among females may be justified. In Sadeghi et al.'s study , it was found that age, marital status, and educational level have a significant relation to death anxiety, which is not consistent with the results of the present study. Furthermore, in this study, death anxiety scores were higher among those who are not heads of families. This result is partially consistent with the high death anxiety scores among single persons. Because the study by Sadeghi et al. was done before the COVID-19 outbreak, it can explain this difference to some extent. It seems that considering the key role of emergency medical staffs in the COVID-19 pandemic, various stressful factors have imposed many psychological effects on this personnel  and led to the creation of such differences before and after the outbreak. In the current study, death anxiety was higher in the group of staffs without a history of first-degree family members being infected with the COVID-19 disease than staffs with a history of first-degree family members being infected with the COVID-19 disease. Health care workers are concerned about family members, many of whom have separated from their families to prevent the spread of the disease . It appears that the reason for the high rates of death anxiety in this group of individuals is because of the fear of disease transmission. In addition, those who have contracted COVID-19 themselves had more death anxiety scores than those who did not. The continued spread of the disease, high morbidity, and mortality cause fear and anxiety and negatively impact staffs 's mental health. This applies to COVID-19 as well. Because assessing the psychological effects of the COVID-19 outbreak in terms of psycho-social health shows that staffs experience the highest level of stress or anxiety . Life-threatening illnesses are associated with some existential problems that have psychological implications such as intrusive thoughts about death . For this reason, it can be explained why the death anxiety scores are lower in samples with no underlying disease history than in others.
In agreement with this study, in the study by Basaber et al. , it was also found that there was a moderate level of job satisfaction among emergency medical staffs. However, in the above study, job satisfaction is closely related to gender and it is not in line with the findings of this study. In the study by Sonems et al. , the overall level of job satisfaction of emergency physicians was rated as high, which is inconsistent with the results of this study. It should be noted that pre-hospital emergency has led to the creation of special conditions for this staffs due to special environmental conditions, time constraints, road traffic, the openness of the workspace, and the expectations of the companions  that it can be said that job satisfaction impacted by these factors, so we see the difference in the results of the two studies. Although the samples of this study are different from those in the Sonmez et al. study. In Yu et al. research , job satisfaction was found to have no significant relation to age and marital status, which is consistent with the results of this study. Although in Yu et al.'s study, job satisfaction increases with the increase in the education level of staffs, and this relation is significant, in the present study, staffs with a master's degree have a low level of job satisfaction. It seems that in the Qazvin pre-hospital emergency personnel community, the existing facilities have not been able to meet the expectations of staffs with higher qualifications, and for this reason, these staffs express low job satisfaction. In the study of Elatif et al. among Egyptian doctors , it was found that the fear of COVID-19 Pandemic has a negative relation with job satisfaction, in other words, it can be said that the results of the above study are somewhat consistent with the present study. Because in this study, staffs without a history of COVID-19 and those with first-degree family members who were not infected with the coronavirus were more satisfied with their job than others. In the study by Jaradi et al. low job satisfaction was found to be associated with low back pain . In the present study, those without underlying illness expressed a higher level of job satisfaction. In other words, there is consistency between the two studies.
One of the limitations of this research is the generalization of the results because the structure of pre-hospital emergencies based on a diversity of missions differs not only from one country to another but also in the cities of the same province. However, in this study, we attempted to resolve this limitation by sampling from every base in the province.
Sampling from all bases of the province in the dispersion and different nature of the missions was one of the strengths of the present study.