An assessment of treatment, transport, and refusal incidence in a National EMS's routine work during COVID-19

Siman‐Tov, Maya; Strugo, Refael; Podolsky, Timna; Blushtein, Oren

doi:10.1016/j.ajem.2021.01.051

Cited by 24 publications

(21 citation statements)

References 27 publications

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“…More interestingly, the proportion of non‐pandemic defunct calls rose after the outbreak of the Covid‐19 pandemic. The rise of refusals to transportation to hospitals has also been observed in Israel 57 . This corroborates with earlier studies in the United States suggesting that people showed reluctance to receive hospitalisation out of fear of contagion 13,58…”

Section: Discussionsupporting

confidence: 87%

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Predicting Covid‐19 emergency medical service incidents from daily hospitalisation trends

Xie

Kulpanowski²,

Ong

et al. 2021

Int J Clinical Practice

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Introduction The aim of our retrospective study was to quantify the impact of Covid‐19 on the temporal distribution of emergency medical services (EMS) demand in Travis County, Austin, Texas and propose a robust model to forecast Covid‐19 EMS incidents. Methods We analysed the temporal distribution of EMS calls in the Austin‐Travis County area between 1 January 2019 and 31 December 2020. Change point detection was performed to identify the critical dates marking changes in EMS call distributions, and time series regression was applied for forecasting Covid‐19 EMS incidents. Results Two critical dates marked the impact of Covid‐19 on the distribution of EMS calls: March 17th, when the daily number of non‐pandemic EMS incidents dropped significantly, and 13 May, by which the daily number of EMS calls climbed back to 75% of the number in pre‐Covid‐19 time. The new daily count of the hospitalisation of Covid‐19 patients alone proves a powerful predictor of the number of pandemic EMS calls, with an r2 value equal to 0.85. In particular, for every 2.5 cases, where EMS takes a Covid‐19 patient to a hospital, one person is admitted. Conclusion The mean daily number of non‐pandemic EMS demand was significantly less than the period before the Covid‐19 pandemic. The number of EMS calls for Covid‐19 symptoms can be predicted from the daily new hospitalisation of Covid‐19 patients. These findings may be of interest to EMS departments as they plan for future pandemics, including the ability to predict pandemic‐related calls in an effort to adjust a targeted response.

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Section: Discussionsupporting

confidence: 87%

“…Prior studies have found an increase in EMS calls regarding cardiac arrest, 34,57,61 stroke 34 mental health 57 and overdose, 34 during the early stages of the Covid‐19 pandemic. Our study confirmed that, in the long term, the EMS demand for these problems did not decrease.…”

Section: Discussionmentioning

confidence: 99%

Predicting Covid‐19 emergency medical service incidents from daily hospitalisation trends

Xie

Kulpanowski²,

Ong

et al. 2021

Int J Clinical Practice

View full text Add to dashboard Cite

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“…The proportion of transport refusal in the present study was 15.0% ( Table 4 ). The levels of prehospital transport refusal in this study were slightly lower (19.9%) than the results of transport refusal incidents reported from the study conducted in Israel amid the COVID-19 pandemic [ 38 ]. The difference could be explained by the fact that the study from Israel included all medical emergency incidents regardless of the causes while the present study focused on transports of COVID-19 patients alone.…”

Section: Discussioncontrasting

confidence: 77%

“…However, our finding was no more statistically significant after adjusting for potential confounders ( Table 6 ). Transport refusal was previously reported as a predictor of clinical deterioration and adverse outcomes in prehospital care [ 38 ]. Further studies are needed to confirm the association between transfer refusal and adverse events in prehospital care in Ethiopia.…”

Section: Discussionmentioning

confidence: 99%

The status of prehospital care delivery for COVID-19 patients in Addis Ababa, Ethiopia: The study emphasizing adverse events occurring in prehospital transport and associated factors

2022

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Background COVID-19 patients may require emergency medical services for emergent treatment and/or transport to a hospital for further treatment. However, it is common for the patients to experience adverse events during transport, even the shortest transport may cause life-threatening conditions. Most of the studies that have been done on prehospital care of COVID-19 patients were conducted in developed countries. Differences in population demographics and economy may limit the generalizability of available studies. So, this study was aimed at investigating the status of prehospital care delivery for COVID-19 patients in Addis Ababa focusing on adverse events that occurred during transport and associated factors. Methods A total of 233 patients consecutively transported to Saint Paul’s Hospital Millennium Medical College from November 6 to December 31, 2020, were included in the study. A team of physicians and nurses collected the data using a structured questionnaire. Descriptive statistics were used to summarize data, and ordinal logistic regression was carried out to assess the association between explanatory variables and the outcome variable. Results are presented using frequency, percentage, chi-square, crude and adjusted odds ratios (OR) with 95% confidence intervals. Results The overall level of adverse events in prehospital setting was 44.2%. Having history of at least one chronic medical illness, [AOR3.2 (95%; CI; 1.11–9.53)]; distance traveled to reach destination facility, [AOR 0.11(95%; CI; 0.02–0.54)]; failure to recognize and administer oxygen to the patient in need of oxygen, [AOR 15.0(95%; CI; 4.0–55.7)]; absent or malfunctioned suctioning device, [AOR 4.0(95%; CI; 1.2–13.0)]; patients handling mishaps, [AOR 12.7(95%; CI; 2.9–56.8)] were the factors associated with adverse events in prehospital transport of COVID-19 patients. Conclusions There were a significant proportion of adverse events in prehospital care among COVID-19 patients. Most of the adverse events were preventable. There is an urgent need to strengthen prehospital emergency care in Ethiopia by equipping the ambulances with essential and properly functioning equipment and trained manpower. Awareness creation and training of transport staff in identifying potential hazards, at-risk patients, adequate documentation, and patient handling during transport could help to prevent or minimize adverse events in prehospital care.

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“…Many different explanations have been proposed: Lifestyle changes brought about by the imposed lockdown may have influenced the propensity to become injured in driving accidents or other recreational activities [ 15 – 19 ]. It is also possible that the fear of contagion of SARS-CoV-2 has reduced the incentive to call for emergency medical assistance [ 6 ]. It has even been reported that patients have refrained from calling on the health care system for fear of “disturbing” the system during the pandemic [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Increased ambulance on-scene times but unaffected response times during the first wave of the COVID-19 pandemic in Southern Denmark

et al. 2022

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Background During the first wave of the COVID-19 pandemic, a lockdown was imposed on the Danish society. Reports from other countries that were hit by the COVID-19 pandemic before Denmark instilled fear of flooding of the emergency departments. To mitigate this flooding, increased competencies were conveyed to the paramedics in the ambulances aiming to allow for a release of a higher number of patients prehospitally. The increased competencies in the prehospital personnel were expected to increase the on-scene time and thus the total workload of the ambulances potentially resulting in delays in the acute care. We sought to elucidate the effects of the pandemic on the workload of the prehospital system during the first wave. Methods This was a retrospective study using operational data from the regional emergency medical dispatch centre in the Region of Southern Denmark. We collected the number of ambulance runs, the response times, the on-scene times, and the mission outcome of all ambulance runs with lights and sirens in the Region of Southern Denmark during the first wave of the pandemic. We compared the numbers with a similar period in the year before. Results Compared with the year before the pandemic we observed a 10.3% reduction in call volume and a corresponding reduction in the total number of missions with lights and sirens. We found an increase in on-scene times in both missions with patients conveyed to hospital (20.6 min vs. 18.7 min) and missions with non-conveyed patients (37.4 min versus 30.7 min). The response times were unaffected. Conclusion The increased on-scene times of the ambulances may largely be attributed to time utilised to exert the increased competencies concerning treat-and-release of patients.. Despite an increased on-scene time of the ambulances, we believe that the combination of a reduction in the number of total missions and the existing capacity in the ambulance service in the Region of Southern Denmark nullified the prolongation of ambulance response times that was seen in other countries during the pandemic. This capacity allowed for time spent performing in-depth examinations of patients with the potential to be released at the scene.

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An assessment of treatment, transport, and refusal incidence in a National EMS's routine work during COVID-19

Cited by 24 publications

References 27 publications

Predicting Covid‐19 emergency medical service incidents from daily hospitalisation trends

Predicting Covid‐19 emergency medical service incidents from daily hospitalisation trends

The status of prehospital care delivery for COVID-19 patients in Addis Ababa, Ethiopia: The study emphasizing adverse events occurring in prehospital transport and associated factors

Increased ambulance on-scene times but unaffected response times during the first wave of the COVID-19 pandemic in Southern Denmark

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