Decrease in emergency medical services utilization during early stages of the COVID-19 pandemic in British Columbia

Abstract

Objective To date in the COVID-19 pandemic, there has been a decrease in patients accessing emergency health services, (EHS) but research has been conducted in areas with a very high incidence of COVID-19. In an area with a low COVID-19 incidence, we estimate changes in EHS use. Methods We compared EHS encounters in British Columbia from March 15 (the date of school and business closures) to May 15, 2020, when compared to the same period in 2019. We categorized EHS encounters into 18 presenting complaints and prespecified critical care complaints including major trauma, cardiac arrest, stroke, and ST-elevation myocardial infarction. We analyzed by descriptive methods. Results Comparing 2019 to 2020, total EHS encounters decreased from 83,925 (incidence rate 834 per 100,000 personmonths) to 71,611 (incidence rate 701 per 100,000 person-months) for a decrease of 133 per 100,000 person-months (95% CI 126-141). The top 18 codes had a significant decrease in every category except respiratory and anxiety. Encounters for critically ill patients decreased significantly overall from 3019 to 2753 (incidence rate difference 3.1 per 100,000 personmonths, 95% CI 1.6-4.5), including stroke, trauma, and STEMI, but the incidence of OHCA appeared stable. Conclusion In a single province with a low incidence of COVID-19, there was a 15% reduction in overall EHS use and a 9% reduction in critical illness. EHS planners will need to match patient need with available resources.

Changes in presentation, presenting severity and disposition among patients accessing emergency services during the first months of the COVID-19 pandemic in Calgary, Alberta: a descriptive study

“…Unlike previous investigators, 3,16 we observed an increased demand for EMS and decreased emergency department and urgent care centre volumes. 17 Despite shifts in the acuity of emergency department and urgent care centre patients, a greater proportion of high-priority EMS dispatches was not observed, which suggests that the EMS system was seeing a different composition of patients than emergency departments and urgent care centres.…”

Impact of the COVID-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: A systematic review and meta-analysis

“…6,49 In addition, independent of the reluctance to seek help, patients with severe acute illness may have deteriorated due to reduced access to emergency health services, such as emergency department overcrowding and delayed ambulance response time. 17,19,50 The relative importance of each causal pathway is likely to differ between cities, as our study found that OHCA of asphyxial etiology was increased in some, but not all studies.…”

“…These may include the interruption of primary care for chronic diseases, reduced willingness to seek early treatment for acute symptoms leading to increased risk of OHCA, as well as worsened prognosis due to less e cient bystander, ambulance, and hospital interventions for OHCA. [11][12][13][14][15] These treatment processes may have, in turn, been adversely affected by reduced bystander willingness to render life-saving interventions, 16,17 altered airway management protocols, 18 or even overwhelmed healthcare facilities. 19 Accordingly, the aim of this study was to evaluate the impact of the COVID-19 pandemic on the incidence, characteristics, and clinical outcomes of OHCA through a systematic review and meta-analysis.…”

Impact of the COVID-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: a systematic review and meta-analysis

“…In other cases, the disruption (or deprioritization) of “non-essential” health services provision during the pandemic may have adversely affected the ongoing management of chronic disease, leading to increased individual-level risk [ 6 , 51 ]. In addition, independent of the reluctance to seek help, patients with severe acute illness may have deteriorated due to reduced access to emergency health services, such as emergency department overcrowding and delayed ambulance response time [ 17 , 19 , 52 ]. The relative importance of each causal pathway is likely to differ between cities, as our study found that OHCA of asphyxial etiology was increased in some, but not all studies.…”

“…These may include the interruption of primary care for chronic diseases, reduced willingness to seek early treatment for acute symptoms leading to increased risk of OHCA, as well as worsened prognosis due to less efficient bystander, ambulance, and hospital interventions for OHCA [ 11 – 15 ]. These treatment processes may have, in turn, been adversely affected by reduced bystander willingness to render life-saving interventions [ 16 , 17 ], altered airway management protocols [ 18 ], or even overwhelmed healthcare facilities [ 19 ].…”