Emergency Medical Service Utilization and Response Following COVID-19 Emergency and Stay-at-Home Policies: An Interrupted Time-Series Analysis

Abstract

Examine changing emergency medical services (EMS) utilization and response patterns associated with coronavirus disease 2019 (COVID-19) emergency declaration and stay-at-home orders during the first year of the COVID-19 pandemic. MethodsWe conducted an uncontrolled interrupted time series analysis of EMS calls (January 1, 2019 -March 1, 2021) in Marin County, California analyzing call volume (All calls, n=46,055); patient refusal of EMS care or transport and patient care resolved on scene (Calls with opportunity for transport; n=37,401); and call severity (Transported calls; n=27,887). ResultsPre-COVID-19 (1/1/2019-3/2/2020), EMS transported patients were predominately female (50.6%), 80+ years old (31.6%), and Marin County residents (68.0%). During COVID-19 (3/3/2020-3/1/2021), EMS transported patients were predominately male (52.7%), 35-64 years old (29.8%), and Marin County residents (70.4%). After the first stay-at-home order on 3/17/2020, call volume immediately decreased by 48% (adjusted incidence rate ratio [aIRR]=0.52; 95% CI=0.35,0.79) for children (0-15 years) and 34% for adults 80+ years (aIRR=0.66;95% CI=0.46,0.95). The odds of a transported call being prioritized as severe doubled (adjusted odds ratio [aOR]=2.26; 95% CI=1.11,4.59). Though transport refusals increased by 69% for children after the first order (aOR, 1.69 [95% CI, 1.13-2.52]), immediately following the second order on 12/8/2020, transport refusals decreased by 30% for children but increased 38-40% for adults for for 65-79 years). Calls resolved on scene by EMS increased after the first order among all ages and after the second order for adults 16-79 years. ConclusionsCall volume reduced for children and older adults after the first COVID-19 stay-at-home order. Changes in call severity, patient care refusals, and on-scene care provided by EMS indicated a changing role for EMS during the outbreak.

Impact of the COVID-19 Pandemic on the Profile of Patients in SAMU-Asturias EMS (Spain): A Two-Year Retrospective Analysis of Advanced Life Support Unit Data

“…In fact, according to some studies, the odds that a call handled by EMS would be prioritized as severe doubled during the pandemic period. 18 Focusing on the context of mental health and substance abuse and the contrast between these results and those of other studies, the most probable explanation is that, although alcohol consumption could have increased, this would not be the case in youth recreational consumption, an important cause of acute alcohol intoxication, and it would be in the chronic drinker/alcoholic profile, which would probably lead to health complications in the medium-long term. In addition, although patients susceptible to pharmacological poisoning continued to be able to purchase medications, the rest of the main substances causing overdose/poisoning (eg, cocaine and amphetamines) probably suffered a decrease in their consumption, secondary to the absence of ludic activity and the difficulty in obtaining it due to mobility restrictions.…”

“…In fact, according to some studies, the odds that a call handled by EMS would be prioritized as severe doubled during the pandemic period. 18 Focusing on the context of mental health and substance abuse and the contrast between these results and those of other studies, the most probable explanation is that, although alcohol consumption could have increased, this would not be the case in youth recreational consumption, an important cause of acute alcohol intoxication, and it would be in the chronic drinker/ Table 2. Gender and Age Differences alcoholic profile, which would probably lead to health complications in the medium-long term.…”

Rethinking Traditional Emergency Department Care Models in a Post-Coronavirus Disease-2019 World

“…Emergency Medical Service call volume decreased during the first wave of the pandemic in early 2020 for a variety of reasons, including fear of infection in the emergency department and mandated restrictions that reduced out-of-home activities. 16 , 17 As a result, patients delayed care, worsening their medical conditions and skewing the triage scales toward life-threatening emergencies. 17 , 18 High overall acuity, patient load, and excessive inpatient boarding in the emergency department contributed significantly to both workforce stress and the breakdown of the standard ED operating paradigm.…”

Emergency Transport Refusal during the Early Stages of the COVID-19 Pandemic in Gyeonggi Province, South Korea

“…Patients’ fears of spreading an infectious disease caused a rejection of hospital treatment. In addition, with social isolation policies such as social distancing and the avoidance of going out if unnecessary, outside activities and contact with people decreased and infectious diseases such as influenza and trauma decreased [ 17 ]. However, patients’ refusal to be transported to hospitals increased.…”