EMS prehospital response to the COVID-19 pandemic in the US: A brief literature review

Abstract

This study aimed to analyze prehospital Emergency Medical Services (EMS) response to the COVID-19 pandemic in the US through a brief systematic review of available literature in context with international prehospital counterparts. An exploration of the NCBI repository was performed using a search string of relevant keywords which returned n=5128 results; articles that met the inclusion criteria (n=77) were reviewed and analyzed in accordance with PRISMA and PROSPERO recommendations. Methodical quality was assessed using critical appraisal tools, and the Eggers test was used for risk of bias reduction upon linear regression analysis of a funnel plot. Sources of heterogeneity as defined by P < 0.10 or I^2 > 50% were interrogated. Findings were considered within ten domains: structural/systemic; clinical outcomes; clinical assessment; treatment; special populations; dispatch/activation; education; mental health; perspectives/experiences; and transport. Findings suggest, EMS clinicians have likely made significant and unmeasured contributions to care during the pandemic via nontraditional roles, i.e., COVID-19 testing and vaccine deployment. EMS plays a critical role in counteracting the COVID-19 pandemic in addition to the worsening opioid epidemic, both of which disproportionately impact patients of color. As such, being uniquely influential on clinical outcomes, these providers may benefit from standardized education on care and access disparities such as racial identity. Access to distance learning continuing education opportunities may increase rates of provider recertification. Additionally, there is a high prevalence of vaccine hesitancy among surveyed nationally registered EMS providers. Continued rigorous investigation on the impact of COVID-19 on EMS systems and personnel is warranted to ensure informed preparation for future pandemic and infectious disease response.

Emergency Medical Services and Public Health Perspectives on Alternative Emergency Response Models

“…Previous evaluations examined the role of EMS clinicians taking on new roles in various medical situations, such as wellness checks, scenarios with patients with dementia, and COVID-19 vaccination. [18][19][20][21] In addition to exploring expanded roles for individual clinicians, some research has examined the incorporation of different types of practitioners into the emergency response model, such as a study by Corcoran et al in 2018 that found favorable feedback from police officers when social workers were integrated to respond on-scene to domestic violence calls. 22 Faddy et al examined how one department paired paramedics with mental health nurses to respond to mental health crises in the community more appropriately, 23 and Cacciatore et al examined embedding social workers in fire stations to provide community members and firefighters postcrisis support.…”

“…Previous evaluations examined the role of EMS clinicians taking on new roles in various medical situations, such as wellness checks, scenarios with patients with dementia, and COVID-19 vaccination 18-21. In addition to exploring expanded roles for individual clinicians, some research has examined the incorporation of different types of practitioners into the emergency response model, such as a study by Corcoran et al in 2018 that found favorable feedback from police officers when social workers were integrated to respond on-scene to domestic violence calls 22.…”

Effect of the pandemic on prehospital management of patients with mental and behavioral disorders: a retrospective cohort study

“…Additionally, EMS teams as well as ED physicians have assumed new and varied healthcare roles during the pandemic, owing to the overall increased healthcare needs. Provision of vaccinations, managing COVID-19 admissions, and caring for post-COVID-19 sequelae belong to the new spectrum of conditions being managed by most specialties, especially internists, pneumologists, and intensive care unit personnel, all specialties commonly involved in the emergency rooms ( 38 , 39 ). It is essential to note that the COVID-19 pandemic has had a significant impact on the mental health of EMTs, resulting in elevated levels of stress and anxiety ( 40 ), which have led to decreased self-efficacy and sleep quality ( 41 ).…”