Impact of the coronavirus disease 2019 outbreak on the transportation of patients requiring emergency care

Abstract

The first confirmed community transmission of coronavirus disease 2019 in Daegu Metropolitan City, South Korea, occurred on February 18, 2020. In the following 70-day period, approximately 6000 new cases occurred, severely impacting the medical service system. This study investigated the crisis-impact on the local emergency transport system. Emergency medical service activity reports were retrospectively reviewed to determine patient demographics and initial vital signs. Delay in reaching the patient, transporting the patient to the hospital, and returning to the fire station were assessed and categorized based on patients’ initial vital signs. The study period was divided into 4 groups (1/1–2/18, 2/19–3/3, 3/4–3/31, and 4/1–04/30) and intergroup differences were analyzed. When compared to Period 1, the time-difference between the request to attend a scene and arrival at the scene was delayed in Periods 2, 3, and 4 by 4 minute 58 s, 3 minute 24 seconds, and 2 minute 20 seconds, respectively; that between arriving at the scene and at the hospital was delayed by 7 minute 43 seconds, 6 minutes 59 seconds, and 4 minutes 30 seconds, respectively; and that between arriving at the hospital and returning to the fire station was delayed by 29 minute 3 second, 25 minute 55 second, and 18 minute 44 second, respectively. In Period 2, for patients with symptoms of severe illness when compared to patients lacking such symptoms, the time-difference between the request to attend the scene and arrival at a hospital and between arrival at the hospital and returning to the fire station were 6 to 23 minute and 12 to 48 minute longer, respectively. Most of the delays impacted patients with a fever. In terms of condition, the statistical effect size for delay in transport time was from large to small: fever, hypoxia, abnormal respiratory rate, respiratory symptom, and hypotension. Outbreaks of infectious disease cause a paradoxical state in emergency medical transport systems, inducing delays in the transport of severely ill patients. Therefore, maintenance and improvement of the medical service system for both patients with infectious disease and those with other severe illnesses is required.

The impact of COVID-19 on Emergency Department length of stay for urgent and life-threatening patients

“…Humanity is still in the exploratory stage of COVID-19 [ 20 ]. The COVID-19 outbreak is severely affecting the health services system worldwide [ 21 , 22 ]. COVID-19 is accompanied by various symptoms; 80% of infected patients have no symptoms or mild symptoms [ 23 ].…”

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

“…After COVID-19, the symptom of fever appeared to be the most relevant factor in the refusal of transport. Fever has already been reported as a factor that delayed prehospital time during COVID-19 [ 21 ]. Most emergency departments require the use of isolation rooms for patients with fever or respiratory symptoms [ 22 , 23 , 24 ].…”

Effects of dynamic response to coronavirus disease outbreak in a regional emergency medical center

“…This is speculated to be because the outbreak led to reduced ED utilization by patients with mild conditions, and public ambulances were utilized more frequently to transport those who needed to present to an ED. Kim et al [ 13 ] reported that the number of public ambulance dispatches slightly decreased during the pandemic compared with a similar period before the pandemic in the same region, and the time of arrival at the scene, transport time, and return time were also delayed compared with that before the pandemic. This could be because paramedics had to confirm whether the patient could be accepted by all EDs before choosing the hospital to transport the patient and had to wait outside the hospital until an isolation bed became available.…”