Not only COVID-19 disease impacts ambulance emergency demands but also lockdowns and quarantines

Abstract

Background The pandemic has impacted both patients infected by the SARS-CoV-2 virus and patients who seek emergency assistance due to other health issues. Changes in emergency demands are expected to have occurred during the pandemic, the objective of this investigation is to characterize the changes in ambulance emergency demands during the first year of the COVID-19 pandemic in the Vaud State of Switzerland. The goal of this research is to identify the collateral effects of the COVID-19 pandemic on emergency demands. To do so, this study quantifies the differences in health issues, level of severity, and patients’ sociodemographic characteristics (age, location, gender) prior to and during the outbreak. Method This is a retrospective, descriptive and comparative statistical analysis of all ambulance emergency missions from 2018 to 2020 (n = 107,150) in the State of Vaud in Switzerland. Variables analyzed were the number of ambulance missions, patient age and gender, health issues, severity (NACA scores), number of non-transports, mission times and locations. Variables were compared between prepandemic and pandemic situations across years and months. Comparative analysis used bivariate analysis, χ2 test, Student’s t test, and Mann‒Whitney U test. Results The pandemic has had two major impacts on the population’s emergency demands. The first appears to be due to COVID-19, with an increase in respiratory distress cases that doubled in November 2020. The second relates to the implementation of lockdown and quarantine measures for the population and the closures of restaurants and bars. These might explain the decrease in both the number of traumas and intoxications, reaching more than 25% and 28%, respectively. An increase in prehospital emergency demands by the older population, which accounted for 53% of all demands in 2020, is measured. Conclusion Collateral effects occurred during 2020 and were not only due to the pandemic but also due to protective measures deployed relative to the population. This work suggests that more targeted reflections and interventions concerning the most vulnerable group, the population of people 65 and older, should be of high priority. Gaining generalizable knowledge from the COVID-19 pandemic in prehospital settings is critical for the management of future pandemics or other unexpected disasters.

Health Outcomes for Older Patients with Chronic Diseases During the First Pandemic Year

“…However, we found that new urgent diagnoses also decreased, such as stroke and acute myocardial infarction, among others. 20 , 29 Likewise, it is noteworthy that several countries such as China, Italy, France, and the USA have reported a decrease in the provision of health care and in the diagnosis of new cases of stroke and acute myocardial infarction which reflects the trends observed in our study. 34–37 In addition, the decrease in hospital emergency department utilization may be attributed to patient concern about possible SARS-CoV-2 contamination if transferred to the hospital.…”

“…Some studies described a reduction in new diagnosis of hypertension, diabetes, and COPD in agreement with our results. 25 , 28 , 29 As evidenced in both the existing literature and our routine clinical practice, the decline in the incidence of chronic diseases can be ascribed to a combination of factors, including widespread mobility restrictions imposed throughout the country. Additionally, patients displayed a hesitancy to seek face-to-face medical care both during and even after the lifting of restrictions.…”

“… 34–37 In addition, the decrease in hospital emergency department utilization may be attributed to patient concern about possible SARS-CoV-2 contamination if transferred to the hospital. 29 …”

Contribution of Live Video to Physicians’ Remote Assessment of Suspected COVID19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey

“…The Coronavirus (COVID19) pandemic had major implications for emergency medical communication centres (EMCC) [1][2][3] which had to be reorganised to respond effectively to the large influx of telephone calls from patients presenting with influenza-like illness and dyspnoea [4][5][6]. Although online triage systems have been developed [7,8], the increase in calls to EMCCs due to the large number of respiratory distress situations was very significant [9]. Some EMCCs developed a two-tiered response, where the first tier performed the initial triage (differentiating between sick/notsick and mild/severe symptoms) and the second tier was comprised of clinicians (emergency physicians, advanced practice nurses or advanced paramedics) who assessed more complex and severe cases [1,5].…”

Contribution of Live Video to Physicians’ Remote Assessment of Suspected COVID-19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey

“…The Coronavirus (COVID-19) pandemic had major implications for emergency medical communication centres (EMCC) [ 1 , 2 , 3 ], which had to be reorganised to respond effectively to the large influx of telephone calls from patients presenting with influenza-like illness and dyspnoea [ 4 , 5 , 6 ]. Although online triage systems were developed [ 7 , 8 ], the increase in calls to EMCCs due to the large number of respiratory distress situations was very significant [ 9 ]. Some EMCCs developed a two-tiered response, where the first tier performed the initial triage (differentiating between sick/not-sick and mild/severe symptoms) and the second tier was comprised of clinicians (emergency physicians, advanced practice nurses or advanced paramedics) who assessed more complex and severe cases [ 1 , 5 ].…”