The impact of COVID-19 on emergency medical services: a case study

By Dr. Ananya Mandal, MDDec 9 2020

The coronavirus disease 2019 (COVID-19) pandemic first detected in Wuhan, China, in December 2019, has infected over 68.78 million people worldwide and has taken over 1.56 million lives. While some healthcare services have taken a back seat over the pandemic's course, others have experienced an immense burden.

A team of researchers based in Turkey has now studied the pandemic's effect on emergency medical services (EMS). Their study, titled "Effects of COVID‐19 pandemic on emergency medical services," was published in the latest issue of The International Journal of Clinical Practice.

Study: Effects of COVID‐19 pandemic on emergency medical services. Image Credit: Alliance Images / Shutterstock

Background

The mortality rate of COVID-19 ranges from around 3 to 9 percent in different countries. However, the effect of the pandemic on other health care services has been profound. Exacerbated by international travel, the team explains that the rapidity with which the disease spread soon overwhelmed the health systems of both developing and developed countries.

Emergency Medical Services

The researchers define EMSs are those that provide emergency care to individuals in times of a disaster, accident, or illness and helps transport them to a hospital set up in time. These services aim to reduce the morbidity and mortality caused due to major injuries or trauma, acute health problems, and emergencies, etc.

The researchers write that the main causes of death among adults include "accidents, traumas, cardiovascular diseases, chronic diseases, excessive drug intake, and suicide." They also note that different communities and societies have different usage rates of EMS. These depend on several factors such as "local, socio-economic, and cultural conditions."

Study design

This study looked at the effects of EMS use during the COVID-19 pandemic in the Ankara province (the capital city of Turkey). The data from hospitals providing EMS were studied between March 11 and April 24 over three consecutive years – 2018, 2019, and 2020.

Findings

The main findings of the study were as follows:

• During the pandemic period, the number of calls to EMS rose by 90.9 percent from 2019 and 2020: 128,954 in the 11 March-24 April time interval in 2018; 132,289 calls in 2019; and 252,519 calls in 2020
• The number of cases needing EMS rose by 9.8 percent between 2019 and 2020. The number of cases attended were: 42,642 in 2018; 43,851 in 2019; and 48,159 in 2020.
• Of all the cases that were transported to the hospital using EMS, 15.2 percent were suspected of, and 2.9 percent were confirmed with, the diagnosis of COVID-19
• The presentation of cases to the EMS during the pandemic fell for children aged below 6 years by 4.1 percent
• The presentation of cases to the EMS during the pandemic fell for children and teenagers aged 7 to 18 years by 39.9 percent
• The number of cases aged between 19 and 65 years and over 65 years needing EMS rose by 12.9 percent and 21.5 percent, respectively
• Authors write, "There was a statistically significant difference between pre‐pandemic and pandemic period in terms of rural area case frequency."
• Among the various diseases presenting to the EMS, the decline from 2019 to the pandemic year was: 32.5 percent for angina pectoris; 45 percent for myocardial infarction or heart attack; 23.8 percent for acute abdomen; 2.9 percent for cerebrovascular diseases such as strokes
• During the pandemic, EMS requirement rose for the following compared to 2019: Fever by 14.1 percent; cough by 956.3 percent.
• The team found that forensic case frequency also rose significantly during the pandemic year.
• They wrote, "there was a statistically significant difference between these periods in terms of the frequency of patients who died at the scene."

Conclusions and implications

The study's authors concluded that, throughout the pandemic, the use of ambulances has risen. But the actual use of EMS for "time-sensitive diseases" such as heart conditions, strokes, acute abdominal diseases, etc., has declined. The need for EMS of pediatric patients has also declined during this year, the team wrote. Patients' fear of infection during transit using EMS remains one of the major factors behind this decline, say the researchers. This has also led to an increase in the number of deaths at the scene, they write.