Department of Emergency Medicine, Morristown Medical Center, Morristown, NJ, USA.
Department of Emergency Medicine, Morristown Medical Center, Morristown, NJ, USA.
Am J Emerg Med. 2021 May;43:46-49. doi: 10.1016/j.ajem.2021.01.024. Epub 2021 Jan 15.
The Novel Coronavirus19 (COVID19) arrived in northern New Jersey (NJ) in early March 2020, peaked at the beginning of April, and then declined. Starting in March, some patients who called 911 and required advanced life support (ALS) may have decompensated more rapidly than would have been expected, possibly because of concomitant COVID19 infection and/or delays in seeking medical care because of fear of exposure to the virus, and social isolation. In this study, our goal was to determine if there was an increase in prehospital ALS pronouncements and a decrease in ED visits for potentially serious conditions such as MI and stroke during the peak of the COVID-19 pandemic in northern NJ.
Retrospective cohort of prehospital patients pronounced dead by paramedics and patients with MI and stroke in the EDs of receiving hospitals of these paramedics. Study Setting and Population: Ten ground ALS units in northern NJ and nine receiving hospital EDs. Each ALS unit is staffed by two NJ-certified mobile intensive care paramedics and respond with a paramedic flycar in a two-tiered dispatch system.
We identified prehospital pronouncements using the EMSCharts electronic record (Zoll Medical, Chelmsford, Massachusetts). We tabulated the number of pronouncements by week from January 1 to June 30 in 2019 and 2020. We tabulated the combined total number of pronouncements and ED visits by month along with visits for MI and stroke and calculated the changes during the same timeframe. We used Chi-square to test for statistical significance for the monthly changes from 2019 to 2020.
For January through June in 2019 and 2020, there were 12,210 and 13,200 ALS dispatches, and 366 and 555 prehospital pronouncements, respectively. In 2020, pronouncements rose from a weekly baseline of 13 in early March, reached a peak of 45 at the beginning of April, then returned to the baseline level by the end of May. April 2020, the month with the most pronouncements, had 183% more pronouncements than April 2019 but total ED visits and visits for MI and stroke were 49%, 46% and 42% less, respectively (p < 0.0001 for each of these changes).
Following the arrival of the COVID-19 pandemic in northern NJ, we found pre-hospital ALS death pronouncements increased and ED visits for MI and stroke decreased. Although we have speculated about the reasons for these findings, further studies are needed to determine what the actual causes were.
新型冠状病毒肺炎（COVID-19）于 2020 年 3 月初抵达新泽西州（NJ）北部，4 月初达到高峰，随后下降。从 3 月开始，一些拨打 911 并需要高级生命支持（ALS）的患者可能比预期更快地恶化，这可能是因为同时感染了 COVID-19 和/或因担心接触病毒而延迟就医，以及社会隔离。在这项研究中，我们的目标是确定在新泽西州北部 COVID-19 大流行高峰期是否有更多的院前 ALS 宣告和更少的因 MI 和中风等潜在严重疾病而前往急诊室就诊的情况。
对被护理人员宣布死亡的院前患者和接受这些护理人员护理的医院急诊科的 MI 和中风患者进行回顾性队列研究。研究地点和人群：新泽西州北部的 10 个地面 ALS 单位和 9 个接收医院急诊科。每个 ALS 单位都配备了两名经过新泽西州认证的移动重症监护护理人员，并在两级调度系统中使用 paramedic flycar 进行响应。
我们使用 EMSCharts 电子记录（Zoll Medical，马萨诸塞州切姆斯福德）确定院前宣告。我们按 2019 年和 2020 年 1 月 1 日至 6 月 30 日的每周计算宣告次数。我们按月份列出宣告次数和急诊科就诊次数的总和，以及 MI 和中风就诊次数，并计算同一时间段内的变化。我们使用卡方检验来检验 2019 年至 2020 年每月变化的统计学意义。
2019 年和 2020 年 1 月至 6 月，ALS 派遣次数分别为 12210 次和 13200 次，院前宣告次数分别为 366 次和 555 次。2020 年 3 月初，宣告次数每周从 13 次的基线开始上升，4 月初达到 45 次的峰值，然后在 5 月底恢复到基线水平。4 月是宣告次数最多的月份，比 2019 年 4 月增加了 183%，但急诊科就诊次数和 MI 和中风就诊次数分别减少了 49%、46%和 42%（这些变化均 p<0.0001）。
在 COVID-19 大流行抵达新泽西州北部后，我们发现院前 ALS 死亡宣告增加，MI 和中风的急诊科就诊减少。尽管我们对这些发现的原因进行了推测，但还需要进一步的研究来确定实际原因。
