Department of Health Policy and Management UCLA Fielding School of Public HealthUniversity of California Los Angeles CA.
Huntington Medical Research Institutes Pasadena CA.
J Am Heart Assoc. 2021 Jun 15;10(12):e019635. doi: 10.1161/JAHA.120.019635. Epub 2021 Jun 1.
Background Public health emergencies may significantly impact emergency medical services responses to cardiovascular emergencies. We compared emergency medical services responses to out-of-hospital cardiac arrest (OHCA) and ST-segment‒elevation myocardial infarction (STEMI) during the 2020 COVID-19 pandemic to 2018 to 2019 and evaluated the impact of California's March 19, 2020 stay-at-home order. Methods and Results We conducted a population-based cross-sectional study using Los Angeles County emergency medical services registry data for adult patients with paramedic provider impression (PI) of OHCA or STEMI from February through May in 2018 to 2020. After March 19, 2020, weekly counts for PI-OHCA were higher (173 versus 135; incidence rate ratios, 1.28; 95% CI, 1.19‒1.37; <0.001) while PI-STEMI were lower (57 versus 65; incidence rate ratios, 0.87; 95% CI, 0.78‒0.97; =0.02) compared with 2018 and 2019. After adjusting for seasonal variation in PI-OHCA and decreased PI-STEMI, the increase in PI-OHCA observed after March 19, 2020 remained significant (=0.02). The proportion of PI-OHCA who received defibrillation (16% versus 23%; risk difference [RD], -6.91%; 95% CI, -9.55% to -4.26%; <0.001) and had return of spontaneous circulation (17% versus 29%; RD, -11.98%; 95% CI, -14.76% to -9.18%; <0.001) were lower after March 19 in 2020 compared with 2018 and 2019. There was also a significant increase in dead on arrival emergency medical services responses in 2020 compared with 2018 and 2019, starting around the time of the stay-at-home order (<0.001). Conclusions Paramedics in Los Angeles County, CA responded to increased PI-OHCA and decreased PI-STEMI following the stay-at-home order. The increased PI-OHCA was not fully explained by the reduction in PI-STEMI. Field defibrillation and return of spontaneous circulation were lower. It is critical that public health messaging stress that emergency care should not be delayed.
背景 公共卫生紧急事件可能会对紧急医疗服务对心血管紧急事件的反应产生重大影响。我们将 2020 年 COVID-19 大流行期间与 2018 年至 2019 年的院外心脏骤停（OHCA）和 ST 段抬高型心肌梗死（STEMI）的紧急医疗服务反应进行了比较，并评估了加利福尼亚州 2020 年 3 月 19 日居家令的影响。
方法和结果 我们使用洛杉矶县紧急医疗服务登记处的数据进行了一项基于人群的横断面研究，该数据来自 2018 年至 2020 年 2 月至 5 月期间有护理人员印象（PI）的 OHCA 或 STEMI 的成年患者。在 2020 年 3 月 19 日之后，每周 OHCA 的 PI 计数较高（173 与 135；发病率比，1.28；95%CI，1.19-1.37；<0.001），而 STEMI 的 PI 计数较低（57 与 65；发病率比，0.87；95%CI，0.78-0.97；=0.02）与 2018 年和 2019 年相比。在调整了 OHCA 的季节性变化和 STEMI 的减少后，在 2020 年 3 月 19 日之后观察到的 OHCA 的 PI 增加仍然具有统计学意义（=0.02）。接受除颤（16%与 23%；风险差异[RD]，-6.91%；95%CI，-9.55%至-4.26%；<0.001）和出现自主循环恢复（17%与 29%；RD，-11.98%；95%CI，-14.76%至-9.18%；<0.001）的 OHCA 的 PI 较低在 2020 年 3 月 19 日之后与 2018 年和 2019 年相比。与 2018 年和 2019 年相比，2020 年到达现场的紧急医疗服务反应的死亡人数也显著增加，这一情况始于居家令发布之时（<0.001）。
结论 加利福尼亚州洛杉矶县的护理人员在居家令后对增加的 OHCA 和减少的 STEMI 做出了反应。增加的 OHCA 不能完全用 STEMI 的减少来解释。现场除颤和自主循环恢复率较低。重要的是，公共卫生信息应强调紧急护理不应延迟。
