Cumming School of Medicine (Lane, Blanchard, Shaw, McRae), University of Calgary; Department of Emergency Medical Services (Blanchard), Alberta Health Services; Department of Emergency Medicine (McRae), University of Calgary, Calgary, Alta.; Institute of Health Policy, Management and Evaluation (Buick), University of Toronto, Toronto, Ont.
CMAJ Open. 2021 Jun 1;9(2):E592-E601. doi: 10.9778/cmajo.20200313. Print 2021 Apr-Jun.
The COVID-19 pandemic has resulted in unique pressures on the emergency services system. This study describes changes in the presentation, presenting severity and disposition of patients accessing emergency services in Calgary, Alberta, during the first wave of the pandemic.
In this descriptive study, we constructed a population cohort of all patients who accessed emergency services by calling emergency medical services (EMS) (ambulance service that provides prehospital treatment and transport to medical facilities) or presenting directly to an emergency department (4 adult and 1 pediatric) or 2 urgent care centres in Calgary during the exposure period (December 2019 to June 2020) compared to 2 historical control periods (December to June, 2017-2018 and 2018-2019) combined. Outcomes included frequency of presentation, system flow indicators, patient severity, disposition and mortality. We used a locally estimated scatterplot smoothing function to visualize trends. We described differences at the maximum and minimum point of the exposure period compared to the control period.
A total of 1 127 014 patient encounters were included. Compared to the control period, there was a 61% increase in the number of patients accessing EMS and a 35% decrease in the number of those presenting to an adult emergency department or urgent care centre in the COVID-19 period. The proportion of EMS calls for the highest-priority patients remained stable, whereas the proportion of patients presenting to an emergency department or urgent care centre with the highest-priority triage classification increased transiently by 0.9 percentage points (increase of 89%). A smaller proportion of patients were transported by EMS (decrease of 21%), and a greater proportion of emergency department patients were admitted to hospital (increase of 25%). After the first case was reported, the mortality rate among EMS patients increased by 265% (3.4 v. 12.4 per 1000 patient encounters).
The first wave of the COVID-19 pandemic was associated with substantial changes in the frequency and disposition of patients accessing emergency services. Further research examining the mechanism of these observations is important for mitigating the impact of future pandemics.
COVID-19 大流行给急救服务系统带来了独特的压力。本研究描述了 COVID-19 大流行第一波期间，艾伯塔省卡尔加里市通过紧急医疗服务（EMS）（提供院前治疗和向医疗机构转运的救护车服务）或直接到急诊就诊的患者就诊、就诊严重程度和处置情况的变化成人急诊部（4 个成人和 1 个儿科）或卡尔加里的 2 个紧急护理中心在暴露期间（2019 年 12 月至 2020 年 6 月）与 2 个历史对照期（2017-2018 年和 2018-2019 年）相结合。结果包括就诊频率、系统流程指标、患者严重程度、处置和死亡率。我们使用局部估计散点平滑函数来可视化趋势。我们描述了与对照期相比，在暴露期的最高点和最低点的差异。
共纳入 1 127 014 例患者就诊。与对照期相比，COVID-19 期间使用 EMS 的患者数量增加了 61%，而到成人急诊就诊或到紧急护理中心就诊的患者数量减少了 35%。最高优先级患者的 EMS 调用比例保持稳定，而在急诊就诊或紧急护理中心就诊的患者中，最高优先级分诊分类的比例暂时增加了 0.9 个百分点（增加了 89%）。通过 EMS 转运的患者比例较小（减少 21%），而更多的急诊患者被收治入院（增加 25%）。首例病例报告后，EMS 患者的死亡率增加了 265%（每 1000 例患者就诊 3.4 例至 12.4 例）。
COVID-19 大流行的第一波与急诊患者就诊频率和处置方式的重大变化有关。进一步研究检查这些观察结果的机制对于减轻未来大流行的影响很重要。
