Epidemiology Unit, Meyer Children's University Hospital, Florence, Italy.
Department of Health Sciences, University of Florence, Florence, Italy.
PLoS One. 2022 Jul 1;17(7):e0264806. doi: 10.1371/journal.pone.0264806. eCollection 2022.
Utilization of Emergency Medical Services (EMS) declined during COVID-19 pandemic, but most of the studies analyzed components of the EMS system individually. The study aimed to evaluate the indirect impact of COVID-19 pandemic on the utilization of all the components of the EMS system of Tuscany Region (Italy) during the first pandemic wave.
Administrative data from the health care system of Tuscany were used. Changes in utilization for out-of-hospital emergency calls and emergency vehicle dispatched, emergency department (ED) visits, and patients being admitted from the ED to an inpatient hospital bed (hospitalizations from ED) during the first pandemic wave were analyzed in relation with corresponding periods of the previous two years. Percentage changes and 95%CI were calculated with Poisson models. Standardized Ratios were calculated to evaluate changes in in-hospital mortality and hospitalizations requiring ICU.
Significant declines were observed in the utilization of all the EMS considered starting from the week in which the first case of COVID-19 was diagnosed in Italy till the end of the first pandemic wave. During the epidemic peak, the maximum decreases were observed: -33% for the emergency calls, -45% for the dispatch of emergency vehicles, -71% for ED admissions. Furthermore, a decline of 37% for hospitalizations from ED was recorded. Significant decreases in ED admissions for life threatening medical conditions were observed: acute cerebrovascular disease (-36%, 95% CI: -43, -29), acute myocardial infarction (-42%, 95% CI: -52, -31) and renal failure (-42%, 95% CI: -52, -31). No significant differences were found between the observed and the expected in-hospital mortality and hospitalizations requiring ICU during the epidemic peak.
All the components of the EMS showed large declines in their utilization during COVID-19 pandemic; furthermore, major reductions were observed for admissions for time-dependent and life-threatening conditions. Efforts should be made to ensure access to safe and high-quality emergency care during pandemic.
在 COVID-19 大流行期间，紧急医疗服务（EMS）的利用率有所下降，但大多数研究单独分析了 EMS 系统的各个组成部分。本研究旨在评估 COVID-19 大流行对意大利托斯卡纳地区 EMS 系统所有组成部分在第一波大流行期间的利用间接影响。
使用托斯卡纳地区医疗保健系统的行政数据。分析了第一波大流行期间，与前两年同期相比，院外急救电话和紧急车辆出动、急诊科就诊以及从急诊科转入住院病床（急诊科住院）的利用变化情况。采用泊松模型计算百分比变化和 95%置信区间。计算标准化比值，以评估 ICU 住院和院内死亡率的变化。
从意大利首例 COVID-19 确诊病例的那一周开始，直到第一波大流行结束，所有被考虑的 EMS 利用都出现了显著下降。在疫情高峰期，观察到的最大降幅为：急救电话下降 33%，紧急车辆出动下降 45%，急诊科就诊下降 71%。此外，急诊科住院下降了 37%。观察到危及生命的医疗状况的急诊科就诊也出现了显著下降：急性脑血管病（-36%，95%CI：-43，-29）、急性心肌梗死（-42%，95%CI：-52，-31）和肾衰竭（-42%，95%CI：-52，-31）。在疫情高峰期，未观察到与预期的院内死亡率和需要 ICU 住院之间存在显著差异。
在 COVID-19 大流行期间，EMS 的所有组成部分的利用率都出现了大幅下降；此外，对于时间依赖性和危及生命的疾病，入院人数也大幅减少。应努力确保在大流行期间获得安全和高质量的紧急护理。
