Los Angeles County Emergency Medical Services Agency, Los Angeles, California, USA.
Harbor-UCLA Medical Center, Torrance, California.
Prehosp Emerg Care. 2023;27(3):321-327. doi: 10.1080/10903127.2022.2112792. Epub 2022 Aug 29.
COVID-19 has had significant secondary effects on health care systems, including effects on emergency medical services (EMS) responses for time-sensitive emergencies. We evaluated the correlation between COVID-19 hospitalizations and EMS responses for time-sensitive emergencies in a large EMS system.
This was a retrospective study using data from the Los Angeles County EMS Agency. We abstracted data on EMS encounters for stroke, ST-elevation myocardial infarction (STEMI), out-of-hospital cardiac arrest (OHCA), and trauma from April 5, 2020 to March 6, 2021 and for the same time period in the preceding year. We also abstracted daily hospital admissions and censuses (total and intensive care unit [ICU]) for COVID-19 patients. We designated November 29, 2020 to February 27, 2021 as the period of surge. We calculated Spearman's correlations between the weekly averages of daily hospital admissions and census and EMS responses overall and for stroke, STEMI, OHCA, and trauma.
During the study period, there were 70,616 patients admitted for confirmed COVID-19, including 12,467 (17.7%) patients admitted to the ICU. EMS responded to 899,794 calls, including 9,944 (1.1%) responses for stroke, 3,325 (0.4%) for STEMI, 11,207 (1.2%) for OHCA, and 114,846 (12.8%) for trauma. There was a significant correlation between total hospital COVID-19 positive patient admissions and EMS responses for all time-sensitive emergencies, including a positive correlation with stroke (0.41), STEMI (0.37), OHCA (0.78), and overall EMS responses (0.37); and a negative correlation with EMS responses for trauma (-0.48). ICU COVID-19 positive patient admissions also correlated with increases in EMS responses for stroke (0.39), STEMI (0.39), and OHCA (0.81); and decreased for trauma (-0.53). Similar though slightly weaker correlations were found when evaluating inpatient census. During the period of surge, the correlation with overall EMS responses increased substantially (0.88) and was very strong with OHCA (0.95).
We found significant correlation between COVID-19 hospitalizations and the frequency of EMS responses for time-sensitive emergencies in this regional EMS system. EMS systems should consider the potential effects of this and future pandemics on EMS responses and prepare to meet non-pandemic resource needs during periods of surge, particularly for time-sensitive conditions.
COVID-19 对医疗保健系统造成了重大的次生影响，包括对紧急医疗服务（EMS）响应时间敏感型紧急情况的影响。我们评估了在一个大型 EMS 系统中 COVID-19 住院患者与时间敏感型紧急情况的 EMS 响应之间的相关性。
这是一项使用洛杉矶县 EMS 机构的数据进行的回顾性研究。我们从 2020 年 4 月 5 日至 2021 年 3 月 6 日和前一年同期提取了中风、ST 段抬高型心肌梗死（STEMI）、院外心脏骤停（OHCA）和创伤的 EMS 遭遇数据。我们还提取了 COVID-19 患者的每日住院人数和人口普查（总数和重症监护病房 [ICU]）。我们将 2020 年 11 月 29 日至 2021 年 2 月 27 日指定为高峰期。我们计算了每周平均每日住院人数和 ICU 人数与 EMS 总体和中风、STEMI、OHCA 和创伤的响应之间的 Spearman 相关性。
在研究期间，有 70616 名确诊 COVID-19 患者住院，其中 12467 名（17.7%）患者入住 ICU。EMS 响应了 899794 次呼叫，其中 9944 次（1.1%）为中风，3325 次（0.4%）为 STEMI，11207 次（1.2%）为 OHCA，114846 次（12.8%）为创伤。总体而言，COVID-19 阳性患者住院人数与所有时间敏感型紧急情况的 EMS 响应之间存在显著相关性，包括与中风（0.41）、STEMI（0.37）、OHCA（0.78）和总体 EMS 响应（0.37）呈正相关；与创伤的 EMS 响应呈负相关（-0.48）。ICU COVID-19 阳性患者入院人数也与中风（0.39）、STEMI（0.39）和 OHCA（0.81）的 EMS 响应增加有关；与创伤的 EMS 响应减少（-0.53）。在评估住院人数时，发现了类似但略微较弱的相关性。在高峰期，与总体 EMS 响应的相关性显著增加（0.88），与 OHCA 的相关性非常强（0.95）。
我们在这个区域 EMS 系统中发现了 COVID-19 住院患者与时间敏感型紧急情况的 EMS 响应频率之间存在显著相关性。EMS 系统应考虑到这种和未来大流行对 EMS 响应的潜在影响，并在高峰期做好应对非大流行资源需求的准备，特别是对于时间敏感的情况。
