Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Department of Family and Community Medicine, Division of Emergency Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
CJEM. 2022 Nov;24(7):742-750. doi: 10.1007/s43678-022-00363-4. Epub 2022 Aug 19.
We examined changes in annual paramedic transport incidence over the ten years prior to COVID-19 in comparison to increases in population growth and emergency department (ED) visitation by walk-in.
We conducted a population-level cohort study using the National Ambulatory Care Reporting System from January 1, 2010 to December 31, 2019 in Ontario, Canada. We included all patients triaged in the ED who arrived by either paramedic transport or walk-in. We clustered geographical regions using the Local Health Integration Network boundaries. Descriptive statistics, rate ratios (RR), and 95% confidence intervals were calculated to explore population-adjusted changes in transport volumes.
Overall incidence of paramedic transports increased by 38.3% (n = 264,134), exceeding population growth fourfold (9.4%) and walk-in ED visitation threefold (13.4%). Population-adjusted transport rates increased by 26.2% (rate ratio 1.26, 95% CI 1.26-1.27) compared to 3.4% for ED visit by walk-in (rate ratio 1.03, 95% CI 1.03-1.04). Patient and visit characteristics remained consistent (age, gender, triage acuity, number of comorbidities, ED disposition, 30-day repeat ED visits) across the years of study. The majority of transports in 2019 had non-emergent triage scores (60.0%) and were discharged home directly from the ED (63.7%). The largest users were persons aged 65 or greater (43.7%). The majority of transports occurred in urbanized regions, though rural and northern regions experienced similar paramedic transport growth rates.
There was a substantial increase in the demand for paramedic transportation. Growth in paramedic demand outpaced population growth markedly and may continue to surge alongside population aging. Increases in the rate of paramedic transports per population were not bound to urbanized regions, but were province-wide. Our findings indicate a mounting need to develop innovative solutions to meet the increased demand on paramedic services and to implement long-term strategies across provincial paramedic systems.
我们考察了 COVID-19 大流行前十年中，每年急救人员转运发病率的变化，并与人口增长和非急救急诊就诊人数的增加进行了比较。
我们在加拿大安大略省使用国家门诊护理报告系统，进行了一项基于人群的队列研究，时间范围为 2010 年 1 月 1 日至 2019 年 12 月 31 日。我们纳入了所有通过急救人员转运或非急救急诊就诊到达急诊分诊的患者。我们使用当地卫生整合网络边界对地理区域进行聚类。计算了描述性统计数据、率比值（RR）和 95%置信区间，以探索转运量的人群调整变化。
总体上，急救人员转运的发病率增加了 38.3%（n=264134），是人口增长的四倍（9.4%），非急救急诊就诊的三倍（13.4%）。与非急救急诊就诊的增长率为 3.4%（RR 1.03，95%CI 1.03-1.04）相比，人群调整后的转运率增加了 26.2%（RR 1.26，95%CI 1.26-1.27）。在研究期间，患者和就诊特征保持一致（年龄、性别、分诊 acuity、合并症数量、急诊处置、30 天内重复急诊就诊）。2019 年的大多数转运都有非紧急分诊评分（60.0%），并且直接从急诊出院（63.7%）。最大的使用者是 65 岁或以上的人（43.7%）。大多数转运发生在城市化地区，尽管农村和北部地区的急救人员转运增长率相似。
对急救人员转运的需求有了大幅增加。急救人员需求的增长明显超过人口增长，并且可能会随着人口老龄化而继续飙升。每人口的急救人员转运率的增加不仅限于城市化地区，而是遍及全省。我们的研究结果表明，需要开发创新的解决方案来满足对急救服务的需求增加，并在全省的急救人员系统中实施长期战略。
