Department of Emergency Medicine & Services, Helsinki University Hospital and the University of Helsinki, P.O. Box 347, 00029 HUS, Helsinki, Finland.
Department of Anaesthesiology & Intensive Care Medicine, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland.
BMC Emerg Med. 2023 Dec 6;23(1):145. doi: 10.1186/s12873-023-00915-6.
Emergency medical services (EMS) were the first point of contact for many COVID-19 patients during the pandemic. The aim of this study was to investigate whether the non-conveyance decision of a COVID-19 patient was more frequently associated with a new EMS call than direct ambulance transport to the hospital.
All confirmed COVID-19 patients with an EMS call within 14 days of symptom onset were included in the study. Patients were compared based on their prehospital transport decision (transport vs. non-conveyance). The primary endpoint was a new EMS call within 10 days leading to ambulance transport.
A total of 1 286 patients met the study criteria; of these, 605 (47.0%) were male with a mean (standard deviation [SD]) age of 50.5 (SD 19.3) years. The most common dispatch codes were dyspnea in 656 (51.0%) and malaise in 364 (28.3%) calls. High-priority dispatch was used in 220 (17.1%) cases. After prehospital evaluation, 586 (45.6%) patients were discharged at the scene. Oxygen was given to 159 (12.4%) patients, of whom all but one were transported. A new EMS call leading to ambulance transport was observed in 133 (10.3%) cases; of these, 40 (30.1%) were in the group primarily transported and 93 (69.9%) were among the patients who were primarily discharged at the scene (p<.001). There were no significant differences in past medical history, presence of abnormal vital signs, or total NEWS score. Supplemental oxygen was given to 33 (24.8%) patients; 3 (2.3%) patients received other medications.
Nearly half of all prehospital COVID-19 patients could be discharged at the scene. Approximately every sixth of these had a new EMS call and ambulance transport within the following 10 days. No significant deterioration was seen among patients primarily discharged at the scene. EMS was able to safely adjust its performance during the first pandemic wave to avoid ED overcrowding.
在疫情期间，急救医疗服务（EMS）是许多 COVID-19 患者的第一接触点。本研究旨在调查 COVID-19 患者的非转运决策是否更频繁地与新的 EMS 呼叫相关，而不是直接救护车转运到医院。
所有在症状出现后 14 天内有 EMS 呼叫的确诊 COVID-19 患者均纳入本研究。根据患者的院前转运决策（转运与非转运）进行比较。主要终点是在 10 天内新的 EMS 呼叫导致救护车转运。
共有 1286 名患者符合研究标准；其中，605 名（47.0%）为男性，平均（标准差 [SD]）年龄为 50.5（SD 19.3）岁。最常见的调度代码是 656 例呼吸困难（51.0%）和 364 例不适（28.3%）。220 例（17.1%）使用了高优先级调度。经过院前评估，586 名（45.6%）患者在现场出院。159 名（12.4%）患者给予吸氧，其中除 1 名患者外均被转运。观察到 133 例（10.3%）新的 EMS 呼叫导致救护车转运；其中，40 例（30.1%）在主要转运组，93 例（69.9%）在主要在现场出院的患者中（p<.001）。两组患者的既往病史、异常生命体征的存在或总 NEWS 评分均无显著差异。给予 33 名（24.8%）患者补充氧气；3 名（2.3%）患者接受其他药物治疗。
所有院前 COVID-19 患者中近一半可在现场出院。其中约每六分之一的患者在接下来的 10 天内出现新的 EMS 呼叫和救护车转运。在主要在现场出院的患者中未观察到明显恶化。EMS 能够在第一波大流行期间安全调整其表现，以避免急诊科过度拥挤。
