Ambulance Calls for Substance-Related Issues Before and After COVID-19

Abstract

A c c e p t e d M a n u s c r i p t Background: The United States is currently facing two epidemics: sustained morbidity and mortality from substance use and the more recent COVID-19 pandemic. We tested the hypothesis that the pandemic has disproportionately affected individuals with substance use disorder by evaluating average daily 911 ambulance calls for substance use-related issues compared with all other calls. Methods: This was a retrospective cross-sectional analysis of 911 ambulance calls before and after the start of COVID-19 in Massachusetts. We used consecutive samples of 911 ambulance calls, categorized into those which were substance-related or not. An interrupted time series analysis was performed to determine if there were changes in numbers of daily calls before a statewide declaration of emergency for COVID-19 (February 15-March 9, 2020), from the emergency declaration until a stay-at-home advisory (March 10-March 22, 2020) and following the stay-at-home advisory (March 23-May 15, 2020). Results: Compared with prior to the statewide emergency, the post-statewide emergency average of daily ambulance calls decreased from 2,453.2 to 1,969.6, a 19.7% decrease. Similarly, calls for substance-related reasons decreased by 16.4% compared with prior to the statewide emergency. However, despite an initial decrease in calls, after the stay-at-home advisory calls for substance use began increasing by 0.7 (95% confidence interval (CI) 0.4-1.1) calls/day, while calls for other reasons did not significantly change (+1.2 (95% CI-0.8 to 3.1) calls/day). Refusal of transport for substance-related calls increased from 5.0% before the statewide emergency to 7.5% after the declaration (p<0.001). Conclusions: After an initial decline in substance-related ambulance calls following a statewide declaration of emergency, calls for substance use increased to pre-COVID-19 levels while those A c c e p t e d M a n u s c r i p t for other reasons remained at a lower rate. The results suggest that COVID-19 is disproportionately affecting individuals with substance use disorder.

The impact of the national stay-at-home order on emergency department visits for suspected opioid overdose during the first wave of the COVID-19 pandemic

“…One study of EMS OOD runs in Kentucky reported a large and significant increase in runs with transportation to ED in late March–April 2020 ( Friedman et al, 2021 ), concordant with the Kentucky trends observed here. Another study in Massachusetts found a small increase in transport refusals after the statewide emergency was declared (from 5.0% to 7.5%) ( Weiner et al, 2020 ), and we find a small but measurable drop in ED encounters for suspected OOD as well. These findings suggest that the relationship between EMS opioid runs and ED encounters for suspected OOD is complex and warrants further research.…”

Understanding the Impacts of Novel Coronavirus Outbreaks on People Who Use Drugs: A Systematic Review to Inform Practice and Drug Policy Responses to COVID-19

“…The impact was found to be greatest for those injecting image and performance enhancing drugs. All five of the studies that were set in EMS (Table 6) employed a quantitative method [38,40,44,45,55]. All were pre-and post-studies of PWUD sampled from those who had visited emergency departments or had contact with ambulance services before and after stay-at-home restriction orders, and all were conducted within the USA.…”

“…Three of the five studies suggested that opioid overdoses increased during the COVID-19 stay-at-home order along with increased number of visits to the emergency department for naloxone administration [38,44,55]. Similarly, two studies showed that emergency medicine calls for opioid overdose increased during this time [40,45]. Two studies reported an increase in drug overdose deaths [38,54] but only one of these was rated as 'good' in terms of methods used and in weight of evidence.…”

“…Arguably the 'strongest' studies included in our review were those that we grouped under 'emergency medical settings' [38,40,44,45,55]. All were conducted in the USA and most used very large secondary data sets which suggested that both fatal and non-fatal drug overdoses had increased in the early stages of the pandemic.…”

Emergency medical services education research priorities during COVID‐19: A modified Delphi study

“…The EMS workforce, and care they provide to ill and injured patients outside of the emergency department, is an integral part of the overall US emergency care system. Impacts from COVID‐19 have affected EMS service call volume, 4–7 increased EMS professional fatigue, and worsened well‐being, 8,9 and slowed the education pipeline 3 . Specifically, for the EMS education pipeline, it is believed that the majority of EMS education programs experienced at least some form of temporary closure, modifications to delivery of content and program requirements, and limited or loss of access to simulated education as well as live field and clinical opportunities 3,10–13 .…”