Call volume, triage outcomes, and protocols during the first wave of the COVID‐19 pandemic in the United Kingdom: Results of a national survey

Abstract

Objectives During the first wave of the COVID‐19 pandemic in the United Kingdom (UK), to describe volume and pattern of calls to emergency ambulance services, proportion of calls where an ambulance was dispatched, proportion conveyed to hospital, and features of triage used. Methods Semistructured electronic survey of all UK ambulance services (n = 13) and a request for routine service data on weekly call volumes for 22 weeks (February 1–July 3, 2020). Questionnaires and data request were emailed to chief executives and research leads followed by email and telephone reminders. The routine data were analyzed using descriptive statistics, and questionnaire data using thematic analysis. Results Completed questionnaires were received from 12 services. Call volume varied widely between services, with a UK peak at week 7 at 13.1% above baseline (service range ‐0.5% to +31.4%). All services ended the study period with a lower call volume than at baseline (service range ‐3.7% to ‐25.5%). Suspected COVID‐19 calls across the UK totaled 604,146 (13.5% of all calls), with wide variation between services (service range 3.7% to 25.7%), and in service peaks of 11.4% to 44.5%. Ambulances were dispatched to 478,638 (79.2%) of these calls (service range 59.0% to 100.0%), with 262,547 (43.5%) resulting in conveyance to hospital (service range 32.0% to 53.9%). Triage models varied between services and over time. Two primary call triage systems were in use across the UK. There were a large number of products and arrangements used for secondary triage, with services using paramedics, nurses, and doctors to support decision making in the call center and on scene. Frequent changes to triage processes took place. Conclusions Call volumes were highly variable. Case mix and workload changed significantly as COVID‐19 calls displaced other calls. Triage models and prehospital outcomes varied between services. We urgently need to understand safety and effectiveness of triage models to inform care during further waves and pandemics.

Trends and associated factors for Covid-19 hospitalisation and fatality risk in 2.3 million adults in England

“…A previous UK study of patients admitted to hospital with Covid-19 found a fall in mortality from March to July 2020, a time over which bed occupancy fell and evidence for new treatments, such as dexamethasone, became available, with similar findings from a US cohort between March and September 2020 12 , 13 . Changes to care delivery at an organisational level may also have an impact, with triage models for Covid-19 patients on the national 111 urgent care service varying between services and over time 14 . The Alpha variant became the dominant Covid-19 strain in England in December 2020, and has been associated with a 64% increase in 28-day mortality compared to prior variants, which may explain part of the rise in the CHR and CFR 15 .…”

The Alternative Pre-hospital Pathway team: reducing conveyances to the emergency department through patient centered Community Emergency Medicine

“…As a retrospective observational study, our data is reliant on accurate documentation of the case by the treating clinician. A large proportion of the study period included the COVID-19 pandemic with varying levels of public health measures which may have impacted the study; other jurisdictions have demonstrated an impact on ambulance service call volumes [33] and emergency department attendances [17].…”

Accuracy of emergency medical service telephone triage of need for an ambulance response in suspected COVID-19: an observational cohort study

“…Although specific EMS telephone triage protocols have been introduced for patients with suspected COVID-19, this appears to be the first evaluation of triage accuracy. 4 Our study used a large cohort of patients identified from routinely collected EMS records and linked this to nationally collected, patient-level healthcare data to provide robust clinical outcomes. We have assessed performance in a cohort of patients with suspected infection which, in the absence of accurate universally available rapid COVID-19 diagnostic tests, reflects the population who must be clinically triaged by urgent and emergency care services.…”

“…EMS call handlers in the UK are typically trained non-clinical staff who use either the Advanced Medical Priority Dispatch System (AMPDS) or NHS pathways to triage the EMS response to calls. 4 On 2 April 2020, six English NHS ambulance services using AMPDS introduced a specific protocol for callers with suspected COVID-19 using the pandemic Card 36. 9 10 Structured questions (summarised in online supplemental material 1 ) were used to triage urgency of EMS response into three levels: Delta (highest priority requiring immediate response), Charlie (medium priority requiring ambulance attendance when able) and Alpha (no ambulance dispatched).…”

“…The AMPDS Card 36 was implemented by UK ambulance services in different ways, with some symptoms and selected high risk-groups receiving a higher priority response than normal, with alterations to the card implemented in the following months. 4 …”