Examining emergency medical services' prehospital transport times for trauma patients during COVID-19

Jarvis, Stephanie; Salottolo, Kristin; Berg, Gina M.; Carrick, Matthew M.; Caiafa, Rachel; Hamilton, David; Banton, Kaysie; Lieser, Mark; Bar‐Or, David

doi:10.1016/j.ajem.2021.01.091

Cited by 16 publications

(13 citation statements)

References 18 publications

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“…Studies have shown that SI can be a tool for early recognition and evaluation of critical illness in prehospital settings [28,29] and SI ≥ 1.0 indicates worsening of hemodynamic status and shock [19]. As reported by other studies [30][31][32], prehospital times, including response time and transportation time in all time-sensitive disease categories, continues to increase.…”

Section: Discussionmentioning

confidence: 78%

Effect of Designating Emergency Medical Centers for Critical Care on Emergency Medical Service Systems during the COVID-19 Pandemic: A Retrospective Observational Study

Park

Kim

et al. 2022

JCM

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During the coronavirus disease 2019 (COVID-19) pandemic, prehospital times were delayed for patients who needed to arrive at the hospital in a timely manner to receive treatment. To address this, in March 2020, the Korean government designated emergency medical centers for critical care (EMC-CC). This study retrospectively analyzed whether this intervention effectively reduced ambulance diversion (AD) and shortened prehospital times using emergency medical service records from 219,763 patients from the Gyeonggi Province, collected between 1 January and 31 December 2020. We included non-traumatic patients aged 18 years or older. We used interrupted time series analysis to investigate the intervention effects on the daily AD rate and compared prehospital times before and after the intervention. Following the intervention, the proportion of patients transported 30–35 km and 50 km or more was 13.8% and 5.7%, respectively, indicating an increased distance compared to before the intervention. Although the change in the AD rate was insignificant, the daily AD rate significantly decreased after the intervention. Prehospital times significantly increased after the intervention in all patients (p < 0.001) and by disease group; all prehospital times except for the scene time of cardiac arrest patients increased. In order to achieve optimal treatment times for critically ill patients in a situation that pushes the limits of the medical system, such as the COVID-19 pandemic, even regional distribution of EMC-CC may be necessary, and priority should be given to the allocation of care for patients with mild symptoms.

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Section: Discussionmentioning

confidence: 78%

Effect of Designating Emergency Medical Centers for Critical Care on Emergency Medical Service Systems during the COVID-19 Pandemic: A Retrospective Observational Study

Park

Kim

et al. 2022

JCM

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“… Clinical Outcomes 41 Jarvis et. al 53 Examining emergency medical services’ prehospital transport times for trauma patients during COVID-19 Cohort Trauma patients transported via EMS to six US trauma centers US ● There was no significant difference in total EMS prehospital times between 2019 and during COVID- 19 pandemic. ● Times during transport were less during the pandemic than in 2019.…”

Section: Resultsmentioning

confidence: 99%

Emergency Medical Services Prehospital Response to the COVID-19 Pandemic in the US: A Brief Literature Review

Ventura¹,

Denton²,

David³

et al. 2022

OAEM

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This study aimed to analyze prehospital Emergency Medical Services (EMS) response to the COVID-19 pandemic in the US through a brief systematic review of available literature in context with international prehospital counterparts. An exploration of the NCBI repository was performed using a search string of relevant keywords which returned n=5128 results; articles that met the inclusion criteria (n=77) were reviewed and analyzed in accordance with PRISMA and PROSPERO recommendations. Methodical quality was assessed using critical appraisal tools, and the Egger’s test was used for risk of bias reduction upon linear regression analysis of a funnel plot. Sources of heterogeneity as defined by P < 0.10 or I^2 > 50% were interrogated. Findings were considered within ten domains: structural/systemic; clinical outcomes; clinical assessment; treatment; special populations; dispatch/activation; education; mental health; perspectives/experiences; and transport. Findings suggest, EMS clinicians have likely made significant and unmeasured contributions to care during the pandemic via nontraditional roles, ie, COVID-19 testing and vaccine deployment. EMS plays a critical role in counteracting the COVID-19 pandemic in addition to the worsening opioid epidemic, both of which disproportionately impact patients of color. As such, being uniquely influential on clinical outcomes, these providers may benefit from standardized education on care and access disparities such as racial identity. Access to distance learning continuing education opportunities may increase rates of provider recertification. Additionally, there is a high prevalence of vaccine hesitancy among surveyed nationally registered EMS providers. Continued rigorous investigation on the impact of COVID-19 on EMS systems and personnel is warranted to ensure informed preparation for future pandemic and infectious disease responses.

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“…However, the increased demand induced by the SARS-CoV-2 pandemic and the subsequent mandatory infection prevention measures could elongate the total EMS prehospital time. A study from the US did not find differences in total prehospital time during the SARS-CoV-2 pandemic compared to 2019, even though transport time was significantly shorter during the pandemic [ 33 ]. Among the Dutch trauma population, the prehospital EMS times were significantly longer in all 2020 time periods.…”

Section: Discussionmentioning

confidence: 99%

Impact of the SARS-CoV-2 pandemic on trauma care: a nationwide observational study

Driessen

Ditshuizen

Waalwijk³

et al. 2022

Eur J Trauma Emerg Surg

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PurposeThe SARS-CoV-2 pandemic severely disrupted society and the health care system. In addition to epidemiological changes, little is known about the pandemic's effects on the trauma care chain. Therefore, in addition to epidemiology and aetiology, this study aims to describe the impact of the SARS-CoV-2 pandemic on prehospital times, resource use and outcome. Methods A multicentre observational cohort study based on the Dutch Nationwide Trauma Registry was performed. Characteristics, resource usage, and outcomes of trauma patients treated at all trauma-receiving hospitals during the first (W1, March 12 through May 11) and second waves (W2, May 12 through September 23), as well as the interbellum period in between (INT, September 23 through December 31), were compared with those treated from the same periods in 2018 and 2019. ResultsThe trauma caseload was reduced by 20% during the W1 period and 11% during the W2 period. The median length of stay was significantly shortened for hip fracture and major trauma patients (ISS ≥ 16). A 33% and 66% increase in the prevalence of minor self-harm-related injuries was recorded during the W1 and W2 periods, respectively, and a 36% increase in violence-related injuries was recorded during the INT. Mortality was significantly higher in the W1 (2.9% vs. 2.2%) and W2 (3.2% vs. 2.7%) periods. ConclusionThe imposed restrictions in response to the SARS-CoV-2 pandemic led to diminished numbers of acute trauma admissions in the Netherlands. The long-lasting pressing demand for resources, including ICU services, has negatively affected trauma care. Further caution is warranted regarding the increased incidence of injuries related to violence and self-harm.

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Examining emergency medical services' prehospital transport times for trauma patients during COVID-19

Cited by 16 publications

References 18 publications

Effect of Designating Emergency Medical Centers for Critical Care on Emergency Medical Service Systems during the COVID-19 Pandemic: A Retrospective Observational Study

Effect of Designating Emergency Medical Centers for Critical Care on Emergency Medical Service Systems during the COVID-19 Pandemic: A Retrospective Observational Study

Emergency Medical Services Prehospital Response to the COVID-19 Pandemic in the US: A Brief Literature Review

Impact of the SARS-CoV-2 pandemic on trauma care: a nationwide observational study

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