Incidence of emergency calls and out-of-hospital cardiac arrest deaths during the COVID-19 pandemic: findings from a cross-sectional study in a UK ambulance service

Charlton, Karl; Limmer, Matthew; Moore, Hayley

doi:10.1136/emermed-2020-210291

Cited by 15 publications

(14 citation statements)

References 7 publications

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“…[1][2][3][4] Other EMS providers in the UK and North America observed initial decreases in call volumes. 5,6 Surges in demand in the second wave of the pandemic led to some ambulance services in the UK declaring major incidents and warning of care being compromised by overwhelming demand. 7,8 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 what emergency care response is needed to calls.…”

Section: Discussionmentioning

confidence: 99%

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

Marincowitz

Stone

Hasan

et al. 2021

Preprint

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BackgroundEmergency Medical Services (EMS) have experienced surges in demand as the COVID-19 pandemic has progressed with ambulances services in the UK declaring major incidents due to the risk of care being compromised. COVID-19 specific EMS telephone triage tools have been introduced to help manage demand. There has been no previous evaluation of the accuracy of EMS telephone triage in identifying patients with suspected COVID-19 at risk of serious adverse outcome.We aimed to assess accuracy of EMS telephone triage in identifying patients who need an EMS response and identify factors which affect triage accuracy.MethodPatients who made an emergency call to Yorkshire Ambulance Service between 2nd April and 29th June 2020 and were assessed using an AMPDS pandemic pathway for suspected COVID-19 were linked to Office for National Statistics death registration data, hospital and general practice electronic health care data collected by NHS Digital.Accuracy of decision to dispatch an ambulance was assessed in terms of death or need for organ support at 30 days from the first 999 call. Multivariable logistic regression was used to identify factors associated with false negative and false positive triage.ResultsOf 12, 653 callers included in the study population, 11.1% experienced the primary composite adverse outcome. Using the triage pathway, 16% of callers did not receive an emergency response and they had a lower risk (3.5%) of the primary outcome. Ambulances were dispatched to 4, 230 callers (33.4%) who were not subsequently conveyed to hospital and did not experience the primary outcome (false positive triage). Multivariable modelling found older age and presence of pre-existing respiratory disease were significant predictors of false positive triage.ConclusionEMS telephone triage avoided 16% of calls receiving an emergency ambulance, of whom 3.5% died or needed organ support by 30 days. Telephone triage can therefore reduce the burden of EMS responses but with the cost of a small proportion of patients who do not receive an initial emergency response deteriorating. Research is needed to identify the appropriate balance between over- and under-triage

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Section: Discussionmentioning

confidence: 99%

“…1-4 Other EMS providers in the UK and North America observed initial decreases in call volumes. 5, 6 Surges in demand in the second wave of the pandemic led to some ambulance services in the UK declaring major incidents and warning of care being compromised by overwhelming demand. 7, 8…”

Section: Introductionmentioning

confidence: 99%

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

Marincowitz

Stone

Hasan

et al. 2021

Preprint

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“…The same evidence was also proved in different part of the world during the first pandemic wave. In Europe, data from Paris area [ 8 ▪ ] reported a 2-fold increase in OHCA incidence immediately before and during the weeks after Paris lockdown; similarly in England, both in London [ 9 ▪ ] and in North East England [ 10 ] where an increase in OHCA incidence strongly correlated with the daily number of COVID-19 cases was noticed in March–April 2020. Moving to America, an increase in OHCA during the first pandemic wave was pointed out not only in New York City, the most important USA outbreak of COVID-19 during the first wave, where a 3-fold increase in OHCA was highlighted [ 11 ▪ , 12 ], but in also in areas other than the United States of America [ 13 – 16 , 17 ▪▪ ], as in Canada [ 18 ] and in Brazil [ 19 ].…”

Section: Out-of-hospital Cardiac Arrest and Coronavirus Disease 2019mentioning

confidence: 99%

“…One of the most alarming and terrible factors concerning this topic is the dramatic reduction in the outcome of OHCA during the pandemic [ 8 ▪ , 9 ▪ , 10 , 11 ▪ , 13 , 17 ▪▪ , 23 ▪ , 27 , 29 , 30 , 31 ▪▪ , 36 , 42 ▪▪ , 43 , 55 , 56 , 57 ▪▪ , 58 ]. This affected all the outcomes commonly used for OHCA following Utstein recommendations [ 59 ], as the return of spontaneous circulation (ROSC), the survival at hospital admission and the survival at hospital discharge or at 30days, with and without good neurological outcome.…”

Section: Changing In Out-of-hospital Cardiac Arrest Patients’ Charact...mentioning

confidence: 99%

Cardiac arrest and coronavirus disease 2019

Baldi

Cortegiani

Savastano

2022

Current Opinion in Critical Care

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Purpose of reviewThe impact of the coronavirus disease 2019 (COVID-19) on the cardiovascular system has been highlighted since the very first weeks after the severe acute respiratory syndrome coronavirus 2 identification. We reviewed the influence of COVID-19 pandemic on cardiac arrest, both considering those occurred out of the hospital (OHCA) and in the hospital (IHCA). Recent findingsAn increase in OHCA incidence occurred in different countries, especially in those regions most burdened by the COVID-19, as this seems to be bounded to the pandemic trend. A change of OHCA patients' characteristics, with an increase of the OHCA occurred at home, a decrease in bystander cardiopulmonary resuscitation and automated external defibrillator use before Emergency Medical Service (EMS) arrival and an increase in non-shockable rhythms, have been highlighted. A dramatic drop in the OHCA patients' survival was pointed out in almost all the countries, regardless of the high or low-incidence of COVID-19 cases. Concerning IHCA, a reduction in survival was highlighted in patients with COVID-19 who sustained a cardiac arrest. SummaryCardiac arrest occurrence and survival were deeply affected by the pandemic. Informative campaigns to the population to call EMS in case of need and the re-allocation of the prehospital resources basing on the pandemic trend are needed to improve survival.

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“…Importantly, most of these patients died without COVID-19 testing [2]. Data from the North East England Ambulance Service revealed that despite reduced incidence of emergency calls during the pandemic compared with 2019, there was a rise in the incidence of OHCA and OHCA deaths during the same period [3]. Also, Glober et al [4] observed increased OHCA incidence during the COVID-19 pandemic when compared with the prior year.…”

mentioning

confidence: 99%