Pre-Hospital Delay in Patients With Acute Stroke During the Initial Phase of the Coronavirus Disease 2019 Outbreak

Seo, Ah Ram; Lee, Woon Jeong; Woo, Seon Hee; Jundong, Moon; Kim, Daehee

doi:10.3346/jkms.2022.37.e47

Cited by 11 publications

(7 citation statements)

References 19 publications

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“…Despite the excellent outcome of Korea's quarantine measures, there have been reports of increased mortality due to specific causes or delayed treatment during the COVID-19 pandemic [12][13][14][15]. When mortality rates were analyzed by separating them by deaths in medical facilities and deaths outside of medical facilities, a significant increase in deaths outside of medical facilities was observed in 2020.…”

Section: Introductionmentioning

confidence: 99%

“…At the end of 2020, the government secured around 6,000 beds in infectious disease hospitals and supported the deployment of medical and paramedical personnel[31], which may disrupt existing medical care. Delays in the management of patients with acute stroke or acute myocardial infarction during the pandemic were reported[14,15, 32].Additionally, longer or delayed emergency transfer times were noted[33]. In particular, in the case of fever with sepsis, emergency transportation was sometimes refused[34].…”

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confidence: 99%

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Cause-specific mortality in Korea during the first year of the COVID-19 pandemic

Bahk¹,

Jung-Choi²

2022

Epidemiol Health

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Objectives: This study aimed to examine the trends in total mortality between 1998 and 2020 and to compare the changes in a wide range of detailed causes of death between 2020 during the COVID-19 pandemic and the previous year in Korea. Methods:We used registered population and mortality data for the years 1998-2020 obtained from Statistics Korea. The age-standardized all-cause mortality rate and the annual percent change between 1998 and 2020 were determined. The rate ratio and rate difference of the age-standardized mortality rate were calculated between 2019 and 2020, respectively. Results:The age-standardized all-cause mortality rate in Korea has been on a downward trend since 1998, and the decline continued in 2020. In 2020, 950 people died from COVID-19, accounting for 0.3% of all deaths. Mortality was decreased for most causes of death; however, the number of deaths attributed to sepsis and aspiration pneumonia increased between 2019 and 2020 for both men and women. Age-specific mortality rates were decreased or stable between 2019 and 2020 for all age groups, except women aged 25-29. This increase was mainly attributed to an increase in suicide deaths. Conclusions:This study shed light on the issues of sepsis and aspiration pneumonia despite the successful response to COVID-19 in Korea in 2020. The causes of death from sepsis and aspiration pneumonia should be identified and monitored. In addition, it is necessary to develop a proactive policy to address suicide among young people, especially young women.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Cause-specific mortality in Korea during the first year of the COVID-19 pandemic

Bahk¹,

Jung-Choi²

2022

Epidemiol Health

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“… Clinical Outcomes 57 Seo et. al 69 Pre-Hospital Delay in Patients With Acute Stroke During the Initial Phase of the Coronavirus Disease 2019 Outbreak Cohort Patient care reports Seoul, KR ● In the initial phase after the Covid-19 outbreak, EMS response times for acute strokes were delayed. ● Clinical outcomes of patients with acute stroke deteriorated.…”

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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“…Studies have verified the impact of COVID-19 on transport interval for acute stroke, acute myocardial infarction, and out-of-hospital cardiac arrest patients. 5 6 7 Early in the COVID-19 pandemic, studies reported that ED transport was delayed and paralyzed due to the explosion in emergency calls by patients with fever or dyspnea due to the rapid spread of coronavirus in some cities, such as New York and Milan. 8 9 10 11 Korea had a low incidence of COVID-19 before omicron emergence; the situation in Korea was different from that in these cities.…”

Section: Introductionmentioning

confidence: 99%

Increased Prehospital Emergency Medical Service Time Interval and Nontransport Rate of Patients With Fever Using Emergency Medical Services Before and After COVID-19 in Busan, Korea

Lim

Park

2023

J Korean Med Sci

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Background In Korea, patients with fever have been preemptively isolated to isolation beds in the emergency department (ED) since the coronavirus disease 2019 (COVID-19) pandemic began. However, isolation beds were not always available, and transport delays or failure (nontransport), especially for infants, were reported in the media. Few studies have focused on delays and failure in transporting fever patients to the ED. Therefore, this study aimed to examine and compare the emergency medical service (EMS) time interval and nontransport rate of patients with fever using EMSs before and after COVID-19. Methods This retrospective observational study analyzed the prehospital EMS time interval and nontransport rate of fever patients who contacted EMSs in Busan, South Korea, from March 1, 2019 to February 28, 2022, using emergency dispatch reports. All fever patients (≥ 37.5°C) who contacted EMSs during this study were included. The EMS time interval was defined as the time between the patient’s EMS call and ED arrival time. Nontransport was defined as a case recorded as not being transported in the emergency dispatch reports. The study population of 2019 was compared to the population of 2020 and 2021 with the independent t -test, Mann-Whitney U test, and χ 2 test. As a subgroup, the EMS time intervals and nontransport rates of infants with fever were compared before and after COVID-19. Results A total of 554,186 patients accessed the EMS during the study period, and 46,253 patients with fever were included. The EMS time interval (mean ± standard deviation, minutes) of fever patients was 30.9 ± 29.9 in 2019, 46.8 ± 127.8 in 2020 ( P < 0.001) and 45.9 ± 34.0 in 2021 ( P < 0.001). The nontransport rate (%) was 4.4 in 2019, 20.6 in 2020 ( P < 0.001), and 19.5 in 2021 ( P < 0.001). For infants with fever, the EMS time interval was 27.6 ± 10.8 in 2019, 35.1 ± 15.4 in 2020 ( P < 0.001), and 42.3 ± 20.5 in 2021 ( P < 0.001), and the nontransport rate (%) was 2.6 in 2019, 25.0 in 2020, and 19.7 in 2021. Conclusion After the emergence of COVID-19, in Busan, the EMS time interval of fever patients was delayed, and approximately 20% of fever patients were not transported. However, infants with fever had shorter EMS time intervals and higher nontransport rates than the overall study population. A comprehensive approach, including prehospital and hospital ED flow improvements, is required beyond increasing the number of isolation beds.

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Pre-Hospital Delay in Patients With Acute Stroke During the Initial Phase of the Coronavirus Disease 2019 Outbreak

Cited by 11 publications

References 19 publications

Cause-specific mortality in Korea during the first year of the COVID-19 pandemic

Cause-specific mortality in Korea during the first year of the COVID-19 pandemic

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

Increased Prehospital Emergency Medical Service Time Interval and Nontransport Rate of Patients With Fever Using Emergency Medical Services Before and After COVID-19 in Busan, Korea

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