The indirect impact of COVID-19 pandemic on the utilization of the emergency medical services during the first pandemic wave: A system-wide study of Tuscany Region, Italy

Abstract

Background Utilization of Emergency Medical Services (EMS) declined during COVID-19 pandemic, but most of the studies analyzed components of the EMS system individually. The study aimed to evaluate the indirect impact of COVID-19 pandemic on the utilization of all the components of the EMS system of Tuscany Region (Italy) during the first pandemic wave. Methods Administrative data from the health care system of Tuscany were used. Changes in utilization for out-of-hospital emergency calls and emergency vehicle dispatched, emergency department (ED) visits, and patients being admitted from the ED to an inpatient hospital bed (hospitalizations from ED) during the first pandemic wave were analyzed in relation with corresponding periods of the previous two years. Percentage changes and 95%CI were calculated with Poisson models. Standardized Ratios were calculated to evaluate changes in in-hospital mortality and hospitalizations requiring ICU. Results Significant declines were observed in the utilization of all the EMS considered starting from the week in which the first case of COVID-19 was diagnosed in Italy till the end of the first pandemic wave. During the epidemic peak, the maximum decreases were observed: -33% for the emergency calls, -45% for the dispatch of emergency vehicles, -71% for ED admissions. Furthermore, a decline of 37% for hospitalizations from ED was recorded. Significant decreases in ED admissions for life threatening medical conditions were observed: acute cerebrovascular disease (-36%, 95% CI: -43, -29), acute myocardial infarction (-42%, 95% CI: -52, -31) and renal failure (-42%, 95% CI: -52, -31). No significant differences were found between the observed and the expected in-hospital mortality and hospitalizations requiring ICU during the epidemic peak. Conclusion All the components of the EMS showed large declines in their utilization during COVID-19 pandemic; furthermore, major reductions were observed for admissions for time-dependent and life-threatening conditions. Efforts should be made to ensure access to safe and high-quality emergency care during pandemic.

Increase in Referrals of Children and Adolescents to the Psychiatric Emergency Room Is Evident Only in the Second Year of the COVID-19 Pandemic—Evaluating 9156 Visits from 2010 through 2021 in a Single Psychiatric Emergency Room

“…In addition, patients suffering from bullying, academic difficulties, and other stressors may experience home schooling as a relief [ 17 , 18 ]. Moreover, there was a decline in the utilization of all emergency medical services for life-threatening medical conditions that are not related to COVID-19, which was the result of a general reduction in help-seeking behaviors during the first year of the pandemic [ 19 , 20 ].…”

Determinants of Actual COVID-19 Vaccine Uptake in a Cohort of Essential Workers: An Area-Based Longitudinal Study in the Province of Prato, Italy

“…Italy has been one of the first Western countries to be severely hit by the COVID-19 pandemic [ 6 , 7 ]. On 20 February 2020, the first local Italian case was confirmed [ 8 , 9 ]. To contain the spread of the virus, a national lockdown (10th March–4th May 2020) was established with the closure of all non-essential activities.…”

Communicating with Patients about COVID-19 Vaccination: A Qualitative Study on Vaccinators in Tuscany Region, Italy

“…Interestingly, all the vaccinators described a similar trend of vaccine confidence over the course of the vaccination campaign (depicted in Figure 1 ); vaccine confidence was reported to be high at the start of the campaign and to increase during the first phases—in this context, it should be taken into account that Italy was one the first western countries to be severely hit by the spread of the pandemic [ 22 , 27 , 28 ]; then, this trend stopped and reversed for several reasons, some directly related to the advancement of the vaccine campaign (the appearance of the first vaccine adverse events and the reduced perception of the disease severity due to the high level of vaccine coverage) and other external factors (i.e., misinformation/disinformation and pandemic fatigue) [ 29 ]. With the return to a pre-COVID-19 situation, the COVID-19 vaccine begins to be internalized by the population as a routine vaccination in terms of safety.…”