Emergency Medical Service Utilization and Response Following COVID-19 Emergency and Stay-at-Home Policies: An Interrupted Time-Series Analysis

Details

• Personal Author:
  Augusto OJ ; Ballard DW ; Burnor EA ; Ereman RR ; Fukutaki KG ; Hannah HA ; O'Connor AW ; Peterson T ; Wagenaar BH ; Willis MD
• Description:
  Objective: Examine changing emergency medical services (EMS) utilization and response patterns associated with coronavirus disease 2019 (COVID-19) emergency declaration and stay-at-home orders during the first year of the COVID-19 pandemic. Methods: We conducted an uncontrolled interrupted time series analysis of EMS calls (January 1, 2019 - March 1, 2021) in Marin County, California analyzing call volume (All calls, n=46,055); patient refusal of EMS care or transport and patient care resolved on scene (Calls with opportunity for transport; n=37,401); and call severity (Transported calls; n=27,887). Results: Pre-COVID-19 (1/1/2019-3/2/2020), EMS transported patients were predominately female (50.6%), 80+ years old (31.6%), and Marin County residents (68.0%). During COVID-19 (3/3/2020-3/1/2021), EMS transported patients were predominately male (52.7%), 35-64 years old (29.8%), and Marin County residents (70.4%). After the first stay-at-home order on 3/17/2020, call volume immediately decreased by 48% (adjusted incidence rate ratio [aIRR]=0.52; 95% CI=0.35,0.79) for children (0-15 years) and 34% for adults 80+ years (aIRR=0.66;95% CI=0.46,0.95). The odds of a transported call being prioritized as severe doubled (adjusted odds ratio [aOR]=2.26; 95% CI=1.11,4.59). Though transport refusals increased by 69% for children after the first order (aOR, 1.69 [95% CI, 1.13-2.52]), immediately following the second order on 12/8/2020, transport refusals decreased by 30% for children but increased 38-40% for adults 35-79 years (aOR=1.40 [95% CI=1.04-1.89] for 35-64 years; 1.38 [95% CI=1.02-1.87] for 65-79 years). Calls resolved on scene by EMS increased after the first order among all ages and after the second order for adults 16-79 years. Conclusions: Call volume reduced for children and older adults after the first COVID-19 stay-at-home order. Changes in call severity, patient care refusals, and on-scene care provided by EMS indicated a changing role for EMS during the outbreak. [Description provided by NIOSH]
• Subjects:
  Communicable Diseases Delivery Of Health Care Emergency Responders Epidemiology Occupational Health Public Health Safety
• Keywords:
  Author Keywords: Emergency Utilization Coronavirus COVID-19 Covid-19 Outbreak Emergency Care Emergency Medical Services Emergency Medical Services Workers EMS Medical Care Policy Public Health Public Health Policy Stay-at-home Orders

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• ISSN:
  2168-8184
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; OSHA Region 10 ; OSHA Region 9 ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  13
• Issue:
  11
• NIOSHTIC Number:
  nn:20064596
• Citation:
  Cureus 2021 Nov; 13(11):e19794
• Email:
  hahannah@uw.edu
• Federal Fiscal Year:
  2022
• Performing Organization:
  University of Washington
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Cureus
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:61d183b1f5dad4942bf015aa31d9982ac7993a8c4fe1d72e6169786f995baf79ff10d4669f8622dcb3d258ad3d463c6ba1b979b1da6c6ec54d618abb9b3d5409
• Download URL:
  https://stacks.cdc.gov/view/cdc/223031/cdc_223031_DS1.pdf
• File Type:
  [PDF - 550.82 KB ]