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. 2021 Jun:44:45-49.
doi: 10.1016/j.ajem.2021.01.051. Epub 2021 Jan 28.

An assessment of treatment, transport, and refusal incidence in a National EMS's routine work during COVID-19

Maya Siman-Tov  1 , Refael Strugo  2 , Timna Podolsky  2 , Oren Blushtein  2
Affiliations

An assessment of treatment, transport, and refusal incidence in a National EMS's routine work during COVID-19

Maya Siman-Tov et al. Am J Emerg Med. 2021 Jun.

Abstract

Background: COVID-19 created lifestyle changes, and induced a fear of contagion affecting people's decisions regarding seeking medical assistance. Concern surrounding contagion and the pandemic has been found to affect the number and type of medical emergencies to which Emergency Medical Services (EMS) have responded.

Aim: To identify, categorize, and analyze Magen David Adom (MDA), Israel's national EMS, pre-hospital activities including patients' refusal to hospital transport, during the COVID-19 pandemic crises.

Methods: A comparative before and after design study of MDA incidents during March/April 2019 and March/April 2020. Medical type, frequency, demographic, location, and transport refusal proportions and outcomes were analyzed.

Results: A decrease of 2.6% in the total volume of incidents was observed during March and April 2020 compared with the equivalent period in 2019. This contrasted with the retrospective trend of annually increase observed through 2016-2019. Medical categories showing increase in 2020 were infectious disease, cardiac arrest, psychiatric, and labor and deliveries, with out-of-hospital deliveries increasing by 14%. Decreases in 2020 were seen in neurology and trauma, with trauma incidents occurring at home showing an 8.6% increase. Patients' refusal to transport rose from 13.4% in 2019 to 19.9% in 2020. Cases of refusals followed by death within 8 days were more prevalent in 2020.

Conclusion: EMS must be prepared for changes in patients' behavior due to COVID concerns. Targeting populations at risk for refraining or refusing hospital transport and implementing diverse models of EMS, especially during pandemic times, will allow EMS to assist patients safely, either by reducing truly unnecessary ED visits minimizing contagion or by increasing hospital transports for patients in urgent or emergent conditions.

Keywords: Covid-19; Pre-hospital activities; Transport refusals.

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Conflict of interest statement

Declaration of Competing Interest None declared.

Figures

Fig. 1
Fig. 1
Number of incidents during March and April 2016–2020.
Fig. 2
Fig. 2
Refusals rates and outcomes (transport or death) 2020 vs. 2019. *The percent of refusals followed by transport/death within 8 days was calculated from the total refusals followed by transport/death (875/1176 in 2019 and 1482/1934 in 2020 for transport; 22/38 in 2019 and 42/56 in 2020 for death).
See this image and copyright information in PMC

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