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.

Fig 1. Number of COVID-19 cases registered in the general population of Tuscany Region during the first pandemic wave (January—June 2020).

Fig 2. Utilization of out-of-hospital emergency medical services in Tuscany Region by week (year 2020 vs 2018–19); percentage changes and 95% CIs.

(A) Weekly frequency of calls for emergency medical assistance; percentage changes and 95% CIs. (B) Weekly frequency of mobile medical care units dispatched; percentage changes and 95% CIs.

Fig 3. Emergency department admissions in Tuscany Region by week (year 2020 vs 2018–19); percentage changes and 95% CIs.

Fig 4. Hospitalizations from the emergency department in Tuscany Region by week (year 2020 vs 2018–19); percentage changes and 95% CIs.

Fig 5. Percentage changes in emergency department admissions by triage category (Year 2020), reference period: Weekly average admissions registered in the pre-pandemic period (week 1 to 6 of 2020).