Impact of the COVID-19 Pandemic on Emergency Air Medical Transport of Pediatric Patients in the Penghu Islands

Abstract

Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted healthcare systems worldwide. As a result, remote areas such as the Penghu Islands have encountered unique challenges related to pediatric care. This study examined the effects of the pandemic on the emergency air medical transport (EAMT) of pediatric patients from the Penghu Islands to Taiwan.

Materials and methods: This retrospective study analyzed 40 pediatric patients who received EAMT from the Penghu Islands to Taiwan between January 2017 and December 2022. This study compared patients before and during the COVID-19 pandemic and focused on patient demographics, reasons for EAMT, and clinical outcomes. Due to the small sample size, non-parametric statistical methods were applied, including the Mann-Whitney U-test for continuous variables and Fisher's exact test for categorical variables.

Results: Among the 40 pediatric patients analyzed, the median age decreased from 3 years (IQR, 0-5 years) before the pandemic to 1 year (IQR, 0-5 years) during the pandemic. While the overall increase in hospital length of stay during the pandemic was not statistically significant, a significant prolongation was observed in preschool-aged children and neonates without trauma (20 days vs. 9 days; p < 0.05). The lack of specialist physicians became an increasingly prominent factor for EAMT during the pandemic (p = 0.056). The most common medical reasons for EAMT were critical illness (35%), neonatal diseases (30%), and neurological conditions (27.5%), with similar distributions across both time periods.

Conclusions: The COVID-19 pandemic heightened existing healthcare disparities in the Penghu Islands, particularly by increasing reliance on EAMT due to a shortage of pediatric specialists. Hospital stays for preschool children and neonates significantly increased during the pandemic, suggesting delayed or prolonged care. These findings underscore the need to strengthen local pediatric infrastructure, decentralize specialist services, and improve emergency preparedness to better support vulnerable populations in remote areas during future public health emergencies.

Keywords: COVID-19 pandemic; Penghu Islands; air transportation; emergency air medical transport; pediatric patients.

Figure 1

Comparison of hospital stays for non-traumatic preschool patients and neonates after air transportation. Solid squares and circles indicate outliers in different groups.