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

• Published in: Curēus (Palo Alto, CA) CA), 2021-11, Vol.13 (11), p.e19794-e19794
• Main Authors: O'Connor, Allyson W, Hannah, Haylea A, Burnor, Elisabeth A, Fukutaki, Kai G, Peterson, Troy, Ballard, Dustin W, Ereman, Rochelle R, Willis, Matthew D, Augusto, Orvalho J, Wagenaar, Bradley H
• Format: Article
• Language: English
• Subjects: Age groups; Coronaviruses; COVID-19; Emergency medical care; Emergency Medicine; Emergency services; Epidemics; Epidemiology/Public Health; Health care; Health facilities; Health Policy; Health services utilization; Pandemics; Patients; Public health; Seasonal variations; Severe acute respiratory syndrome coronavirus 2; Shelter in place; Time series; Trends
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.19794

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.