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An assessment of treatment, transport, and refusal incidence in a National EMS's routine work during COVID-19.
Am J Emerg Med. 2021 06; 44:45-49.AJ

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.

Authors+Show Affiliations

Magen David Adom, Tel Aviv, Israel; Sackler Faculty, Public Health School, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: mayas@mda.org.il.Magen David Adom, Tel Aviv, Israel.Magen David Adom, Tel Aviv, Israel.Magen David Adom, Tel Aviv, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33578331

Citation

Siman-Tov, Maya, et al. "An Assessment of Treatment, Transport, and Refusal Incidence in a National EMS's Routine Work During COVID-19." The American Journal of Emergency Medicine, vol. 44, 2021, pp. 45-49.
Siman-Tov M, Strugo R, Podolsky T, et al. An assessment of treatment, transport, and refusal incidence in a National EMS's routine work during COVID-19. Am J Emerg Med. 2021;44:45-49.
Siman-Tov, M., Strugo, R., Podolsky, T., & Blushtein, O. (2021). An assessment of treatment, transport, and refusal incidence in a National EMS's routine work during COVID-19. The American Journal of Emergency Medicine, 44, 45-49. https://doi.org/10.1016/j.ajem.2021.01.051
Siman-Tov M, et al. An Assessment of Treatment, Transport, and Refusal Incidence in a National EMS's Routine Work During COVID-19. Am J Emerg Med. 2021;44:45-49. PubMed PMID: 33578331.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An assessment of treatment, transport, and refusal incidence in a National EMS's routine work during COVID-19. AU - Siman-Tov,Maya, AU - Strugo,Refael, AU - Podolsky,Timna, AU - Blushtein,Oren, Y1 - 2021/01/28/ PY - 2020/12/10/received PY - 2021/01/18/revised PY - 2021/01/20/accepted PY - 2021/2/13/pubmed PY - 2021/6/8/medline PY - 2021/2/12/entrez KW - Covid-19 KW - Pre-hospital activities KW - Transport refusals SP - 45 EP - 49 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 44 N2 - 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. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/33578331/An_assessment_of_treatment_transport_and_refusal_incidence_in_a_National_EMS's_routine_work_during_COVID_19_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(21)00054-1 DB - PRIME DP - Unbound Medicine ER -