Changes in EMS utilization in the state of Maryland during the first 6 months of the COVID-19 pandemic.

INTRODUCTION AND OBJECTIVES: Emergency medical services (EMS) is an invaluable healthcare resource, providing life-saving care in the prehospital setting. During the COVID-19 pandemic, there have been concerns that healthcare resources, including EMS, would be overwhelmed by the potential surge in critically ill patients. This study seeks to determine the impact of the COVID-19 pandemic on EMS utilization in the state of Maryland. METHODS: A retrospective review of data from the Maryland Emergency Medical Services Data System was performed. EMS call volumes were compared from March 1 to August 31 in the years 2018, 2019, and 2020. In addition, adult cases from the three time periods that contained an EMS impression of stroke, cardiac arrest, asthma, traumatic injury, ST elevation myocardial infarction (STEMI), sepsis, and overdose were also analyzed. RESULTS: There was a significant decrease in overall EMS call volumes in the state of Maryland in the first 6 months of 2020 compared to the prior 2 years. While the total number of calls decreased, a higher proportion of patients in 2020 had EMS impressions of cardiac arrest, STEMI, stroke, and traumatic injury compared to the previous 2 years. Additionally, there was an increase in termination of resuscitation for out of hospital cardiac arrest. CONCLUSION: In the state of Maryland, overall call volumes decreased, but the proportion of EMS patients with time-sensitive illnesses increased during the COVID-19 pandemic.

Nonfatal opioid overdoses before and after Covid-19: Regional variation in rates of change.

BACKGROUND: The Covid-19 pandemic and its accompanying public-health orders (PHOs) have led to (potentially countervailing) changes in various risk factors for overdose. To assess whether the net effects of these factors varied geographically, we examined regional variation in the impact of the PHOs on counts of nonfatal overdoses, which have received less attention than fatal overdoses, despite their public health significance. METHODS: Data were collected from the Overdose Detection Mapping Application Program (ODMAP), which recorded suspected overdoses between July 1, 2018 and October 25, 2020. We used segmented regression models to assess the impact of PHOs on nonfatal-overdose trends in Washington DC and the five geographical regions of Maryland, using a historical control time series to adjust for normative changes in overdoses that occurred around mid-March (when the PHOs were issued). RESULTS: The mean level change in nonfatal opioid overdoses immediately after mid-March was not reliably different in the Covid-19 year versus the preceding control time series for any region. However, the rate of increase in nonfatal overdose was steeper after mid-March in the Covid-19 year versus the preceding year for Maryland as a whole (B = 2.36; 95% CI, 0.65 to 4.06; p = .007) and for certain subregions. No differences were observed for Washington DC. CONCLUSIONS: The pandemic and its accompanying PHOs were associated with steeper increases in nonfatal opioid overdoses in most but not all of the regions we assessed, with a net effect that was deleterious for the Maryland region as a whole.

A Statewide EMS Viral Syndrome Pandemic Triage Protocol: 24 Hour Outcomes.

Background: Early during the COVID-19 pandemic, Emergency Medical Services (EMS) systems encountered many challenges that prompted crisis-level strategies. Maryland's statewide EMS system implemented the Viral Syndrome Pandemic Triage Protocol which contained a decision tool to help identify patients potentially safe for self-care at home. Objectives: This study assessed the effects of the Maryland Viral Syndrome Pandemic Triage Protocol and the safety of referring patients for self-care at home. Methods: This is a retrospective statewide analysis of EMS patients from March 19 thru September 4, 2020, who were not transported and had documentation of the Viral Syndrome Pandemic Triage Protocol's decision support tool completed, as well as a random sample of 150 patients who were not transported and did not have documentation of the decision tool. Descriptive statistics were performed as well as a two-stage multivariable logistic regression model for the outcomes of ED presentation within 24 hours and subsequent hospitalization. Results: 301 EMS patients were documented as triaged to home using the protocol and outcomes data were available for 282 (94%). 41(14.5%) patients presented to an ED within 24 hours and 14 (5% of 282) required inpatient hospitalization. Nine (3.2%) patients were subsequently hospitalized with a diagnosis of COVID-19 illness. Of those patients for whom the decision tool was not documented, 35 (23%) had an ED visit within 24 hours and 15 (10%) were hospitalized (p = 0.075). Multivariate logistic regression model results (N = 432) suggest that those with documentation of triage protocol use had some advantage over those patients without documentation. The 95% CIs of the estimated effect of Triage/No Triage protocol documented were wide and crossed the 1.0 limit but overall, all effects Odds Ratios and Adjust Odds Ratios were consistently over 1.0 with the lowest value of 1.3 and the highest value of 2.1. Conclusion: Most patients (95%) who were triaged to self-care at home with home documented decision support tool use did not require hospitalization within 24 hours following EMS encounter and this appears to be safe. Future opportunity exists to incorporate such tools into comprehensive pandemic preparedness strategies along with appropriate follow up and quality improvement mechanisms.

911 EMS Activations by Pregnant Patients in Maryland (USA) during the COVID-19 Pandemic.

INTRODUCTION: In the early phase of the coronavirus disease 2019 (COVID-19) pandemic, United States Emergency Medical Services (EMS) experienced a decrease in calls, and at the same time, an increase in out-of-hospital deaths. This finding led to a concern for the implications of potential delays in care for the obstetric population. HYPOTHESIS/PROBLEM: This study examines the impact of the pandemic on prehospital care amongst pregnant women. METHODS: A retrospective observational study was conducted comparing obstetric-related EMS activations in Maryland (USA) during the pandemic (March 10-July 20, 2020) to a pre-pandemic period (March 10-July 20, 2019). Comparative analysis was used to analyze the difference in frequency and acuity of calls between the two periods. RESULTS: There were fewer obstetric-related EMS encounters during the pandemic compared to the year prior (daily average during the pandemic 12.5 [SD = 3.8] versus 14.6 [SD = 4.1] pre-pandemic; P <.001), although the percent of total female encounters remained unchanged (1.6% in 2020 versus 1.5% in 2019; P = .091). Key indicators of maternal status were not significantly different between the two periods. African-American women represented a disproportionately high percentage of obstetric-related activations (36.2% in 2019 and 34.8% in 2020). CONCLUSIONS: In this state-wide analysis of EMS calls in Maryland early in the pandemic, no significant differences existed in the utilization of EMS by pregnant women. Prehospital EMS activations amongst pregnant women in Maryland only decreased slightly without an increase in acuity. Of note, over-representation by African-American women compared to population statistics raises concern for broader systemic differences in access to obstetric care.

Correlation between Emergency Medical Services Suspected COVID-19 Patients and Daily Hospitalizations.

Objective: We sought to determine if Emergency Medical Services (EMS) identified Persons Under Investigation (PUI) for COVID-19 are associated with hospitalizations for COVID-19 disease for the purposes of serving as a potential early indicator of hospital surge. Methods: A retrospective analysis was conducted using data from the Maryland statewide EMS electronic medical records and daily COVID-19 hospitalizations from March 13, 2020 through July 31, 2020. All unique EMS patients who were identified as COVID-19 PUIs during the study period were included. Descriptive analysis was performed. The Box-Jenkins approach was used to evaluate the relationship between EMS transports and daily new hospitalizations. Separate Auto Regressive Integrated Moving Average (ARIMA) models were constructed to transform the data into a series of independent, identically distributed random variables. Fit was measured using the Akaike Information Criterion (AIC). The Box-Ljung white noise test was utilized to ensure there was no autocorrelation in the residuals. Results: EMS units in Maryland identified a total of 26,855 COVID-19 PUIs during the 141-day study period. The median patient age was 62 years old, and 19,111 (71.3%) were 50 years and older. 6,886 (25.6%) patients had an abnormal initial pulse oximetry (<92%). A strong degree of correlation was observed between EMS PUI transports and new hospitalizations. The correlation was strongest and significant at a 9-day lag from time of EMS PUI transports to new COVID-19 hospitalizations, with a cross correlation coefficient of 0.26 (p < .01). Conclusions: A strong correlation between EMS PUIs and COVID-19 hospitalizations was noted in this state-wide analysis. These findings demonstrate the potential value of incorporating EMS clinical information into the development of a robust syndromic surveillance system for COVID-19. This correlation has important utility in the development of predictive tools and models that seek to provide indicators of an impending surge on the healthcare system at large.