The comparison of emergency medical service responses to and outcomes of out-of-hospital cardiac arrest before and during the COVID-19 pandemic in Thailand: a cross-sectional study.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, the format of patients with out-of-hospital cardiac arrest (OHCA) management was modified. Therefore, this study compared the response time and survival at the scene of patients with OHCA managed by emergency medical services (EMS) before and during the COVID-19 pandemic in Thailand. METHODS: This retrospective, observational study used EMS patient care reports to collect data on adult patients with OHCA coded with cardiac arrest. Before and during the COVID-19 pandemic was defined as the periods of January 1, 2018-December 31, 2019, and January 1, 2020-December 31, 2021, respectively. RESULTS: A total of 513 and 482 patients were treated for OHCA before and during the COVID-19 pandemic, respectively, showing a decrease of 6% (% change difference =- 6.0, 95% confidence interval [CI] - 4.1, - 8.5). However, the average number of patients treated per week did not differ (4.83 ± 2.49 vs. 4.65 ± 2.06; p value = 0.700). While the mean response times did not significantly differ (11.87 ± 6.31 vs. 12.21 ± 6.50 min; p value = 0.400), the mean on-scene and hospital arrival times were significantly higher during the COVID-19 pandemic compared with before by 6.32 min (95% CI 4.36-8.27; p value < 0.001), and 6.88 min (95% CI 4.55-9.22; p value < 0.001), respectively. Multivariable analysis revealed that patients with OHCA had a 2.27 times higher rate of return of spontaneous circulation (ROSC) (adjusted odds ratio = 2.27, 95% CI 1.50-3.42, p value < 0.001), and a 0.84 times lower mortality rate (adjusted odds ratio = 0.84, 95% CI: 0.58-1.22, p value = 0.362) during the COVID-19 pandemic period compared with that before the pandemic. CONCLUSIONS: In the present study, there was no significant difference between the response time of patients with OHCA managed by EMS before and during COVID-19 pandemic period; however, markedly longer on-scene and hospital arrival times and higher ROSC rates were observed during the COVID-19 pandemic than those in the period before the pandemic.

Comparing Emergency Medical Services Processing Times for Stroke Patients Before and During COVID-19 Pandemic; A Cross-sectional Study.

Introduction: Coronavirus disease 2019 (COVID-19) has directly affected global healthcare, especially the front-line of healthcare provision, including emergency medical services (EMS). The present study aimed to compare EMS processing times and the number of acute stroke patients serviced by EMS before and during COVID-19 pandemic. Methods: This is a retrospective observational review of Bangkok Surgico Medical Ambulance and Rescue Team (S.M.A.R.T.) EMS data from 2018 to 2021. The EMS processing times and the number of acute strokes were compared between pre-COVID-19 era (January 1st, 2018, and December 31st, 2019) and during COVID-19 pandemic (January 1st, 2020, and December 31st, 2021). Results: The number of stroke patients transported by EMS in one year, before and during COVID-19 pandemic was 128 and 150 cases, respectively (Change difference = 17.2%, 95% CI: 11.1-24.9). However, the average number of acute stroke patients per week was not significantly different (p = 0.386). The mean total EMS processing times before and during COVID-19 era were 25.59 ± 11.12 and 45.47 ± 14.61 minutes, respectively (mean difference of 19.88 (95% CI: 16.77-22.99) minutes; p < 0.001). The mean time from symptom onset to EMS arrival (p < 0.001), the mean call time (p < 0.001), the mean response time (p < 0.001), and the mean scene time (p < 0.001) were significantly higher during COVID-19 period. The mean transportation times for stroke patients was similar before and during COVID-19 pandemic (10.14 ± 6.28 and 9.41 ± 6.31 minutes, respectively; p = 0.338). Conclusions: During COVID-19 pandemic, the number of acute stroke patients serviced by EMS increased substantially, but there was no difference in the average number of patients per week. During the pandemic, EMS processing times markedly increased.

The Impact of the Coronavirus Disease 2019 (Covid-19) Pandemic on the Use of Emergency Medical Services System in Bangkok, Thailand.

Background: Coronavirus disease 2019 (COVID-19) has widely affected the global public health system, especially the emergency medical service (EMS), which has been the first responders since 2020. However, this pandemic persists with still limited studies on its impact on EMS. This study aimed to compare the number of EMS patients and the operation periods of Bangkok EMS in Thailand between 2020 (severe COVID-19 pandemic) and 2019 (prepandemic). Patients and Methods: We retrospectively analyzed data of patients with severe COVID-19 were collected from the emergency medical information system of Bangkok EMS center. Data were compared between the two periods. The COVID-19 pandemic period (study period) spanned from January 01, 2020 to December 31, 2020, whereas the control period referred to the same period in the previous year (January 01, 2019 to December 31, 2019). Results: A total of 178,594 patients were serviced by EMS, with 93,288 during the study period and 85,306 during the control period. The study period had more EMS patients overall by 9.36% (95% confidence interval [CI]: 9.16-9.55) and significantly more EMS patients per day, with a mean difference of 21.19 (254.90 ± 25.55 vs 233.71 ± 23.49; 95% CI: 17.63-24.76, p < 0.001), than the control period. Furthermore, all EMS operation periods studied were significantly longer during the study period. Conclusion: During COVID-19 pandemic period, a significantly increased number of EMS patients compared to one during non-COVID-19 pandemic period for both traumatic and non-traumatic patients, as well as remarkably increased every EMS operation period of both groups during COVID-19 pandemic period were found in the present study. From this knowledge, provision of necessary EMS resources and preparation of emergency staff to be ready for management of future pandemics should be obtained to reduce EMS operation period in the future pandemics.

The Impact of COVID-19 Pandemic on the Use of Emergency Medical Services System in Bangkok, Thailand (preprint)

Coronavirus disease 2019 (COVID-19) has widely affected the global public health system, especially the emergency medical service (EMS), which has been the first responders since 2020. However, this pandemic persists with still limited studies on its impact on EMS. This study aimed to compare the number of EMS patients and the operation periods of Bangkok EMS in Thailand between 2020 (severe COVID-19 pandemic) and 2019 (prepandemic). Data of patients with severe COVID-19 were collected from the emergency medical information system of Bangkok EMS center. Data were compared between the two periods. A total of 178,594 patients were serviced by EMS, with 93,288 during the study period and 85,306 during the control period. The study period had more EMS patients overall by 9.36% (95% confidence interval [CI]: 9.16–9.55) and significantly more EMS patients per day, with a mean difference of 21.19 (254.90 ± 25.55 vs. 233.71 ± 23.49;95% CI: 17.63–24.76, p < 0.001), than the control period. Furthermore, all EMS operation periods were significantly longer during the study period. The COVID-19 pandemic period had more patients managed by EMS and longer EMS operation periods than the prepandemic period.