Maximizing the Role of Emergency Medical Services in COVID-19 Response.

The Centers for Disease Control and Prevention define 6 intervals of a pandemic: (1) investigation of cases, (2) recognition of the increased potential for ongoing transmission, (3) initiation of a pandemic wave, (4) acceleration of a pandemic wave, (5) deceleration of a pandemic wave, and (6) preparation for future pandemic waves. Each of these stages has 8 domains. Following China's coronavirus disease 2019 (COVID-19) outbreak announcement, Israel's National Emergency Medical Services (EMS) Organization immediately began working in conjunction with the Ministry of Health (MOH) to address the threat of the COVID-19 outbreak. This article will describe how a national EMS organization acted according to these pandemic intervals and domains. In the initial stages, EMS managed a checkpoint in the international airport voluntarily testing people for febrile symptoms. Calls to the dispatch centers that aroused the suspicion of COVID-19 resulted in EMS transport to the hospital with protective gear. During the period of first exposure, the scope of the medical emergency number was increased to include questions concerning coronavirus, telemedicine, and home sampling by protected EMS workers. In the contagion stages, epidemiological tests were conducted by the MOH, and EMS began operating dedicated telephone triage, mass drive-through sampling, and finally, administration of vaccinations.

Responses of a Pre-hospital Emergency Medical Service During Military Conflict Versus COVID-19: A Retrospective Comparative Cohort Study.

BACKGROUND: Decreases in routine healthcare practices have been shown to occur during disasters. However, research regarding the impacts of natural disasters, pandemics, or military conflicts on emergency medical services (EMS) is scarce. OBJECTIVES: This study assessed the impact of a military conflict versus the coronavirus disease 2019 (COVID-19) pandemic on a national EMS organization in terms of responses to overall daily emergencies, medical illnesses, motor vehicle collisions, and other injuries. METHODS: This retrospective comparative cohort study assessed daily routine emergency ambulance calls to Magen David Adom (MDA), Israel's national EMS organization. This included overall emergency calls as well as those related to medical illnesses, motor vehicle collisions (MVCs), and other injuries. All data were obtained from the MDA command and control database. During the military conflict Operation Protective Edge (2014), the civilian population was subjected to intensive rocket attacks for 24 days, followed by 26 days of a progressive withdrawal of operations and then to a post-conflict period. During the first wave of the COVID-19 pandemic (March-April 2020), the population was subjected to 32 days of total lockdown, followed by 27 days of progressive relief of confinement, and then to a post-lockdown period. RESULTS: The total number of emergency calls in this study was 330,430. During the conflict, the mean number of daily calls decreased, followed by an increase during Relief and Post-Conflict with higher values in Post-Conflict than in Pre-Conflict. During the COVID-19 pandemic, there was a decrease in the mean daily number of calls during Lockdown. It remained low during Relief and increased during Post-Lockdown. However, it remained lower in Post-Lockdown than during Pre-Lockdown. Calls related to medical illnesses decreased during the conflict and during the lockdown. The post-conflict period was characterized by a similar baseline call magnitude but not during the post-lockdown period. Decreases in calls for MVC and other injuries were significant during the lockdown but not during the military conflict. Post-lockdown was accompanied by return to baseline call volumes for MVC, whereas calls for other injuries increased above baseline both after the lockdown and military conflict. CONCLUSION: This study shows decreasing trends in routine daily calls for EMS during both Operation Protective Edge and COVID-19. However, different patterns of needs for EMS were evidenced for medical illnesses, MVC, or calls concerning other injuries. These results are instrumental for managing the operational demands of EMS during military conflicts and pandemics.

Evolution of emergency medical calls during a pandemic – An emergency medical service during the COVID-19 outbreak

IntroductionEmergency Medical Services (EMS) are expected to be affected by a pandemic outbreak. However, the available data about trends and extents of these effects is limited.MethodsWe analyzed numbers of ambulance calls for all 136 diagnosis codes used by Magen David Adom (MDA), Israel's national EMS during 121 days between January 01 and April 30, 2020.ResultsThere was an increase in calls for COVID-19 symptoms (cough, fever, throat pain). This trend followed the same shape as the curve for confirmed COVID-19 patients. Trends were found to increase for calls not followed by transport to the hospital as well as in calls for mental or psychiatric causes. Simultaneously, there was a decrease in calls for cardiovascular issues, pneumonia, and all injuries.ConclusionUnderstanding these correlations may allow better preparedness of the EMS and a better response towards the public needs in the period of an epidemic or a pandemic.

The rapid development of AmboVent: a simple yet sustainable ventilation solution for use in a pandemic.

INTRODUCTION: COVID-19 (SARS-CoV-2) emerged at the end of 2019, generating a rapidly evolving pandemic, raising serious global health implications. Among them was the fear of a mechanical ventilator shortage due to COVID-19's high contagion rate and pathophysiology. Fears of a ventilator shortage unleashed a wave of innovations. MATERIAL AND METHOD: This manuscript describes the AmboVent, a ventilator, rapidly developed with a sense of urgency, by a group of Israeli volunteers. RESULTS: Using a decentralized approach, we worked extensively and managed within ten days to create a working ventilator. It utilizes a 64-year-old technological concept, the bag valve mask (BVM), sometimes known by the proprietary name Ambu bag, which we transformed into an automatic, controlled, and feature-rich ventilator by endowing it with contemporary computing technology. CONCLUSIONS: Applying a functional rather than a commercial-oriented approach can result in the ad hoc development of lifesaving solutions during a rapidly spreading pandemic.

Flattening the COVID-19 Curve: The Unique Role of Emergency Medical Services in Containing a Global Pandemic.

BACKGROUND: The potential excess flow of patients into emergency departments and community clinics for testing and examination during a pandemic poses a major issue. These additional patients may lead to the risk of viral transmission to other patients and medical teams. To contain the spread of coronavirus disease-2019 (COVID-19), the Israeli Ministry of Health initiated a plan spearheaded by Magen David Adom (MDA), Israel's national emergency medical services (EMS) organization. OBJECTIVES: To describe outbreak containment actions initiated by MDA, including a COVID-19 tele-triage center and home testing by paramedics. METHODS: Retrospective analysis was conducted of de-identified data from the call management and command and control systems during the first period of the COVID-19 outbreak in Israel (23 February 2020-15 March 2020). RESULTS: During the study period, the total number of calls to the dispatch centers was 477,321 with a daily average of 21,696, compared to 6000-6500 during routine times. The total number of COVID-19 related calls was 334,230 (daily average 15,194). There were 28,454 calls (8.51% of all COVID-19 related calls, average 1293/day) transferred to the COVID-19 call center. Of the COVID-19 call center inquiries, 8390 resulted in the dispatch of a dedicated vehicle, including a paramedic wearing personal protective equipment, to collect samples for testing (daily average 381). CONCLUSIONS: Maximizing EMS during a pandemic using phone triage, in addition to dispatching paramedics to perform home testing, may significantly distance infected patients from the public and health care system. These steps can further minimize the spread of disease.

The Role of Israel's Emergency Medical Services During a Pandemic in the Pre-Exposure Period.

OBJECTIVE: The scientific literature on coronavirus disease (COVID-19) is extensive, but little is written about the role of emergency medical services (EMS). The objective of this study is to describe the role of Magen David Adom (MDA), Israel's national emergency prehospital medical organization, in the pre-exposure period, before widespread governmental action. These efforts were based on (1) phone diagnosis, dispatch, and transport; and (2) border management checkpoints. METHODS: This is a descriptive study of MDA's role in pandemic response during the pre-exposure period. Medical emergency telephone calls from either individuals or medical sources were identified by a dispatcher as "suspected COVID-19" based on symptoms and travel exposure. Data were also collected for travelers approaching the MDA border checkpoint at Ben-Gurion International Airport. RESULTS: The total number of protected transports during this time was 121. Of these, 44 (36.3%) were referred by medical sources, and 77 (63.7%) were identified as "suspected COVID-19" by dispatchers. The checkpoint was accessed by 156 travelers: 87 were sent to home-quarantine; 12 were transported to the hospital; 18 were refused entry; and 39 required no further action. CONCLUSION: EMS can work effectively in the pre-exposure period through instructing home quarantine, providing protected transport, and staffing border control checkpoints.

Flattening the COVID-19 Curve: The Unique Role of Emergency Medical Services in Containing a Global Pandemic

BACKGROUND: The potential excess flow of patients into emergency departments and community clinics for testing and examination during a pandemic poses a major issue. These additional patients may lead to the risk of viral transmission to other patients and medical teams. To contain the spread of coronavirus disease-2019 (COVID-19), the Israeli Ministry of Health initiated a plan spearheaded by Magen David Adom (MDA), Israel's national emergency medical services (EMS) organization. OBJECTIVES: To describe outbreak containment actions initiated by MDA, including a COVID-19 tele-triage center and home testing by paramedics. METHODS: Retrospective analysis was conducted of de-identified data from the call management and command and control systems during the first period of the COVID-19 outbreak in Israel (23 February 2020-15 March 2020). RESULTS: During the study period, the total number of calls to the dispatch centers was 477,321 with a daily average of 21,696, compared to 6000-6500 during routine times. The total number of COVID-19 related calls was 334,230 (daily average 15,194). There were 28,454 calls (8.51% of all COVID-19 related calls, average 1293/day) transferred to the COVID-19 call center. Of the COVID-19 call center inquiries, 8390 resulted in the dispatch of a dedicated vehicle, including a paramedic wearing personal protective equipment, to collect samples for testing (daily average 381). CONCLUSIONS: Maximizing EMS during a pandemic using phone triage, in addition to dispatching paramedics to perform home testing, may significantly distance infected patients from the public and health care system. These steps can further minimize the spread of disease.

Epidemic investigations within an arm's reach - role of google maps during an epidemic outbreak.

Epidemics such as novel Coronavirus 2019 (COVID-19) can be contained and the rate of infection reduced by public health measures such as epidemiologic inquiries and social distancing. Epidemiologic inquiry requires resources and time which may not be available or reduced when the outbreak is excessive. We evaluated the use of Google Maps Timeline (GMTL) for creating spatial epidemiologic timelines. The study compares locations, routes, and means of transport between GMTL and user recall for 17 suitable users who were recruited during March 2020. They were interviewed about their timeline using the Timeline Follow-Back (TLFB) method which was then compared to their GMTL and discrepancies between both methods were addressed. Interviewer conclusions were divided into categories: (1) participant recalled, (2) no recall (until shown). Categories were subdivided by GMTL accuracy: [a] GMTL accurate, [b] GMTL inaccurate, [c] GMTL data missing. A total of 362 locations were compared. Participants recalled 322 (88.95% SD = 8.55) locations compared with 40 (11.05%, SD = 2.05) locations not recalled. There were 304 locations found accurate on GMTL (83.98%, SD = 9.49), 29 (8.01%, SD = 1.11) inaccurate locations, and 29 (8.01%, SD = 0.54) missing locations. The total discrepancy between GMTL and TLFB recall was 95 cases (26.24%, SD = 3.25). Despite variations between users, Google Maps with GMTL technology may be useful in identifying potentially exposed individuals in a pandemic. It is especially useful when resources are limited. Further research is required with a larger number of users who are undergoing a real epidemiologic investigation to corroborate findings and establish further recommendations.