DID THE STROKE CODE IN MADRID JAM DURING THE FIRST WAVE OF COVID-19?

Background and aims: Madrid was one of the epicentres of the COVID-19 pandemic in Spain. The entire healthcare system was severely affected by the first wave of the pandemic. We aimed to assess the extent to which the acute stroke care chain was impacted. Methods: Using the stroke code (SC) cohort of SUMMA 112 (the main emergency medical service in the region), we compared all patients in the first wave of the pandemic and in the same period of the previous year. Subsequently, we collected all anonymized records from the main hospital administrative database (minimum basic data set at hospital discharge). We used ambulance response times, concordance between pre-hospital and hospital diagnosis, hospital times, and mortality to evaluate the SC protocol. The study was approved by the Ethics Committee of the Community of Madrid. Results: 966 SC were analysed (514 pre-pandemic and 452 during the first wave). Pre-hospital attention times were longer (39 vs. 35 minutes), patients stayed longer in the emergency room before admission (7.5 vs. 6.1 hours), the concordance between pre-hospital and in-hospital diagnostic suspicion did not change significantly (86% vs. 89%) and mortality decreased (9% vs 13%) during the first wave of the pandemic Conclusions: During the first wave of the pandemic, there were delays in care, especially in the on-scene time. Improvements in training might have prevented it. The high qualification of pre-hospital teams enabled them to maintain their diagnostic accuracy. The reduction in mortality needs further exploration.

EFFECTS OF THE COVID-19 PANDEMIC ON PRE - HOSPITAL CARE FOR STROKE AND TRANSIENT ISCHAEMIC ATTACK : A PROTOCOL FOR A SYSTEMATIC REVIEW AND META-ANALYSIS

Background and aims: The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions. Stroke and transient ischaemic attacks (TIA) are particularly vulnerable to pressures on health system care delivery. The aim of this study is to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on pre - hospital care for stroke or TIA. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, the review will be registered on PROSPERO. Peer-reviewed quantitative studies in English, which report the impact of the COVID-19 pandemic on pre - hospital care for adult stroke/TIA patients will be considered for inclusion. A systematic search of databases including Pubmed, Embase and Scopus from January 2020 to present day will be conducted. Studies will be screened for inclusion and, data extraction and quality assessment will be conducted by the authors. Meta-analysis will be performed to calculate overall pooled estimates of ambulance response times (primary outcome) and stroke/TIA call volumes (secondary outcome), where appropriate. Heterogeneity will be addressed as per the Cochrane Handbook criteria. Results: Data on primary and secondary outcomes will be provided. Conclusions: This study will summarise existing literature investigating the impact of the COVID-19 pandemic on pre - hospital care for those with stroke/TIA.

Emergency medical services calls during COVID-19: Bottleneck explained<a narrative review>

Background: During COVID-19 peak in 2020, EMS calls have surged unprecedently internationally, causing global disruption in EMS dispatch centers' services and significant delays in emergency response worldwide. This negatively impacted the chain of survival for cardiac and stroke, and other emergencies. No studies yet have been done to examine this phenomenon globally. Objectives: This paper examines the interrelated effects of the unprecedented global increase of EMS calls, the effect of the COVID-19 crisis on responding to non-COVID-19 emergencies;mainly cardiac and stroke emergencies- among others, and the concurrent effects of having overwhelmed dispatch centers. We examined the bottleneck phenomenon that resulted in the disruption of EMS calls in different countries, and found three main factors: 1.EMS-related factors 2.Social-related factors 3.Patient-related factors. For better understanding, we also explained each factor based on the available literature.Eligibility Criteria: We examined the numbers of EMS calls internationally between March and June 2020, derived from published literature and news media. Only articles in English were selected, with certain keywords related to EMS calls, ambulance delay, stroke and cardiac arrest. Results: After applying the selection criteria, a total of 29 citations were chosen, and a pattern of knowledge resulted in the emergence of five themes: •EMS calls during COVID-19 •Reduced EMS operator response time •Ambulance response delays •Collateral mortality and morbidity among nonCOVID-19 casesConclusion: Over the course of COVID-19 progress, there was a global phenomenon of exponential increases in EMS calls, which is expected to impose a great pressure on EMS dispatch centers. Several factors contributing to the bottleneck of EMS calls are identified and explained. By understanding these factors and their collateral impact on EMS calls, we can implement better crises and disaster response plans. This is an informative paper to EMS decision makers worldwide.

Emergency Medical Services (EMS) Calls During COVID-19: Early Lessons Learned for Systems Planning (A Narrative Review).

BACKGROUND: Over the course of the COVID-19 progress, reports from many locations around the world indicated major increases in EMS call volume, which imposed great pressure on EMS dispatch centers (EMSDC) globally. No studies yet have been done to examine this phenomenon. OBJECTIVE: This paper examines the interrelated effects of the unprecedented global increase of EMS call, the effect of the COVID-19 crisis on responding to non-COVID-19 emergencies, and the concurrent effects of having overwhelmed dispatch centers. It tries to explain the current evidence of the bottleneck of EMS calls during the early phase of the worldwide pandemic. ELIGIBILITY CRITERIA: We examine the numbers of EMS calls internationally between March and June 2020, derived from published literature and news media. Only articles in English were selected, with certain keywords related to EMS calls, ambulance delay, stroke and cardiac arrest. SOURCE OF EVIDENCE: Google Scholar was the main searching source. RESULTS: After applying the selection criteria, a total of 29 citations were chosen, and a pattern of knowledge resulted in the emergence of five themes: EMS calls during COVID-19, Reduced EMS operator response time, Ambulance response delays, Collateral mortality and morbidity among non-COVID-19 cases, and Total ambulance call time. CONCLUSION: Over the course of COVID-19 progress, there was a global phenomenon of exponential increases in EMS calls, which is expected to impose a great pressure on EMS dispatch centers. Several factors contributing to the bottleneck of EMS calls are identified and explained.