COVID-19 Testing Among Out-of-Hospital Cardiac Arrest Patients: Implications for Public Health.

OBJECTIVE: The objective of this study was to compare COVID-19 test positivity among out-of-hospital cardiac arrest patients whose resuscitative efforts were terminated in the field with the surrounding community. METHODS: This was a retrospective cohort study of out-of-hospital cardiac arrest patients for whom unsuccessful resuscitative efforts were terminated in the field. Emergency medical services (EMS) personnel obtained postmortem COVID-19 nasal swab specimens from these patients between July 1, 2020 and February 28, 2022 to facilitate patient contact tracing and awareness of potential occupational exposure. A chi-square (n-1) was used to compare test result proportions between cardiac arrest patients and the community at large. A Pearson correlation was used to correlate test positivity among the two groups. RESULTS: EMS personnel obtained postmortem specimens from 648 cardiac arrest patients; 20 (3.1%) were inconclusive. Of the 628 specimens successfully tested, 69 (11.0%) were positive, and 559 (89.0%) were negative. Monthly positivity ranged from 0.0% to 34.0%. For the community at large, overall test positivity during the same period was 5.1%, with a monthly range from 0.4% to 15.2%. Overall, expired and tested cardiac arrest patients had 5.9% (95%CI 3.68 - 8.59) greater COVID-19 test positivity than the general community. There was significant correlation in monthly positivity rates between the groups (r = 0.778, p < .001, 95%CI0.51 - 0.91). CONCLUSIONS: Compared to the general population, COVID-19 was over-represented among EMS cardiac arrest patients who died in the field. Postmortem testing by EMS personnel, not typical practice, identified infectious disease cases that would have otherwise gone undetected, indicating potential for future surveillance applications.

An EMS Transport Destination Officer is Associated with Reductions in Simultaneous Emergency Department Arrivals.

Objective: A centralized transport destination officer (TDO) is one technique used by EMS systems to distribute patients. This retrospective analysis examines the effect of a TDO on simultaneous arrivals and consecutive simultaneous arrivals at emergency departments in a suburban EMS system, and their relationship to transport unit throughput.Methods: Each system hospital arrival from July 1, 2020 to February 28, 2022, at six study hospitals was evaluated. An arrival within 300 seconds of the previous arrival at the same hospital was designated as a simultaneous arrival. Any simultaneous arrival where the previous arrival was also a simultaneous arrival was further designated as a consecutive simultaneous arrival. Simultaneous and consecutive simultaneous arrivals were aggregated by day to produce countywide daily totals. Median and interquartile ranges were calculated and a Wilcoxon rank-sum test was used to compare each outcome, with the presence of the TDO as the grouping variable. A Pearson correlation was used to assess the relationship between daily total simultaneous and consecutive simultaneous arrivals to median daily hospital turnaround interval.Results: Median simultaneous arrivals showed a 15% reduction from 21 [IQR: 17 - 26] to 18 [IQR: 15 - 22] (p < 0.001). Consecutive simultaneous arrivals decreased 33%, from 6 [IQR: 4 - 9] to 4 per day [IQR: 2 - 6] on days when the TDO was in place (p < 0.001). Increased total daily simultaneous and consecutive simultaneous arrivals also showed statistically significant correlation with increased median daily hospital turnaround interval (simultaneous r = 0.488, p < 0.001; consecutive simultaneous r = 0.360 p < 0.001).Conclusions: A centralized EMS transport destination officer is associated with a reduction in simultaneous and consecutive simultaneous arrivals of patients in the emergency department. Further analysis also shows a significant correlation between the number of simultaneous and consecutive simultaneous arrivals and transport unit hospital turnaround interval. This technique to achieve load balancing across transport destinations appears to be effective and can be considered in systems experiencing throughput difficulties.

Decreases in out of hospital cardiac arrest (OHCA) outcome metrics persist when known COVID patients are excluded from analysis.

OBJECTIVE: A decline in OHCA performance metrics during the pandemic has been reported in the literature but the cause is still not known. The Montgomery County Fire and Rescue Service (MCFRS) observed a decline in both the rate of return of spontaneous circulation (ROSC) and the proportion of resuscitations that resulted in cerebral performance category (CPC) 1 or 2 discharge of the patient beginning in March of 2020. This study examines whether the decline in these performance metrics persists when known COVID positive patients are excluded from the analysis. METHODS: Two samples of OHCA patients for similar time periods (one year apart) before and after the start of the COVID pandemic were developed. A database of known COVID positive patients among EMS encounters was used to identify and exclude COVID positive patients. OHCA outcomes in these two groups were then compared using a Chi-square test and Fisher's exact test for difference in proportions and Analysis of Variance (ANOVA) for difference in means. A two-stage multivariable logistic regression model was used to develop odds ratios for achieving ROSC and CPC 1 or 2 discharge in each period. RESULTS: After excluding known COVID patients, 32.5% of the patients in the pre-COVID period achieved ROSC compared to 25.1% in the COVID period (p = 0.007). 6% of patients in the pre-COVID period were discharged with CPC 1 or 2 compared to 3.2% from the COVID era (p = 0.026). Controlling for all available patient characteristics, patients undergoing OHCA resuscitation prior to be beginning of the pandemic were 1.2 times more likely to achieve ROSC and 1.6 times more likely to be discharged with CPC 1 or 2 than non-COVID patients in the pandemic era sample. CONCLUSIONS: When known COVID patients are excluded, pre-pandemic OHCA resuscitation patients were more likely to achieve ROSC and CPC 1 or 2 discharge. The prevalence of known COVID positive patients among all OHCA resuscitations during the pandemic was not sufficient to fully account for the marked decrease in both ROSC and CPC 1 or 2 discharges. Other causative factors must be sought.

Notes From the Field: Use of Emergency Medical Service Data to Augment COVID-19 Public Health Surveillance in Montgomery County, Maryland, From March to June 2020.

Epidemiologic and syndromic surveillance metrics traditionally used by public health departments can be enhanced to better predict hospitalization for coronavirus disease (COVID-19). In Montgomery County, Maryland, measurements of oxygen saturation (SpO2) by pulse oximetry obtained by the emergency medical service (EMS) were added to these traditional metrics to enhance the public health picture for decision makers. During a 78-day period, the rolling 7-day average of the percentage of EMS patients with SpO2 <94% had a stronger correlation with next-day hospital bed occupancy (Spearman ρ=0.58, 95% CI 0.40-0.71) than either the rolling 7-day average of the percentage of positive tests (ρ=0.55, 95% CI: 0.37-0.69) or the rolling 7-day average of the percentage of emergency department visits for COVID-19-like illness (ρ=0.49, 95% CI: 0.30-0.64). Health departments should consider adding EMS data to augment COVID-19 surveillance and thus improve resource allocation.