News

ESO: Impact of COVID-19 on Documented EMS Encounters

Dr. Scott Bourn, Senior Quality Consultant for ESO; Dr. Antonio Fernandez, Research Scientist at ESO

04/24/2020

PRESS RELEASE

Since early March 2020 American society has been dramatically altered in an effort to stem the wave of COVID-19 infection across the country. While much of the country is shut down, hospitals, health systems, EMS, and other first responders are on the front line providing evaluation, treatment, and transport of potential COVID-19 patients (in addition to the usual requests for service).

Operational planning for pandemic EMS response is challenging because, to a great extent, none of the potential variables are known in advance. These challenges illustrate the importance of accurate data for planning and adjustment of deployment, staffing and—especially useful during an infectious disease outbreak—supply and PPE inventory. Thoughtful utilization of CAD and operational data, as well as electronic health records from both the EMS encounter and hospital stay, is critical to safe and effective EMS and fire response during the COVID-19 pandemic.

ESO created the COVID-19 Resource Center as a way to provide data and insights to the EMS, fire, and hospital communities in hopes that the information proves useful during the pandemic. The data are from ESO’s customer base and comprised of records from more than 2,600 agencies across the United States. In the data dashboard on the Resource Center, we see the impact of COVID-19-related responses on ESO’s agencies as measured by these data, including overall responses for service, number and nature of patients with COVID secondary impressions, treatments administered, and transports provided. Perhaps more important, it also provides data on the use of PPE by providers.

1) During the writing of this article, there were more than 41,000 COVID-19 calls since ESO started COVID-19 EMS surveillance. There are four categories of calls included:

Total calls
9-1-1 calls
Interfacility/medical transports
Other (intercepts, mutual aid, standby, etc.)

The number of total COVID-19 calls has steadily increased from less than 20 calls on March 6 to over 600 COVID-19 calls. The daily percentage of 9-1-1 COVID-19 patients that were transported or had care transferred by EMS has remained around 80% for most of 18 days since surveillance began.

2) To contextualize the additional burden COVID-19 has placed on EMS response, the Resource Center Data Dashboard next compares EMS responses during the current flu season to those from previous flu seasons. Flu seasons are defined by following the CDC methodology for Influenza-Like Illness (ILI) reporting, which begins at week 40 of the calendar year and ends at week 39 of the following year (week 1 is around New Year’s Day and April 1 is in week 14). EMS encounters for COVID-19 and ILI combined remained near national baseline between week 3 and week 10. Weeks 11 and 12 (late March 2020) saw a substantial increase in EMS encounters with COVID-19 and ILI impressions (week 10 = 1.58% of 9-1-1 calls; week 12 = 3.85% of 9-1-1 calls).

The dramatic increase in COVID-19 calls coupled with ILI calls, which were already above the national baseline, as well as all other calls to which EMS is expected to respond have contributed to a substantial increase in the reported use of personal protective equipment (PPE). We do not include an evaluation of the use of gloves because it is expected that they are used on nearly 100% of 9-1-1 calls. Specifically, the use of N95 is the most striking. Reported N95 use increased from approximately 250 to almost 25,000 reported uses of N95s. Granted, many N95s are being reused as well – which is measured in the Data Dashboard.

3) Patient age is described in deciles. The highest percentage of 9-1-1 COVID-19 patients were in the 60-69 years old age group (16%) and the lowest is among those patients 0-9 years old (2%). It should be noted that the percentage of patients in each age group is similar (11% to 16%) for age categories from those 30-39 years old to those who are 80-89 years old. Similar to the 0-9-year-old category, the 10-19-year-old (3%), 20-29-year-old (9%), and 90+ year-old categories (4%) each account for less than 10% of patients.

4) Finally, the majority of 9-1-1 COVID-19 patients do not require prehospital airway interventions nor medication administration. Less than 2% of these patients required any airway intervention with 0.5% requiring intubation, supraglottic airways, or an oropharyngeal or nasal airway, respectively. CPAP was required for 0.6% of 9-1-1 COVID-19 patients. Less than 10% of these patients required medication administration. Antiemetic medication administrations were reported most often (2.9%) followed by bronchodilators (2.7%). Airway/sedation medications (0.5%) and antibiotics (0.1%) account for the least often reported medication administrations for these patients.

Data that doesn’t guide action is of limited use. These data offer some definite opportunities that EMS organizations can consider improving their system’s response and care for these challenging patients:

The decision to transport minor patients to the hospital increases the risk of disease transmission, and significantly impacts patient flow in already overloaded emergency departments. As ED volume continues to grow it is logical that communities may work with EMS to reduce transports of minor patients, or to transport those patients to alternative destinations.
For the safety of EMS providers (and their families) it is important to assure that appropriate PPE is used in the assessment and care of all potential COVID patients. Local agencies can reinforce PPE guidelines and documentation expectations. Surveillance of PPE use in COVID cases, with crew feedback on cases in which PPE did not appear to match the patient condition, can improve PPE use and safety for EMS crews. In addition, if follow-up reveals that PPE use was in fact inadequate, appropriate quarantine can be prescribed to prevent potential transmission across the entire workforce.
As the world copes with potential shortages of key PPE equipment, including N95 respirators, it is important that all healthcare providers avoid “overuse” of scarce PPE resources. If these data accurately represent clinical practice it appears that N95 respirators use may be excessive given the low frequency of high acuity patients requiring medications or intubation. EMS providers may have an opportunity to better align their PPE utilization in a way that preserves N95 inventories for use throughout the pandemic surge.

Actual operational data from EMS providers offers a unique perspective on how the COVID pandemic is impacting EMS organizations, their personnel, and the patients they care for. These data identify the need to further study patterns of response and care during this pandemic.

Disclaimer: The views, thoughts, and opinions expressed in the press release above belong solely to the company/vendor/author and do not necessarily reflect those of EMS World or HMP.