Assessing the Impact of the COVID-19 Pandemic on EMS Transport Patterns for Patients with Suspected Acute Coronary Syndrome 

Introduction: During the first months of the COVID-19 pandemic, ED visits for time-sensitive conditions including acute coronary syndrome (ACS) declined. It is unknown whether EMS encounters resulting in nontransport for time-sensitive conditions have changed during the pandemic and whether patterns differ by patient characteristics. 

Objective: Describe changes in EMS use and transport patterns for patients with suspected ACS during the COVID-19 pandemic compared to a control period one year prior. 

Methods: This retrospective analysis used prehospital records from the ESO Data Collaborative. The authors compared responses for patients with suspected ACS from the first three months of the pandemic (study period: March 1–May 31, 2020) to the previous year (control period: March 1–May 31, 2019). Only agencies contributing records in both time periods were included. The proportion of EMS responses resulting in nontransport were compared using chi-square tests. Multivariable logistic regression models were used to assess odds of transport for patients with suspected ACS during each period controlling for age, sex, and race/ethnicity. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) are reported.

Results: Records from 1,241 agencies were included. Total 9-1-1 call volume decreased 5% between the control period (1,131,399) and study period (1,071,868). Nontransports increased from 17% to 19% of all encounters (p  <  0.001). Total encounters for suspected ACS decreased by 16% (67,697 to 56,969). Suspected ACS encounters resulting in nontransport increased from 6% to 9% (p  <  0.001). Controlling for age and race/ethnicity, females with suspected ACS were less likely to be transported in the study period (aOR 0.76, 95% CI 0.72–0.81) and control period (0.81, 0.75–0.94) compared to males. Compared to white non-Hispanic patients, Hispanic patients were less likely to be transported during the study period (0.82, 0.74–0.91) and control period (0.84, 0.75–0.94). Black non-Hispanic patients were less likely to be transported during the study period only (0.91, 0.84–0.97). 

Conclusions: EMS encounters for suspected ACS decreased for March, April, and May during the COVID-19 pandemic compared to a year earlier. More encounters resulted in nontransport, even for patients with suspected ACS. Future work could explore root causes of observed disparities in nontransport by race/ethnicity and gender.