Increased Prehospital Emergency Medical Service Time Interval and Nontransport Rate of Patients With Fever Using Emergency Medical Services Before and After COVID-19 in Busan, Korea

다국어 초록 (Multilingual Abstract)

Background: In Korea, patients with fever have been preemptively isolated to isolation beds in the emergency department (ED) since the coronavirus disease 2019 (COVID-19) pandemic began. However, isolation beds were not always available, and transport delays or failure (nontransport), especially for infants, were reported in the media. Few studies have focused on delays and failure in transporting fever patients to the ED. Therefore, this study aimed to examine and compare the emergency medical service (EMS) time interval and nontransport rate of patients with fever using EMSs before and after COVID-19.
Methods: This retrospective observational study analyzed the prehospital EMS time interval and nontransport rate of fever patients who contacted EMSs in Busan, South Korea, from March 1, 2019 to February 28, 2022, using emergency dispatch reports. All fever patients (≥ 37.5°C) who contacted EMSs during this study were included. The EMS time interval was defined as the time between the patient’s EMS call and ED arrival time. Nontransport was defined as a case recorded as not being transported in the emergency dispatch reports.
The study population of 2019 was compared to the population of 2020 and 2021 with the independent t-test, Mann-Whitney U test, and χ2 test. As a subgroup, the EMS time intervals and nontransport rates of infants with fever were compared before and after COVID-19.
Results: A total of 554,186 patients accessed the EMS during the study period, and 46,253 patients with fever were included. The EMS time interval (mean ± standard deviation, minutes) of fever patients was 30.9 ± 29.9 in 2019, 46.8 ± 127.8 in 2020 (P < 0.001) and 45.9 ± 34.0 in 2021 (P < 0.001). The nontransport rate (%) was 4.4 in 2019, 20.6 in 2020 (P < 0.001), and 19.5 in 2021 (P < 0.001). For infants with fever, the EMS time interval was 27.6 ± 10.8 in 2019, 35.1 ± 15.4 in 2020 (P < 0.001), and 42.3 ± 20.5 in 2021 (P < 0.001), and the nontransport rate (%) was 2.6 in 2019, 25.0 in 2020, and 19.7 in 2021.
Conclusion: After the emergence of COVID-19, in Busan, the EMS time interval of fever patients was delayed, and approximately 20% of fever patients were not transported.
However, infants with fever had shorter EMS time intervals and higher nontransport rates than the overall study population. A comprehensive approach, including prehospital and hospital ED flow improvements, is required beyond increasing the number of isolation beds.

참고문헌 (Reference)

1 최효정 ; 김호중 ; 이효주 ; 이보라, "일개 대도시의 병원전 단계와 병원 단계의 중증도 분류체계 간의 결과 분석" 대한응급의학회 29 (29): 391-398, 2018

2 Lucero A, "Worsening of emergency department length of stay during the COVID-19 pandemic" 2 (2): e12489-, 2021

3 World Health Organization, "WHO coronavirus (COVID-19) dashboard"

4 Spina S, "The response of Milan’s emergency medical system to the COVID-19 outbreak in Italy" 395 (395): e49-e50, 2020

5 Kim S, "The impact of social distancing and public behavior changes on COVID-19 transmission dynamics in the Republic of Korea" 15 (15): e0238684-, 2020

6 Asaro PV, "The impact of input and output factors on emergency department throughput" 14 (14): 235-242, 2007

7 Guo F, "The impact of COVID-19 on emergency department length of stay for urgent and life-threatening patients" 22 (22): 696-, 2022

8 Fagoni N, "The Lombardy emergency medical system faced with COVID-19 : the impact of out-of-hospital outbreak" 25 (25): 1-7, 2021

9 Lim Daesung ; Park Song Yi ; Choi Byungho ; Kim Sun Hyu ; 류지호 ; Kim Yong Hwan ; Sung Ae Jin ; Bae Byung Kwan ; Kim Han Byeol, "The Comparison of Emergency Medical Service Responses to and Outcomes of Out-of-hospital Cardiac Arrest before and during the COVID-19 Pandemic in an Area of Korea" 대한의학회 36 (36): 1-13, 2021

10 Prezant DJ, "System impacts of the COVID-19 pandemic on New York City’s emergency medical services" 1 (1): 1205-1213, 2020

11 Statistical Geographical Information Service, "Statistical Geographical Information Service homepage"

12 Jonkmans N, "Scoping future outbreaks : a scoping review on the outbreak prediction of the WHO blueprint list of priority diseases" 6 (6): e006623-, 2021

13 Spaite DW, "Prospective validation of a new model for evaluating emergency medical services systems by in-field observation of specific time intervals in prehospital care" 22 (22): 638-645, 1993

14 Seo Ah Ram ; Lee Woon Jeong ; Woo Seon Hee ; Moon Jundong ; Kim Daehee, "Pre-Hospital Delay in Patients With Acute Stroke During the Initial Phase of the Coronavirus Disease 2019 Outbreak" 대한의학회 37 (37): 1-12, 2022

15 Edelson DP, "Interim guidance for basic and advanced life support in adults, children, and neonates with suspected or confirmed COVID-19 : from the emergency cardiovascular care committee and get with the guidelines-resuscitation adult and pediatric task forces of the American Heart Association" 141 (141): e933-43, 2020

16 Baker RE, "Infectious disease in an era of global change" 20 (20): 193-205, 2022

17 Eitel DR, "Improving service quality by understanding emergency department flow : a white paper and position statement prepared for the American Academy of Emergency Medicine" 38 (38): 70-79, 2010

18 Choi Hyohun ; Lee Jang Hoon ; Park Hyuk Kyoon ; Lee Eunkyu ; Kim Myeong Seop ; Kim Hyeon Jeong ; Park Bo Eun ; Kim Hong Nyun ; Kim Namkyun ; Jang Se Yong ; Bae Myung Hwan ; Yang Dong Heon ; Park Hun Sik ; Cho Yongkeun, "Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients With Acute Myocardial Infarction" 대한의학회 37 (37): 1-12, 2022

19 Kim J, "Impact of COVID-19 on emergency medical services for patients with acute stroke presentation in Busan, South Korea" 11 (11): 94-, 2021

20 National Emergency Medical Center, "General situation board"

21 Friedman J, "Excess out-of-hospital mortality and declining oxygen saturation : the sentinel role of emergency medical services data in the COVID-19 crisis in Tijuana, Mexico" 76 (76): 413-426, 2020

22 Peck KR, "Early diagnosis and rapid isolation : response to COVID-19 outbreak in Korea" 26 (26): 805-807, 2020

23 Satty T, "EMS responses and non-transports during the COVID-19 pandemic" 42 : 1-8, 2021

24 Couturier K, "EMS non-transport of low-risk COVID-19 patients" 1-5, 2022

25 Asplin BR, "Developing models for patient flow and daily surge capacity research" 13 (13): 1109-1113, 2006

26 Cooney DR, "Ambulance diversion and emergency department offload delay : resource document for the National Association of EMS Physicians position statement" 15 (15): 555-561, 2011