The Correlation between COVID-19 Hospitalizations and Emergency Medical Services Responses for Time-Sensitive Emergencies during the COVID-19 Pandemic

Abstract

Objective

COVID-19 has had significant secondary effects on health care systems, including effects on emergency medical services (EMS) responses for time-sensitive emergencies. We evaluated the correlation between COVID-19 hospitalizations and EMS responses for time-sensitive emergencies in a large EMS system.

Methods

This was a retrospective study using data from the Los Angeles County EMS Agency. We abstracted data on EMS encounters for stroke, ST-elevation myocardial infarction (STEMI), out-of-hospital cardiac arrest (OHCA), and trauma from April 5, 2020 to March 6, 2021 and for the same time period in the preceding year. We also abstracted daily hospital admissions and censuses (total and intensive care unit [ICU]) for COVID-19 patients. We designated November 29, 2020 to February 27, 2021 as the period of surge. We calculated Spearman’s correlations between the weekly averages of daily hospital admissions and census and EMS responses overall and for stroke, STEMI, OHCA, and trauma.

Results

During the study period, there were 70,616 patients admitted for confirmed COVID-19, including 12,467 (17.7%) patients admitted to the ICU. EMS responded to 899,794 calls, including 9,944 (1.1%) responses for stroke, 3,325 (0.4%) for STEMI, 11,207 (1.2%) for OHCA, and 114,846 (12.8%) for trauma. There was a significant correlation between total hospital COVID-19 positive patient admissions and EMS responses for all time-sensitive emergencies, including a positive correlation with stroke (0.41), STEMI (0.37), OHCA (0.78), and overall EMS responses (0.37); and a negative correlation with EMS responses for trauma (-0.48). ICU COVID-19 positive patient admissions also correlated with increases in EMS responses for stroke (0.39), STEMI (0.39), and OHCA (0.81); and decreased for trauma (-0.53). Similar though slightly weaker correlations were found when evaluating inpatient census. During the period of surge, the correlation with overall EMS responses increased substantially (0.88) and was very strong with OHCA (0.95).

Conclusion

We found significant correlation between COVID-19 hospitalizations and the frequency of EMS responses for time-sensitive emergencies in this regional EMS system. EMS systems should consider the potential effects of this and future pandemics on EMS responses and prepare to meet non-pandemic resource needs during periods of surge, particularly for time-sensitive conditions.

Acknowledgments

The authors would like to acknowledge Richard Tadeo, RN, Assistant Director at the Los Angeles County EMS Agency, who oversaw the hospital data collection and provided those data for this analysis. RAKs contribution was supported by the Francis Bacon Foundation and the Pasadena Community Foundation, the John and Lucille Crumb Medical Research Endowment to the Huntington Medical Research Institute, and by the Marylou Endowment to Huntington Medical Research Institute.

Disclosure Statement

JLS has served as an unpaid site investigator in multicenter trials sponsored by Boehringer-Ingelheim, Hoffman LaRoche, Medtronic, Stryker, and Neuravia, for which the UC Regents received payments on the basis of clinical trial contracts for the number of subjects enrolled. JLS has received funding for services as a scientific consultant regarding rigorous trial design and conduct to Medtronic, Stryker, Cerenovus, and Boehringer Ingelheim (prevention only), and stock options for services as a scientific consultant regarding rigorous trial design and conduct to Rapid Medical. DMS has received research support from V-wave medical, Avicena and Neurescue. The other authors have no disclosures.