Change in Emergency Medical Services-Attended Out-of-Hospital Deliveries during COVID-19 in the United States

Abstract

Background

The COVID-19 pandemic disrupted access to routine in-person prenatal care, potentially leading to higher risk of out-of-hospital deliveries. Unplanned out-of-hospital deliveries pose a substantial risk of morbidity and mortality for pregnant patients and newborns. Our objective was to determine the change in rate of emergency medical services (EMS)-attended out-of-hospital deliveries during the COVID-19 pandemic. We hypothesized that COVID-19-related stay-at-home orders were associated with a higher rate of out-of-hospital deliveries during the initial wave of COVID-19.

Methods

We conducted an interrupted time series analysis using the 2019 and 2020 National EMS Information System datasets. We included 9-1-1 scene activations for patients 12-50 years old with out-of-hospital deliveries who were treated and transported by EMS. We calculated the weekly rate of deliveries per 100,000 EMS emergency activations each year overall, and for each census division. The interruption modeled was the enactment of stay-at-home orders, with March 25-31 selected as when most orders had been enacted. We fit ordinary least squares regression models with Newey-West standard errors to adjust for autocorrelation, testing for a change in level and slope overall and by census division.

Results

A total of 10,778 out-of-hospital deliveries were included, 58% (n = 6,254) in 2020. The mean weekly rate of out-of-hospital deliveries in 2019 was 29.4 per 100,000 activations (95% CI: 28.4 to 30.4) versus 33.0 (95% CI: 31.8 to 34.1) in 2020. There was an immediate increase of 6.3 deliveries per 100,000 activations (95% CI: 3.3 to 9.3) after the week of March 25-31, with a subsequent decrease of 0.3 deliveries per 100,000 per week after (95% CI: −0.4 to −0.2). There were also statistically significant immediate increases in out-of-hospital deliveries after March 25-31 in the New England, East North Central, West South Central, and Mountain divisions.

Conclusion

EMS-attended out-of-hospital deliveries remained rare during the COVID-19 pandemic, but there was an immediate increase during the initial wave of the pandemic with evidence of geographic variation. Large-scale disruptions in the health care system may result in increases in uncommon patient presentations to EMS.

Acknowledgments

The content reproduced from the NEMSIS Database remains the property of the National Highway Traffic Safety Administration. The National Highway Traffic Safety Administration is not responsible for any claims arising from works based on the original data, text, tables, or figures.

Availability of Data and Materials

The dataset supporting the conclusions of this article is available from the National Emergency Medical Services Information System Technical Assistance Center (https://nemsis.org) through a data request process.

Disclosure Statement

No potential conflict of interest was reported by the authors.

Prior Presentations

An abstract of this work was presented at the 2022 National Association of EMS Physicians Annual Meeting (San Diego, CA; January 12-15, 2022).

Additional information

Funding

This work was supported by the Emergency Medicine Foundation and National Association of EMS Physicians.