Challenges and Complexities of Providing Emergency Medical Services During Covid-19 Pandemic in Nepal

Abstract

Introduction:During the Covid-19 Pandemic, the Department of Emergency Medicine is the one of most busy in Nepal. Challenges and complexities of providing emergency medical service during the waves of the Covid-19 pandemic in Nepal were analyzed.Method:Three years (2020 – 2022) of data was analyzed from Covid patients registered in Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine for reference with National Data of Ministry of Health and Population, Government of Nepal.Results:On November 15, 2022, there were 5,969,338 Covid PCR tests and 1,452,639 Covid Antigen tests in Nepal with 1,000,826 (16.8%) PCR, 152,197 (10.5%) being positive. The cure rate was 98.7% (988,316 cases). There were 12,019 mortalities with 1.2% case fatality. In TUTH 2020 – 2022 records; 3,794 total severe Covid-19 patients were admitted; In the first year, only two patients (1M:1F); In the second year 2,056 patients 1.8M:1F and in the third year 1,736 with 1.1M:1F. The age groups with the first wave vs the second wave were 6.42% vs 5.47% of 0-20 years; 24.22% vs 26.84% of 21-40 years; 30.57% vs 30.87 of 41-60 years and 38.57% vs 36.87% of above 60 years. The hospital mortality rate was 751 (19.8%). Challenges were due to resource limitation, limited PPE, scarcity of oxygen, medication, and ventilators. In TUTH, all levels of emergency management and various definite care were provided 24/7 hours in the pandemic period. There are a lot of challenges in Pre-Hospital Emergency Care Service due to a limited number of designated Advance Ambulances during transportation of severe Covid patients. With these challenges and complexities, there were six deaths of their own hospital staff due to severe Covid-19.Conclusion:The challenges and complexities of providing emergency medical services during the Covid-19 pandemic in Nepal have been overcome with teamwork and activation of the emergency care system in Nepal.