Abstract
BackgroundCOVID-19 has overwhelmed health services across the world; its global death toll has exceeded 5.3 million and continues to grow. There have been almost 15 million cases of COVID-19 in the UK. The need for rapid accurate identification, appropriate clinical care and decision making, remains a priority for UK ambulance service. To support identification and conveyance decisions of patients presenting with COVID-19 symptoms the Scottish Ambulance Service introduced the revised Medical Priority Dispatch System Protocol 36, enhanced physician led decision support and prehospital clinical guidelines. This study aimed to characterise the impact of these changes on the pathways and outcomes of people attended by the SAS) with potential COVID-19.MethodsA retrospective record linkage cohort study using National Data collected from NHS Scotland over a 5 month period (April–August 2020).ResultsThe SAS responded to 214,082 emergency calls during the study time period. The positive predictive value of the Protocol 36 to identify potentially COVID-19 positive patients was low (17%). Approximately 60% of those identified by Protocol 36 as potentially COVID-19 positive were conveyed. The relationship between conveyance and mortality differed between Protocol 36 Covid-19 positive calls and those that were not. In those identified by Protocol 36 as Covid-19 negative, 30 day mortality was higher in those not conveyed (not conveyed 9.2%; conveyed 6.6%) but in the Protocol 36 Covid-19 positive calls, mortality was higher in those conveyed (not conveyed 4.3% conveyed 8.8%). Thirty-day mortality rates of those with COVID-19 diagnosed through virology was between 28.8 and 30.2%.ConclusionThe low positive predictive value (17%) of Protocol 36 in identifying potential COVID-19 in patients emphasises the importance of ambulance clinicians approaching each call as involving COVID-19, reinforcing the importance of adhering to existing policy and continued use of PPE at all calls. The non-conveyance rate of people that were categorised as COVID-19 negative was higher than in the preceding year in the same service. The reasons for the higher rates of non-conveyance and the relationship between non conveyance rates and death at 3 and 30 days post index call are unknown and would benefit from further study.
Highlights
COVID-19 has overwhelmed health services across the world; its global death toll has exceeded 5.3 million and continues to grow [1]
Cases were identified as calls to the Scottish Ambulance Service coded by the Medical Priority Dispatch System (MPDS) Protocol 36, which indicates the presence of COVID-19 symptoms
Clinical characteristics and mortality rates of patient‐calls sub‐grouped by Protocol 36 COVID‐19 status and subsequent virology test status Table 2 shows the clinical characteristics and mortality rates for patient-calls sub-grouped by Protocol 36
Summary
COVID-19 has overwhelmed health services across the world; its global death toll has exceeded 5.3 million and continues to grow [1]. The need for rapid and accurate identification, enhanced by proactive approaches to the development of appropriate care and decision making, remains a priority. Ensuring timely allocation of ambulances and subsequent conveyance decisions based on clinical acuity has been a longstanding challenge for ambulance services [5]. These challenges have been amplified during COVID19, when ambulance services have found themselves under periods of intense pressure whilst trying to match resource with demand [6]. The need for rapid accurate identification, appropriate clinical care and decision making, remains a priority for UK ambulance service. This study aimed to characterise the impact of these changes on the pathways and outcomes of people attended by the SAS) with potential COVID-19
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