Abstract
The purpose of this retrospective observational study was to identify the impact of COVID-19 on emergency medical services (EMS) processing times and transfers to the emergency department (ED) among patients with acute stroke symptoms before and during the COVID-19 pandemic in Busan, South Korea. The total number of patients using EMS for acute stroke symptoms decreased by 8.2% from 1570 in the pre-COVID-19 period to 1441 during the COVID-19 period. The median (interquartile range) EMS processing time was 29.0 (23–37) min in the pre-COVID-19 period and 33.0 (25–41) minutes in the COVID-19 period (p < 0.001). There was a significant decrease in the number of patients transferred to an ED with a comprehensive stroke center (CSC) (6.37%, p < 0.001) and an increase in the number of patients transferred to two EDs nearby (2.77%, p = 0.018; 3.22%, p < 0.001). During the COVID-19 pandemic, EMS processing time increased. The number of patients transferred to ED with CSC was significantly reduced and dispersed. COVID-19 appears to have affected the stroke chain of survival by hindering entry into EDs with stroke centers, the gateway for acute stroke patients.
Highlights
Academic Editor: Roland BingisserEarly recognition of the symptoms of acute stroke and admitting a patient to a capable stroke center within the golden hour are closely related to a patient’s outcomes and are highly emphasized [1]
This study presents the changes in emergency medical services (EMS) processing times and transfers to emergency department (ED) for adult patients with acute stroke symptoms who used EMS before and during the COVID-19 pandemic in Busan, South Korea
The total number of patients using EMS amid COVID-19 declined by 8.2% compared to the pre-COVID-19 period, and the ED processing time was delayed by four minutes
Summary
Recognition of the symptoms of acute stroke and admitting a patient to a capable stroke center within the golden hour are closely related to a patient’s outcomes and are highly emphasized [1]. This series of steps—the recognition of stroke signs and symptoms, the activation of emergency medical services (EMS), prompt transport and prehospital notification to a stroke center, immediate emergency department (ED) triage and evaluation, diagnosis and decision about appropriate therapy, and administration of appropriate drugs or other interventions—is called the stroke chain of survival [2]. The use of EMS by a patient and transport to an ED with a stroke center by EMS providers can be important factors influencing the treatment outcomes of patients with acute stroke symptoms
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