Emergency Medical Services Incidents Research Articles

Dispatch Categories as Indicators of Out-of-Hospital Time Critical Interventions and Associated Emergency Department Outcomes

Objectives Emergency medical services (EMS) systems increasingly grapple with rising call volumes and workforce shortages, forcing systems to decide which responses may be delayed. Limited research has linked dispatch codes, on-scene findings, and emergency department (ED) outcomes. This study evaluated the association between dispatch categorizations and time-critical EMS responses defined by prehospital interventions and ED outcomes. Secondarily, we proposed a framework for identifying dispatch categorizations that are safe or unsafe to hold in queue. Methods This retrospective, multi-center analysis encompassed all 9-1-1 responses from 8 accredited EMS systems between 1/1/2021 and 06/30/2023, utilizing the Medical Priority Dispatch System (MPDS). Independent variables included MPDS Protocol numbers and Determinant levels. EMS treatments and ED diagnoses/dispositions were categorized as time-critical using a multi-round consensus survey. The primary outcome was the proportion of EMS responses categorized as time-critical. A non-parametric test for trend was used to assess the proportion of time-critical responses Determinant levels. Based on group consensus, Protocol/Determinant level combinations with at least 120 responses (∼1 per week) were further categorized as safe to hold in queue (<1% time-critical intervention by EMS and <5% time-critical ED outcome) or unsafe to hold in queue (>10% time-critical intervention by EMS or >10% time-critical ED outcome). Results Of 1,715,612 EMS incidents, 6% (109,250) involved a time-critical EMS intervention. Among EMS transports with linked outcome data (543,883), 12% had time-critical ED outcomes. The proportion of time-critical EMS interventions increased with Determinant level (OMEGA: 1%, ECHO: 38%, p-trend < 0.01) as did time-critical ED outcomes (OMEGA: 3%, ECHO: 31%, p-trend < 0.01). Of 162 unique Protocols/Determinants with at least 120 uses, 30 met criteria for safe to hold in queue, accounting for 8% (142,067) of incidents. Meanwhile, 72 Protocols/Determinants met criteria for unsafe to hold, accounting for 52% (883,683) of incidents. Seven of 32 ALPHA level Protocols and 3/17 OMEGA level Protocols met the proposed criteria for unsafe to hold in queue. Conclusions In general, Determinant levels aligned with time-critical responses; however, a notable minority of lower acuity Determinant level Protocols met criteria for unsafe to hold. This suggests a more nuanced approach to dispatch prioritization, considering both Protocol and Determinant level factors.

Abstract WP89: National Assessment of Key Prehospital Stroke Care Practices and Their Association to Patient Characteristics

Background: Emergency medical service (EMS) clinicians provide time-sensitive care for patients with suspected stroke. While model evidence-based guidelines (EBG) exist, there is limited research on national adoption. Our objectives were to describe nationwide care delivery for suspected stroke patients and measure associations between guideline-compliant stroke care (GCSC) and patient characteristics. Methods: This retrospective analysis of the 2022 national ImageTrend Collaborate dataset evaluated 9-1-1 transported EMS incidents with primary impression of stroke. Included are advanced life support agencies with &gt;6 annual strokes. Key components of GCSC from the National Model EMS Clinical Guidelines include documented stroke screen, 12-lead electrocardiogram, blood glucose (BG), onset time/last known well (LKW/Onset), pre-alert hospital notification, and scene time &lt;15 minutes. Provision of GCSC was defined as providing at least five of the six components above. Multivariable logistic regression(OR,95%CI) used to describe the odds of GCSC adjusted for race/ethnicity, gender, and urbanicity. Results: In 2022, 43,555 events met inclusion criteria. Patients were commonly White (70.5%), female (52.3%), and with a median age 73 (IQR:62, 82). Most were in urban areas (88.2%) and had a dispatch complaint of stroke (56.1%). Key components of GCSC had varying degrees of compliance: stroke assessment (83.9%), LKW/Onset (93.7%), BG (85.1%), 12-lead (42.3%), pre-alert (58.7%) and on-scene time &lt;15 minutes (58.9%). At least five components were completed in 43.0% of patients, and only 10.0% had all six. Adjusted odds of GCSC were higher for males (1.12,1.08-1.17), lower for Black/African American patients (0.71,0.67-0.76; referent: White), and lower for suburban and rural areas (0.52,0.48-0.56; 0.39,0.32-0.47; referent: urban). Conclusion: Prehospital GCSC delivery in the United States varies widely even with EBG’s providing a standardized approach. Variations in care are associated with gender, race, and urbanicity. Our results may be limited by reporting bias in the medical record. Future efforts may focus on agency-level implementation and documentation of these criteria to improve patient-based outcomes.

Hourly Associations between Heat Index and Heat-Related Emergency Medical Service (EMS) Calls in Austin-Travis County, Texas.

This paper aims to investigate the following research questions: (1) what are the hourly patterns of heat index and heat-related emergency medical service (EMS) incidents during summertime?; and (2) how do the lagged effects of heat intensity and hourly excess heat (HEH) vary by heat-related symptoms? Using the hourly weather and heat-related EMS call data in Austin-Travis County, Texas, this paper reveals the relationship between heat index patterns on an hourly basis and heat-related health issues and evaluates the immediate health effects of extreme heat events by utilizing a distributed lag non-linear model (DLNM). Delving into the heat index intensity and HEH, our findings suggest that higher heat intensity has immediate, short-term lagged effects on all causes of heat-related EMS incidents, including in cardiovascular, respiratory, neurological, and non-severe cases, while its relative risk (RR) varies by time. HEH also shows a short-term cumulative lagged effect within 5 h in all-cause, cardiovascular, and non-severe symptoms, while there are no statistically significant RRs found for respiratory and neurological cases in the short term. Our findings could be a reference for policymakers when devoting resources, developing extreme heat warning standards, and optimizing local EMS services, providing data-driven evidence for the effective deployment of ambulances.

Does Housing Status Matter in Emergency Medical Services Administration of Naloxone? A Prehospital Cross-sectional Study.

Introduction: Persons experiencing homelessness (PEH) use emergency medical services (EMS) at disproportionately high rates relative to housed individuals due to several factors including disparate access to healthcare. Limited access to care is compounded by higher rates of substance use in PEH. Despite growing attention to the opioid epidemic and housing crisis, differences in EMS naloxone administration by housing status has not been systematically examined. Our objective in this study was to describe EMS administration of naloxone by housing status in the City of Los Angeles. Methods: This was a 12-month retrospective, cross-sectional analysis of electronic patient care reports (ePCRs) for all 9-1-1 EMS incidents attended by the Los Angeles Fire Department (LAFD), the sole EMS agency for the City of Los Angeles during the study period, January-December 2018. During this time, the City had a population of 3,949,776 with an estimated 31,825 (0.8%) PEH. We included in the study individuals to whom LAFD responders had administered naloxone. Housing status is a mandatory field on ePCRs. The primary study outcome was the incidence of EMS naloxone administration by housing status. We used descriptive statistics and logistic regression models to examine patterns by key covariates. Results: There were 345,190 EMS incidents during the study period. Naloxone was administered during 2,428 incidents. Of those incidents 608 (25%) involved PEH, and 1,820 (75%) involved housed individuals. Naloxone administration occurred at a rate of 19 per 1,000 PEH, roughly 44 times the rate of housed individuals. A logistic regression model showed that PEH remained 2.38 times more likely to receive naloxone than their housed counterparts, after adjusting for gender, age, and respiratory depression (odds ratio 2.38, 95% confidence interval 2.15-2.64). The most common impressions recorded by the EMS responders who administered naloxone were the same for both groups: overdose; altered level of consciousness; and cardiac arrest. Persons experiencing homelessness who received naloxone were more likely to be male (82% vs 67%) and younger (41.4 vs 46.2years) than housed individuals. Conclusion: In the City of Los Angeles, PEH are more likely to receive EMS-administered naloxone than their housed peers even after adjusting for other factors. Future research is needed to understand outcomes and improve care pathways for patients confronting homelessness and opioid use.

Emergency Medical Service responses as latent social capital toward Deliberate Self-Harm, Suicidality and Suicide

ABSTRACT Escalation in Deliberate Self-Harm (DSH) is indicative of a rise in poor mental health and/or a failure of social and health services. The phenomenon of DSH exacerbates mental illness sequela, while being an essential indicator of suicide risk. Globally, about 800 000 people commit suicide yearly, averaging almost one suicide every 40 s. Based on a Retrospective Cross-Sectional Study, the aim sought to establish the scope of the DSH, suicidality and suicide case-load from a Western Cape Emergency Medical Services (EMS) prehospital perspective. A census of 3 years of EMS Incident Management Records (IMR) from a large rural district with seven local municipalities was undertaken using a novel data collection instrument. The 2976 (N) mental health-related incidents that met the inclusion criteria (from 413 712 cases) suggest a presentation rate of 7 per 1000 EMS calls. Sixty percent (n = 1776) were regarded to have deliberately self-harmed, attempted suicide or committed suicide. Overdose/deliberate self-poisoning accounted for 52% (n = 1550) of all the DSH caseload of the study. Attempted suicide accounted for 2.7% (n = 83) and Suicide for 3.4% (n = 102) of the suicidality case-load from the study, respectively. Suicide averaged 2.8. suicides per month in the Garden Route District over the 3-year period. Men were five times more likely to commit suicide than women, commonly using strangulation, while women mostly ingested household detergents and poison, and overdosed on chronic medication. Understandably, the EMS needs to assess its own capability to respond, treat, and transport health-care users with DSH and suicidality. This study demonstrates the EMS ‘everyday’ exposure to DSH, suicidality and suicide case-load. It represents a critical first step in the problem-space definition upon which a determination of the need for EMS responses can be based, to interrupt suicidality by removing methods of harm and strengthening the mental health economy through social capital investment.

The Epidemiology of Pre-Hospital EMS Treatment of Geriatric Patients in the City of Vienna-An Overview.

Background: The city of Vienna, Austria, has a gradually aging population. Elderly people, over 65 years old and living at home or in nursing homes, frequently use Emergency Medical Services (EMS). However, there is no previous data comparing the EMS utilization of elderly- and non-elderly patients in Vienna. Methods: We retrospectively analyzed all EMS incidents in Vienna from 2012 to 2019. Transport- and emergency physician treatment rates, annual fluctuations, and the number of non-transports were compared between elderly (≥65 years) and non-elderly (18−64 years) patients. Results: Elderly people accounted for 42.6% of the total EMS responses in adult patients, representing an annual response rate of 223 per 1000 inhabitants ≥ 65 years. Compared to 76 per 1000 inhabitants in patients 18−64 years old, this results in an incidence rate ratio (IRR) of 2.93 [2.92−2.94]. Elderly people were more likely (OR 1.68 [1.65−1.70]) to need emergency physicians, compared to 18−64 year-olds. Nursing home residents were twice (OR 2.11 [2.06−2.17]) as likely to need emergency physicians than the rest of the study group. Non-transports were more likely to occur in patients over 65 years than in non-elderlies (14% vs. 12%, p < 0.001). Conclusions: The elderly population ≥ 65 years in Vienna shows higher EMS response rates than younger adults. They need emergency physicians more often, especially when residing in nursing homes. The economical and organizational strain this puts on the emergency response system should trigger further research and the development of solutions, such as specific response units dedicated to elderly people.

Abstract 122: The Impact Of The Covid-19 Pandemic On The Incidence Of Ems Treated Out-of-hospital Cardiac Arrest Patients And The Incidence Of Bystander Cardiopulmonary Resuscitation (cpr); A World-wide Perspective

Introduction: Survival after OHCA is dependent on early recognition, early cardiopulmonary resuscitation (CPR) and early defibrillation. The purpose of CPR is to maintain some blood flow until the arrival of the emergency medical services (EMS). Our concern was that the Covid-19 pandemic would have a negative effect on the number of patients who got CPR before EMS arrival. The aim of this study is to compare the incidence of EMS treated patients and the incidence of bystander CPR during the pandemic with data from before the pandemic. Method: This is a retrospective cohort study using data from existing cardiac arrest registries. The participants are from 24 countries, where Australia and USA have four regions each, resulting in 30 individual participants. All participating registries share aggregated data from 2017 to 2020, and results from before and after lockdown is compared. Poisson regression was used to look at differences. Results: Preliminary results from 14 registries show that the incidence of EMS treated patients per 100.000 inhabitants was statistically increased in five registries, decreased in three registries, and had no statistical difference in six registries. The incidence of bystander CPR was statistically higher after lockdown in five registries, decreased in one registry and was unchanged in eight registries. Four regions had an increase in both incidence of EMS treated patients and the incidence of bystander CPR. Conclusion: Bystanders willingness to perform CPR seems unchanged by the Covid-19 pandemic.

Evaluating the effects of heat vulnerability on heat-related emergency medical service incidents: Lessons from Austin, Texas

Extreme heat exposure and sensitivity have been a growing concern in urban regions as the effects of extreme heat pose a threat to public health, the water supply, and the infrastructure. Heat-related illnesses demand an immediate Emergency Medical Service (EMS) response since they might result in death or serious disability if not treated quickly. Despite increased concerns about urban heat waves and relevant health issues, a limited amount of research has investigated the effects of heat vulnerability on heat-related illnesses. This study explores the geographical distribution of heat vulnerability in the city of Austin and Travis County areas of Texas and identifies neighborhoods with a high degree of heat vulnerability and restricted EMS accessibility. We conducted negative binomial regressions to investigate the effects of heat vulnerability on heat-related EMS incidents. Heat-related EMS calls have increased in neighborhoods with more impervious surfaces, Hispanics, those receiving social benefits, people living alone, and the elderly. Higher urban capacity, including efficient road networks, water areas, and green spaces, is likely to reduce heat-related EMS incidents. This study provides data-driven evidence to help planners prioritize vulnerable locations and concentrate local efforts on addressing heat-related health concerns.

Prevalence and correlates of incarceration following emergency medical services response to overdose

BackgroundTo describe the prevalence of incarceration among survivors of non-fatal overdose addressed through an emergency medical services (EMS) response, and compare incarceration by whether the emergency was for opioid-involved or stimulant-involved overdose. MethodsAdministrative records on 192,113 EMS incidents and 70,409 jail booking events occurring between January 1, 2019 and December 31, 2020 in Indianapolis, Indiana were record-linked at the event level. Incarceration taking place within 6-hours of an EMS incident was associated with that incident. Logistic regression was used to calculate adjusted odds ratios (AOR) of incarceration after an overdose. ResultsAmong all EMS incidents, 2.6% were followed by incarceration. For overdose EMS incidents, the prevalence of incarceration was 10.0%. Overdose incidents had higher odds than non-overdose incidents of leading to a charge of felony, booked on a warrant, and transferred to another law enforcement agency upon release. Prevalence of incarceration following a stimulant-involved overdose was 21.3%, compared to 9.3% for opioid-involved overdose survivors. Compared to persons from other EMS incidents, overdose survivors had greater odds of incarceration (AOR=3.48, 95% confidence interval (CI)= 3.22, 3.75, p < .001), with opioid-involved overdoses (AOR=3.03, 95% CI=2.76, 3.33, p < .001) and stimulant-involved overdoses (AOR=6.70, 95% CI=5.26, 8.55, p < .001) leading to higher odds of incarceration. ConclusionIncarceration in county jail followed one in ten overdose-involved EMS responses. As illicit drug consumption increasingly involves stimulants, the frequency of incarceration following these events is likely to increase. Policy changes and interventions are needed to reduce incarceration after overdose emergencies.

Stimulant-related incident surveillance using emergency medical service records in Massachusetts, 2013–2020.

BackgroundAs stimulant use increases across the United States, emergency medical services (EMS) are crucial touchpoints in the health care system. To better measure the prevalence of stimulant use, misuse, and EMS incidents related to stimulant intoxication, definitions for stimulant-related incidents (SRIs) are needed. MethodsWe used the Massachusetts Ambulance Trip Record Information System (MATRIS) from 2013 to 2020 to develop definitions of stimulant-related incidents. EMS runs reported to MATRIS were categorized based on stimulant-related words and symptoms. The three tiers were “any stimulant use” (class 1), “problematic stimulant use” (class 2), and “acute stimulant-related incidents” (class 3). A group of four reviewers studied over 650 cases in eight rounds to refine the search terms, achieving definitions with a correct characterization of over 80% of cases that the code selected. ResultsSRI definitions were applied against all EMS runs within Massachusetts between 2013 and 2020 (n = 6,584,836 runs). Of these, 43,538 (0.7%) met the class 1 definition, 38,669 (0.6%) met the class 2 definition, and 19,157 (0.3%) met the class 3 definition. Incidents at all tiers of severity increased over time and were more likely to occur among younger adults and males. Race and ethnicity data indicated that Hispanic/Latinx and Black non-Hispanic/non-Latinx residents formed a disproportionately large percentage of SRIs relative to their total percentage of EMS runs. ConclusionsThe prevalence of all three tiers of SRIs are increasing in Massachusetts, and this protocol provides a source of administrative data on stimulant use that complements sources such as hospital, treatment-based, and/or prescribing records.

Differences in Out-of-Hospital Cardiac Arrest Management and Outcomes across Urban, Suburban, and Rural Settings

Background Rural prehospital care settings are underrepresented in the out-of-hospital cardiac arrest (OHCA) literature. This study aimed to describe treatment patterns and the odds of a favorable patient outcome (e.g., return of spontaneous circulation (ROSC) or being presumptively alive at the end of the incident) among rural OHCA patients in the U.S. Methods Using the 2018 National Emergency Medical Services Informational System (NEMSIS) dataset, we analyzed OHCA incidents where an emergency medical services (EMS) unit provided cardiopulmonary resuscitation (CPR) and either terminated the resuscitation or completed transport. We excluded traumatic injuries, pediatric patients, and incidents with response time >60 minutes. The primary outcome was ROSC at any time during the EMS incident. The secondary outcome was a binary end-of-event indicator previously described for use in NEMSIS to estimate longer-term outcomes. Multivariable logistic regression was performed for each outcome measure comparing rural, suburban, and urban settings while controlling for key factors. Results A total of 64,489 OHCA incidents were included, with 5,601 (8.9%) in rural settings. Among the full sample of OHCA incidents, ROSC was achieved in 20,578 (33.6%) cases, including 29.2% in rural settings and 34.1% in urban or suburban settings (p < 0.001). Advanced life support units responded to 95.3% of all calls, and a greater proportion of rural OHCA incidents were managed by basic life support units (7.4% vs. 4.2%, p < 0.001). Rural OHCA incidents had longer response times (7.5 vs. 5.9 minutes, p < 0.001), and rural patients were less likely to receive epinephrine (69.3% vs. 73.3%, p < 0.001). Further, EMS clinicians in rural areas were more likely to use mechanical CPR (29.5% vs. 27.6%, p < 0.01) and were less likely to perform advanced airway management (48.5% vs. 54.2%, p < 0.001). Rural patients had lower odds of achieving ROSC than urban patients after controlling for other factors (OR 0.81, 95% CI: 0.75–0.87). Rural patients also had lower odds of having a positive end-of-event outcome (i.e., presumptively alive) after controlling for other factors (OR 0.86, 95% CI: 0.79–0.93). Conclusion In this national sample of EMS-treated OHCAs, rural patients had lower odds of a favorable outcome (e.g., ROSC or presumptively alive) compared to those in urban settings.

Effects of Urban Landscape and Sociodemographic Characteristics on Heat-Related Health Using Emergency Medical Service Incidents.

It is well known that extremely hot weather causes heat-related health issues. Health problems, especially in urban areas, are becoming increasingly important due to urban heat island effect. Understanding the impact of neighborhood characteristics is important for research into the relationship between thermal environment and human health. The objectives of this study were to explore the urban landscape and sociodemographic characteristics affecting heat-related health and identify spatial inequalities for vulnerable groups. A total of 27,807 heat-related EMS incidents were used at the census block group level (N = 285). We used land cover database and Landsat satellite images for urban landscape variables and used 2019 U.S. Census data for sociodemographic variables. Negative binomial regression was used to identify the neighborhood variables associated with the heat-related EMS incidents in each block group. Heat-related health has been alleviated in block groups with high green areas. However, the negative effects of thermal environments on human health were higher in areas with a high percentage of impervious surface, over 65 years, non-white people, no high school diploma, or unemployment. The results indicate that heat-related health problems can be addressed through prevention strategies for block group variables. Local intervention efforts to solve health issues should be targeted at more vulnerable areas and groups.

Predicting Covid-19 emergency medical service incidents from daily hospitalisation trends.

The aim of our retrospective study was to quantify the impact of Covid-19 on the temporal distribution of emergency medical services (EMS) demand in Travis County, Austin, Texas and propose a robust model to forecast Covid-19 EMS incidents. We analysed the temporal distribution of EMS calls in the Austin-Travis County area between 1 January 2019 and 31 December 2020. Change point detection was performed to identify the critical dates marking changes in EMS call distributions, and time series regression was applied for forecasting Covid-19 EMS incidents. Two critical dates marked the impact of Covid-19 on the distribution of EMS calls: March 17th, when the daily number of non-pandemic EMS incidents dropped significantly, and 13 May, by which the daily number of EMS calls climbed back to 75% of the number in pre-Covid-19 time. The new daily count of the hospitalisation of Covid-19 patients alone proves a powerful predictor of the number of pandemic EMS calls, with an r2 value equal to 0.85. In particular, for every 2.5 cases, where EMS takes a Covid-19 patient to a hospital, one person is admitted. The mean daily number of non-pandemic EMS demand was significantly less than the period before the Covid-19 pandemic. The number of EMS calls for Covid-19 symptoms can be predicted from the daily new hospitalisation of Covid-19 patients. These findings may be of interest to EMS departments as they plan for future pandemics, including the ability to predict pandemic-related calls in an effort to adjust a targeted response.

Clinical, Operational, and Socioeconomic Analysis of EMS Bypass of the Closest Facility for Pediatric Asthma Patients

IntroductionPediatric hospital care is becoming increasingly regionalized, with fewer facilities providing inpatient care for common conditions such as asthma. That trend has major implications for emergency medical services (EMS) medical care and operations because EMS historically transports patients to the closest facility. This study describes EMS transport patterns of pediatric asthma patients in greater depth, including an analysis of facility bypass rates and the association of bypass with demographics and clinical outcomes.MethodsThis was a retrospective study of pediatric asthma patients ages 2–18 years transported by Lee County, FL EMS between March 1, 2018 – December 31, 2019. A priori, we defined bypass as greater than five minutes extra transport time. We performed geospatial analysis and mapping of EMS pediatric asthma encounters. We used the Pediatric Destination Tree (PDTree) project’s tiered approach to characterize receiving hospital facility pediatric capability. We analyzed incidence and characteristics of bypass, and bypass and non-bypass patient characteristics including demographics, emergency department (ED) clinical outcomes, and socioeconomic disadvantage (SED).ResultsFrom the study period, there were a total of 262 encounters meeting inclusion criteria, 254 (96.9%) of which could be geocoded to EMS incident and destination locations. Most encounters (72.8%) bypassed at least one facility, and the average number of facilities bypassed per encounter was 1.52. For all 185 bypass encounters, there was a median additional travel time of 13.5 minutes (interquartile range 7.5 – 17.5). Using the PDTree’s classification of pediatric capability of destination facilities, 172 of the 185 bypasses (93%) went to a Level I facility. Bypass incidence varied significantly by age, but not by minority status, asthma severity, or by the area deprivation index of the patient’s home address. Overall, the highest concentrations of EMS incidents tended to occur in areas of greater SED. With regard to ED outcomes, ED length of stay did not vary between bypass and non-bypass patients (P = 0.54), and neither did hospitalization (P = 0.80).ConclusionWe found high rates of bypass for pediatric EMS encounters for asthma exacerbations, and that bypass frequency was significantly higher in younger age groups. With national trends pointing toward increasing pediatric healthcare regionalization, bypass has significant implications for EMS operations.

The impact of COVID-19 on statewide EMS use for cardiac emergencies and stroke in Massachusetts.

ObjectiveTo evaluate the impact of coronavirus disease 2019 (COVID‐19) on emergency medical services (EMS) use for time‐sensitive medical conditions. We examined EMS use for cardiac arrest, stroke, and other cardiac emergencies across Massachusetts during the peak of the COVID‐19 pandemic, evaluating their relationship to statewide COVID‐19 incidence and a statewide emergency declaration.MethodsA retrospective analysis of all EMS calls between February 15 and May 15, 2020 and the same time period for 2019. EMS call volumes were compared before and after March 10, the date of a statewide emergency declaration.ResultsA total of 408,758 calls were analyzed, of which 49,405 (12.1%) represented stroke, cardiac arrest, or other cardiac emergencies. Average call volume before March 10 was similar in both years but decreased significantly after March 10, 2020 by 18.7% (P < 0.001). Compared to 2019, there were 35.6% fewer calls for cardiac emergencies after March 10, 2020 (153.6 vs 238.4 calls/day, P < 0.001) and 12.3% fewer calls for stroke (40.0 vs 45.6 calls/day, P = 0.04). Calls for cardiac arrest increased 18.2% (28.6 vs 24.2 calls/day, P < 0.001). Calls for respiratory concerns also increased (208.8 vs 199.7 calls/day, P < 0.001). There was no significant association between statewide incidence of COVID‐19 and EMS call volume.ConclusionsEMS use for certain time‐sensitive conditions decreased after a statewide emergency declaration, irrespective of actual COVID‐19 incidence, suggesting the decrease was related to perception instead of actual case counts. These findings have implications for public health messaging. Measures must be taken to clearly inform the public that immediate emergency care for time‐sensitive conditions remains imperative.

Abstract 247: Cardiac Arrest Management in Rural Prehospital Care

Introduction: Rural prehospital care settings are underrepresented in the out-of-hospital cardiac arrest (OHCA) literature. We analyzed a nationwide database of emergency medical services (EMS) incidents in the US to describe treatment patterns and the odds of return of spontaneous circulation (ROSC) among rural OHCA patients. Methods: Using the 2018 National EMS Informational System dataset, we analyzed OHCA incidents where CPR provided by EMS was documented. We excluded incidents in which trauma was involved, patient age &lt;18 years, transport was not by completed by an advanced life support unit, or response time &gt;60 minutes. The primary outcome was ROSC during the EMS incident. Multivariable logistic regression was performed comparing rural, suburban, and urban settings while controlling for age and gender, incident location type, response time, CPR prior to EMS arrival, arrest witnessed by EMS, initial rhythm, epinephrine administration, mechanical CPR, and advanced airway used. Results: A total of 60,281 OHCA incidents were identified for inclusion, including 5,013 (8.6%) in rural settings. Rural OHCA patients achieved ROSC in 28.8% of cases, compared to 33.0% in urban or suburban settings (p&lt;0.001). Neither age nor gender significantly differed between settings (Table 1). Rural OHCA incidents had greater response times (7.5 vs. 5.9 minutes, p&lt;0.001) and were less likely to receive epinephrine (71.6% vs. 74.9%, p&lt;0.001). Further, EMS were more likely to use mechanical CPR (29.8% vs. 28.1%, p=0.01) and less likely to provide an advanced airway (56.3% vs. 50.5%, p&lt;0.001) for rural OHCA. On multivariable logistic regression, rural OHCA patients had lower odds of achieving ROSC than urban OHCA patients after controlling for other factors (0.80, 95%CI: 0.75-0.86). Conclusion: In this national sample of EMS-treated OHCA, rural patients were less likely to achieve ROSC than patients in urban or suburban settings.

Effects of social vulnerability and heat index on emergency medical service incidents in San Antonio, Texas, in 2018

BackgroundExcessive heat is a leading weather-related cause of fatalities in the USA. Vulnerable populations can face greater exposure to health risks during extreme heat events. The aim of this study...

Effect of the Coronavirus Disease 2019 (COVID-19) Pandemic on the U.S. Emergency Medical Services System: A Preliminary Report.

BackgroundOur objective was to quantify trends in emergency medical services (EMS) incidents as the effects of the COVID‐19 pandemic spread across the United States and to determine if there was an increase in EMS‐attended deaths.MethodsWe conducted a 3‐year comparative retrospective cohort analysis of data from the National EMS Information System. Data were included if care was provided between the 40th and 21st weeks of the next year and compared over 3 years. We included incidents identified through 9‐1‐1 where patient contact was made. The total number of EMS incidents per week was used as the denominator to calculate the rate of patient deaths and possible injury. We assessed for temporal and seasonal trends.ResultsStarting in the 10th week of 2020 there was a decrease in the number of EMS activations in the United States compared to the prior weeks and the same time period in previous years. The number of activations between week 10 and week 16 decreased by 140,292 or 26.1%. The portion of EMS activations reporting a patient disposition of death nearly doubled between the 11th and 15th weeks of 2020 (1.49%–2.77% of all activations). The number of EMS activations documenting a possible injury decreased from 18.43% to 15.27% between weeks 10 and 13.ConclusionWe found that early in the COVID‐19 outbreak there was a significant decrease in the number of EMS responses across the United States. Simultaneously the rate of EMS‐attended death doubled, while the rate of injuries decreased.

Dynamic Floating Stations Model for Emergency Medical Services with a Consideration of Traffic Data

To equally distribute the workload and minimize the travel distance for fire departments, we developed a new dynamic floating stations model (DFSM) to target traffic-related emergency medical services (EMS) during peak hours. This study revealed that traffic-related EMS incidents have different characteristics to other EMS incidents. The number of floating stations was determined by the number of available ambulances at a given time. The optimum floating station location was identified by using the given capacity to establish the smallest service radius. In DFSM simulations using floating stations with a capacity of 100 and 150 EMS incidents, the result shows significant improvements in comparison to the current situation.

Out-of-hospital cardiac arrest across the World: First report from the International Liaison Committee on Resuscitation (ILCOR)

BackgroundSince development of the Utstein style recommendations for the uniform reporting of cardiac arrest, increasing numbers of national and regional out-of-hospital cardiac arrest (OHCA) registries have been established worldwide. The International Liaison Committee on Resuscitation (ILCOR) created the Research and Registries Working Group and aimed to systematically report data collected from these registries. MethodsWe conducted two surveys of voluntarily participating national and regional registries. The first survey aimed to identify which core elements of the current Utstein style for OHCA were collected by each registry. The second survey collected descriptive summary data from each registry. We chose the data collected for the second survey based on the availability of core elements identified by the first survey. ResultsSeven national and four regional registries were included in the first survey and nine national and seven regional registries in the second survey. The estimated annual incidence of emergency medical services (EMS)-treated OHCA was 30.0–97.1 individuals per 100,000 population. The combined data showed the median age varied from 64 to 79 years and more than half were male in all 16 registries. The provision of bystander cardiopulmonary resuscitation (CPR) and bystander automated external defibrillator (AED) use was 19.1–79.0% in all registries and 2.0–37.4% among 11 registries, respectively. Survival to hospital discharge or 30-day survival after EMS-treated OHCA was 3.1–20.4% across all registries. Favorable neurological outcome at hospital discharge or 30 days after EMS-treated OHCA was 2.8–18.2%. Survival to hospital discharge or 30-day survival after bystander-witnessed shockable OHCA ranged from 11.7% to 47.4% and favorable neurological outcome from 9.9% to 33.3%. ConclusionThis report from ILCOR describes data on systems of care and outcomes following OHCA from nine national and seven regional registries across the world. We found variation in reported survival outcomes and other core elements of the current Utstein style recommendations for OHCA across nations and regions.