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Effect of the First Wave of the Belgian COVID-19 Pandemic on Physician-Provided Prehospital Critical Care in the City of Antwerp (Belgium)

Published online by Cambridge University Press:  22 November 2021

Tina Lavigne Open the ORCID record for Tina Lavigne [Opens in a new window] ,
Brecht De Tavernier ,
Niels Van Regenmortel ,
Wouter De Tavernier ,
Jan Christiaen ,
Ives Hubloue  and
Kurt Anseeuw
Tina Lavigne*
Affiliation:
Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Brussels, Belgium
Brecht De Tavernier
Affiliation:
Emergency Department, GZA Hospitals Campus Sint-Vincentius, Antwerp, Belgium
Niels Van Regenmortel
Affiliation:
Intensive Care Unit, ZNA Stuivenberg, Antwerp, Belgium
Wouter De Tavernier
Affiliation:
Emergency Department, GZA Hospitals Campus Sint-Vincentius, Antwerp, Belgium
Jan Christiaen
Affiliation:
Emergency Department, GZA Hospitals Campus Sint-Vincentius, Antwerp, Belgium
Ives Hubloue
Affiliation:
Emergency Department, University Hospital Brussels, Free University of Brussels, Brussels, Belgium
Kurt Anseeuw
Affiliation:
Emergency Department, ZNA Stuivenberg, Antwerp, Belgium
*
Correspondence: Tina Lavigne, MD Albrecht Rodenbachstraat 13 bus 4 2140 Borgerhout, Antwerp, Belgium E-mail: tinalavigne@gmail.com
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Abstract

Introduction:

There is evidence to suggest that patients delayed seeking urgent medical care during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. A delay in health-seeking behavior could increase the disease severity of patients in the prehospital setting. The combination of COVID-19-related missions and augmented disease severity in the prehospital environment could result in an increase in the number and severity of physician-staffed prehospital interventions, potentially putting a strain on this highly specialized service.

Study Objective:

The aim was to investigate if the COVID-19 pandemic influences the frequency of physician-staffed prehospital interventions, prehospital mortality, illness severity during prehospital interventions, and the distribution in the prehospital diagnoses.

Methods:

A retrospective, multicenter cohort study was conducted on prehospital charts from March 14, 2020 through April 30, 2020, compared to the same period in 2019, in an urban area. Recorded data included demographics, prehospital diagnosis, physiological parameters, mortality, and COVID-status. A modified National Health Service (NHS) National Early Warning Score (NEWS) was calculated for each intervention to assess for disease severity. Data were analyzed with univariate and descriptive statistics.

Results:

There was a 31% decrease in physician-staffed prehospital interventions during the period under investigation in 2020 as compared to 2019 (2019: 644 missions and 2020: 446 missions), with an increase in prehospital mortality (OR = 0.646; 95% CI, 0.435 – 0.959). During the study period, there was a marked decrease in the low and medium NEWS groups, respectively, with an OR of 1.366 (95% CI, 1.036 – 1.802) and 1.376 (0.987 – 1.920). A small increase was seen in the high NEWS group, with an OR of 0.804 (95% CI, 0.566 – 1.140); 2019: 80 (13.67%) and 2020: 69 (16.46%). With an overall decrease in cases in all diagnostic categories, a significant increase was observed for respiratory illness (31%; P = .004) and cardiac arrest (54%; P < .001), combined with a significant decrease for intoxications (-58%; P = .007). Due to the national test strategy at that time, a COVID-19 polymerase chain reaction (PCR) result was available in only 125 (30%) patients, of which 20 (16%) were positive.

Conclusion:

The frequency of physician-staffed prehospital interventions decreased significantly. There was a marked reduction in interventions for lower illness severity and an increase in higher illness severity and mortality. Further investigation is needed to fully understand the reasons for these changes.

Keywords

COVID-19Emergency Medical Servicespandemicphysician-led prehospital care
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 1 , February 2022 , pp. 12 - 18
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Feral-Pierssens, AL, Claret, PG, Chouihed, T. Collateral damage of the COVID-19 outbreak: expression of concern. Eur J Emerg Med. 2020;27(4):233–234.CrossRefGoogle ScholarPubMed
Giamello, JD, Abram, S, Bernardi, S, Lauria, G. The emergency department in the COVID-19 era. Who are we missing? Eur J Emerg Med. 2020;27(4):305–306.CrossRefGoogle ScholarPubMed
Hartnett, KP, Kite-Powell, A, DeVies, J, et al. Impact of the COVID-19 pandemic on emergency department visits - United States, January 1, 2019-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(23):699-704.CrossRefGoogle Scholar
Lange, SJ, Ritchey, MD, Goodman, AB, et al. Potential indirect effects of the COVID-19 pandemic on use of emergency departments for acute life-threatening conditions - United States, January-May 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):795–800.CrossRefGoogle ScholarPubMed
Stella, F, Alexopoulos, C, Scquizzato, T, Zorzi, A. Impact of the COVID-19 outbreak on emergency medical system missions and emergency department visits in the Venice area. Eur J Emerg Med. 2020;27(4):298–300.CrossRefGoogle ScholarPubMed
Baum, A, Schwartz, MD. Admissions to Veterans Affairs hospitals for emergency conditions during the COVID-19 Pandemic. JAMA. 2020;324(1):96–99.CrossRefGoogle ScholarPubMed
Casalino, E, Choquet, C, Bouzid, D, et al. Analysis of emergency department visits and hospital activity during influenza season, COVID-19 epidemic, and lockdown periods in view of managing a future disaster risk: a multicenter observational Study. Int J Environ Res Public Health. 2020;17(22):8302.CrossRefGoogle ScholarPubMed
Smith, GB, Prytherch, DR, Meredith, P, Schmidt, PE, Featherstone, PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013;84(4):465–470.CrossRefGoogle ScholarPubMed
Pirneskoski, J, Kuisma, M, Olkkola, KT, Nurmi, J. Prehospital National Early Warning Score predicts early mortality. Acta Anaesthesiol Scand. 2019;63(5):676–683.CrossRefGoogle ScholarPubMed
Penverne, Y, Jenvrin, J, Montassier, E. EMS dispatch center activity during the COVID-19 containment. Am J Emerg Med. 2020;S0735-6757(20):30678-30681.Google Scholar
Lapostolle, F, Goix, L, Vianu, I, et al. COVID-19 epidemic in the Seine-Saint-Denis Department of Greater Paris: one month and three waves for a tsunami. Eur J Emerg Med. 2020;27(4):274–278.CrossRefGoogle ScholarPubMed
Prezant, DJ, Lancet, EA, Zeig-Owens, R, et al. System impacts of the COVID-19 pandemic on New York City’s emergency medical services. J Am Coll Emerg Physicians Open. 2020;1(6):1205–1213.CrossRefGoogle ScholarPubMed
Lerner, EB, Newgard, CD, Mann, NC. Effect of the coronavirus disease 2019 (COVID-19) pandemic on the United States Emergency Medical Services system: a preliminary report. Acad Emerg Med. 2020;27(8):693–699.CrossRefGoogle ScholarPubMed
Fagoni, N, Perone, G, Villa, GF, et al. The Lombardy Emergency Medical System faced with COVID-19: the impact of out-of-hospital outbreak. Prehosp Emerg Care. 2021;25(1):1–7.CrossRefGoogle ScholarPubMed
Perlini, S, Canevari, F, Cortesi, S, et al. Emergency department and out-of-hospital emergency system (112-AREU 118) integrated response to coronavirus disease 2019 in a Northern Italy center. Intern Emerg Med. 2020;15(5):825–833,CrossRefGoogle Scholar
Dami, F, Berthoz, V. Lausanne medical dispatch center’s response to COVID-19. Scand J Trauma Resusc Emerg Med. 2020;28(1):37.CrossRefGoogle Scholar
Patel, R, Nugawela, MD, Edwards, HB, et al. Can early warning scores identify deteriorating patients in prehospital settings? A systematic review. Resuscitation. 2018;132:101–111.CrossRefGoogle Scholar
Silcock, DJ, Corfield, AR, Gowens, PA, Rooney, KD. Validation of the National Early Warning Score in the prehospital setting. Resuscitation. 2015;89:31–35.CrossRefGoogle ScholarPubMed
Endo, T, Yoshida, T, Shinozaki, T, et al. Efficacy of prehospital National Early Warning Score to predict outpatient disposition at an emergency department of a Japanese tertiary hospital: a retrospective study. BMJ Open. 2020;10(6):e034602.CrossRefGoogle ScholarPubMed