key: cord-0879475-5apwinla authors: Şan, İshak; Usul, Eren; Bekgöz, Burak; Korkut, Semih title: Effects of COVID‐19 Pandemic on Emergency Medical Services date: 2020-12-25 journal: Int J Clin Pract DOI: 10.1111/ijcp.13885 sha: 9a9fd02908a90dac52e481fffd2506079d96a594 doc_id: 879475 cord_uid: 5apwinla INTRODUCTION: In this study, we aimed to analyse the changes that occurred after the COVID‐19 pandemic using the data of EMS of Ankara province. MATERIALS AND METHODS: EMS data for the same time interval (March 11‐April 24) in the last 3 years (2018, 2019 and 2020) were compared. RESULTS: While the number of calls increased by 90.9% during the pandemic period (from 2019 to 2020), the number of cases increased by 9.8%. Of all cases transported to hospital, 15.2% were suspected of and 2.9% were diagnosed with COVID‐19. In the pandemic period, case frequency decreased in the 0‐6 age group (−4.1%) and 7‐18 age group (‐39.9%) while the number of patients in the 19‐65 age group (12.9%) and 65+ age group (21.5%) increased. There was a statistically significant difference between pre‐pandemic and pandemic period in terms of rural area case frequency. During the pandemic period, case frequency of angina pectoris (−35.2%), myocardial infarction (−45%), acute abdomen (−23.8%) and cerebrovascular diseases (−2.9%) decreased contrary to pre‐pandemic period (2019). During the same period, symptoms of fever (+14.1%) and cough (+956.3%) increased. There was a statistically significant difference between pre‐pandemic and pandemic period in terms of forensic case frequency (P < .05). In addition, there was a statistically significant difference between these periods in terms of the frequency of patients who died at the scene. CONCLUSION: Although the use of ambulances has increased in the pandemic process, the use of EMS for time‐sensitive diseases has decreased. In December 2019, cases of unknown pneumonia began to emerge in Wuhan, China. The clinical course of these cases resembled viral pneumonia. 1 It was determined that a virus named 2019-nCoV caused this clinic. 2 Coronavirus Disease 2019 (COVID- 19) is a pandemic that has caused approximately 2 million confirmed cases and nearly 120 000 deaths worldwide as of 15 April 2020. The mortality rate ranges from 3% to 9% between continents. 3 The 2019-nCoV infection as a result of the SARS-CoV-2 agent has been named as COVID-19 and has spread rapidly worldwide causing a pandemic. The first case in Turkey was detected on 11 March 2020, and day-by-day, the number of cases has increased. A pandemic is an epidemic occurring worldwide or over a wide area crossing international boundaries and affecting a large number of people. An epidemic anywhere in the world is now a threat to all countries as a result of easier transportation and increased globalisation. Many serious acute diseases occurring in a short time will push the capacities of health systems of both developing and developed countries. 4 Pandemic affects vital activities and ordinary life for societies. Emergency Medical Services (EMS) include providing emergency care to individuals who need it as a result of disaster, accident or illness and transporting them to a hospital. 5, 6 The main purpose of these services, which are an important part of modern health systems, is to increase morbidity and mortality as a result of major trauma, chronic disease and sudden health problems. 5, 7 The main causes of death in adults are accidents, traumas, cardiovascular diseases, chronic diseases, excessive drug intake and suicide. 8, 9 The effect of EMS on reducing the mortality and morbidity of trauma and chronic diseases increases its importance worldwide. 10 EMS usage rates of societies differ depending on local, socio-economic and cultural conditions. This study was carried out in Ankara province (the capital city of Turkey) to evaluate the rate of EMS use after the COVID-19 pandemic. This study retrospectively evaluated the Ankara (Capital of Turkey) EMS data for the period after the pandemic was first seen in Turkey. The necessary permissions for the study were obtained from the Ankara Provincial Health Directorate. EMS data for the same time interval (March 11-April 24) in the last 3 years (2018, 2019 and 2020) were compared. All data were analysed using IBM SPSS for Windows version 25. In addition to descriptive statistics (frequency, percentage, mean, standard deviation, median, min-max), chi-squared (χ 2 ) test was used to compare qualitative data. The consistency of the data to normal distribution was evaluated by the Kolmogorov-Smirnov test. As a result of the tests, it was found that the data were consistent with the normal distribution. Independent samples t test was used for comparison between groups. A value of p <0.05 was considered statistically significant. The study interval was 11 March-24 April time period of the years 2018, 2019 and 2020. EMS data of the Ankara province for this study interval were evaluated in this study. While Ankara EMS re- • It is known that the use of EMS varies according to cultural, economic and sociocultural differences. The pandemic process is also thought to affect EMS use. • EMS utilisation rates of the individuals increased during the COVID-19 pandemic process. Anxiety of transmission prevents individuals from using EMS for time-sensitive diseases such as acute myocardial infarction and stroke, and this leads to increased mortality rates. period (11 March-24 2020), the mean age was 50.3 ± 23.7 for men and 54.0 ± 24.5 for women ( There was a statistically significant decrease between pre-pandemic and pandemic period in terms of forensic case frequency ( Table 2) . While the number of cases in the rural area was 2010 (4.6%) in the pre-pandemic period (11 March-24 April 2019), it was 2738 (5.7%) in the pandemic period (11 March-24 April 2020). There was a statistically significant difference between pre-pandemic and pandemic period in terms of rural area case frequency ( Table 2 ). The number of patients who died at the scene in pre-pandemic period (11 March-24 April 2019) was 907 (2.1%) while it was 1353 (%2.8) in pandemic period. There was a statistically significant difference between pre-pandemic and pandemic period in terms of frequency of patients who died at the scene. The most common cause of death at the scene, both in the pre-pandemic period and in the pandemic period, was "sudden death of unknown cause" and "cardiac sudden death" ( Table 2) . in the same period (Table 3) . During the pandemic period, frequency of angina pectoris (−35.2%), myocardial infarction (−45%), acute abdomen (−23.8%) and cerebrovascular diseases (−2.9%) decreased contrary to pre-pandemic period (2019). During the same period, symptoms of fever (+14.1%) and cough (+956.3%) increased (Table 3 ). In the pandemic period, the number of patients suspected of COVID-19 was 7364 while the number of patients diagnosed with COVID-19 was 1437 (Table 3 ). There was a significant increase in fever, cough, joint pain and respiratory abnormalities during the pandemic period (P < .05). The most common symptoms in COVID-19 are fever, cough, fatigue, weakness, respiratory distress, nausea and diarrhea. 12, 13 Therefore, we think that the increase in these symptoms is as The distribution of cases to age groups changed during the pandemic period. In the pandemic period, the number of patients decreased in the 0-6 age group (−4.1%) and 7-18 age group (−39.9%). The decrease in the number of cases in the 7-18 age group was mostly in the diagnosis of undefined pain, falls, head injuries, nausea, vomiting and abdominal pain. In children who are concerned about going to school, abdominal pain, nausea, vomiting, headache and dizziness are the most common symptoms. In children, these symptoms usually appear in the morning or when they are asked to go to school. [16] [17] [18] As a result of the measures taken, we think that the closure of schools and the curfew imposed on individuals under the age of 20 caused this result. Cough symptom frequency increased in the 0-18 age group patients. Although only cough complaints do not require ambulance transport, we think this increase was as a result of COVID-19-suspected patients. The number of cases in the 19-65 age group increased by 12.9%. In the age group over 65, the number of cases increased by 21.5%. We think this is mostly as a result of the suspected or diagnosed cases of COVID-19 and the occurrence of COVID-19 at an advanced age. In the study of Li et al., the median age of COVID-19 patients was 59 years. 13 The increase in the number of cases in these age groups also explains the mean age increase in both male and female patients. There was a 36.2% increase in the frequency of the rural area cases. In this period, the transport of the cases from rural areas to the city centre was more than before. The reason for this may be the increase in the need for specialist physicians and intensive care in rural hospitals as a result of the pandemic. The number of patients who died at the scene increased by 19 .4%. More patients died as a result of the "sudden death of unknown cause" and "cardiac sudden death" in the pandemic period. Ischemic heart disease and stroke are the biggest killers worldwide, resulting in 15.2 million deaths in 2016. These diseases are the leading causes of death globally over the past 15 years. 8 Even in Turkey, the most common causes of death are ischemic heart disease and cerebrovascular disease. Cardiovascular diseases caused 40.4% of the deaths in Turkey in 2014. 20 In addition, thrombosis as a result of COVID-19 can cause sudden cardiac deaths according to Liu et al. 21 The increase in the number of patients found dead at home during the pandemic process suggests that these patients may have been afraid of the COVID-19 pandemic and therefore did not want to go to the hospital. Therefore, sudden thrombosis as a result of COVID-19 may have caused an increase in the frequency of deaths at home. EMS utilisation rates of the individuals increased during the COVID-19 pandemic process. Anxiety of transmission prevents individuals from using EMS for time-sensitive diseases such as acute myocardial infarction and stroke, and this leads to increased mortality rates. None. The data that support the findings of this study are available from the corresponding author upon reasonable request. A novel coronavirus from patients with pneumonia in China World Health Organization. Corona virus disease (COVID-19) situation reports Ethical considerations in developing a public health response to pandemic influenza Kitlesel Olaylarda Hastane Öncesi Acil Sağlık Hizmetleri Yönetimi. İzmir: Kitapana Samsun 112 Acil Çağrılarının ve Acil Sağlık Hizmet İstasyonlarının Konumlarının CBS ile Değerlendirilmesi. III. Uzaktan Algılama ve Coğrafi Bilgi Sistemleri Sempozyumu Recent Advances in Emergency Medical Services Management. 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