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Emergency Medical Services Responses to Out-of-Hospital Cardiac Arrest and Suspected ST-Segment-Elevation Myocardial Infarction During the COVID-19 Pandemic in Los Angeles County.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2021 Jun 15; Vol. 10 (12), pp. e019635. Date of Electronic Publication: 2021 Jun 01. - Publication Year :
- 2021
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Abstract
- Background Public health emergencies may significantly impact emergency medical services responses to cardiovascular emergencies. We compared emergency medical services responses to out-of-hospital cardiac arrest (OHCA) and ST-segment‒elevation myocardial infarction (STEMI) during the 2020 COVID-19 pandemic to 2018 to 2019 and evaluated the impact of California's March 19, 2020 stay-at-home order. Methods and Results We conducted a population-based cross-sectional study using Los Angeles County emergency medical services registry data for adult patients with paramedic provider impression (PI) of OHCA or STEMI from February through May in 2018 to 2020. After March 19, 2020, weekly counts for PI-OHCA were higher (173 versus 135; incidence rate ratios, 1.28; 95% CI, 1.19‒1.37; P <0.001) while PI-STEMI were lower (57 versus 65; incidence rate ratios, 0.87; 95% CI, 0.78‒0.97; P =0.02) compared with 2018 and 2019. After adjusting for seasonal variation in PI-OHCA and decreased PI-STEMI, the increase in PI-OHCA observed after March 19, 2020 remained significant ( P =0.02). The proportion of PI-OHCA who received defibrillation (16% versus 23%; risk difference [RD], -6.91%; 95% CI, -9.55% to -4.26%; P <0.001) and had return of spontaneous circulation (17% versus 29%; RD, -11.98%; 95% CI, -14.76% to -9.18%; P <0.001) were lower after March 19 in 2020 compared with 2018 and 2019. There was also a significant increase in dead on arrival emergency medical services responses in 2020 compared with 2018 and 2019, starting around the time of the stay-at-home order ( P <0.001). Conclusions Paramedics in Los Angeles County, CA responded to increased PI-OHCA and decreased PI-STEMI following the stay-at-home order. The increased PI-OHCA was not fully explained by the reduction in PI-STEMI. Field defibrillation and return of spontaneous circulation were lower. It is critical that public health messaging stress that emergency care should not be delayed.
- Subjects :
- COVID-19 transmission
Cross-Sectional Studies
Humans
Incidence
Los Angeles epidemiology
Out-of-Hospital Cardiac Arrest diagnosis
Out-of-Hospital Cardiac Arrest epidemiology
Out-of-Hospital Cardiac Arrest physiopathology
Physical Distancing
Registries
Return of Spontaneous Circulation
ST Elevation Myocardial Infarction diagnosis
ST Elevation Myocardial Infarction epidemiology
ST Elevation Myocardial Infarction physiopathology
Time Factors
Treatment Outcome
COVID-19 prevention & control
Electric Countershock
Emergency Medical Services
Out-of-Hospital Cardiac Arrest therapy
Patient Acceptance of Health Care
ST Elevation Myocardial Infarction therapy
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 10
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 34058862
- Full Text :
- https://doi.org/10.1161/JAHA.120.019635