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Ethics code: IR.MUQ.REC.1401.113
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Behradfard M, Babaii A, Khoramirad A. The Emergency Medical Services Provided to Trauma Patients During the COVID-19 Pandemic Compared to the Pre-COVID Period in Qom, Iran. Qom Univ Med Sci J 2024; 18 : 2777.1
URL: http://journal.muq.ac.ir/article-1-3859-en.html
URL: http://journal.muq.ac.ir/article-1-3859-en.html
1- Department of Medical- Surgical Nursing, Faculty of Nursing, Qom University of Medical Sciences, Qom, Iran.
2- Department of Medical- Surgical Nursing, Faculty of Nursing, Qom University of Medical Sciences, Qom, Iran. ,A.babaii1400@gmail.com
2- Department of Medical- Surgical Nursing, Faculty of Nursing, Qom University of Medical Sciences, Qom, Iran. ,
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Trauma is a major public health concern worldwide due to causing high death cases and a heavy financial burden on the health system, such that it has been called the “neglected disease of modern society”. The emergency medical services (EMS) or ambulance services, are services that provide urgent pre-hospital treatment for serious illness and injuries. Providing good EMS can reduce the risks of death. The number of EMS missions can affect their performance. The number of calls for EMS is important because it affects the response time which is a major factor associated with the survival of patients. Difference in the number of missions can lead to actual changes in EMS resources and affect patient outcome.
One of the causes related to changes in the number of EMS missions are pandemics. There is limited information about the impact of the COVID-19 pandemic on the EMS especially for trauma patients. Some studies showed that, during the COVID-19 pandemic, the total number of EMS missions decreased. Sabrian et al. [4] showed that, although the total number of EMS missions increased significantly during the pandemic, the increase was mostly related to patients with fever and respiratory problems; the number of trauma-related missions decreased compared to the pre-COVID period. Azbel et al. [11] argued that restrictions due to measures such as quarantine and social distancing during the pandemic led to a reduction in the number of trauma-related EMS missions.
Moreover, there is limited information about how EMS provides services to emergency patients during the COVID-19 pandemic. Jarvis showed that the transportation time for trauma patients was significantly shorter during the pandemic, while other EMS times were not significantly affected by the pandemic. On the contrary, Elmer et al. reported that the on-scene time in the post-COVID period was significantly longer; however, their study included non-traumatic patients who experienced an out-of-hospital cardiac arrest. Ageta et al. [14] argued that the pandemic affected EMS and delayed arrival/response even in a minimally affected region. Sabbaghi et al. [7] also concluded that the time-related indicators of EMS increased during the pandemic.
EMS performance plays an important role in the community health, especially in crises. Limited studies have examined the EMS performance during the COVID-19 pandemic in Iran. These limited studies have sometimes reported conflicting results. Therefore, this study aims to compare the EMS provided to trauma patients during the COVID-19 pandemic with those provided in the pre-COVID period in Qom, Iran.
Methods
This cross-sectional study was conducted from March 16 to June 11, 2023 in Qom, Iran. The data were obtained from among the data reported by the Statistics Unit of the Qom EMS Center. These data included the demographic information (such as age and gender), type of trauma and the time of service delivery. The time intervals in this study include response time, on-scene time and transportation time. Trained EMS personnel recorded the patients’ medical information during the first and second waves of the pandemic (from February 20 to April 3, 2020 and from September 5 to November 5, 2020, respectively) and two similar periods before the pandemic (from February 20 to April 3, 2019 and from September 5 to November 5, 2019, respectively) which were extracted from the Asayar database (Iranian pre-hospital information management system). The information related to urban trauma-related EMS missions was extracted. From each period, 615 missions were randomly selected and included in the study. The information of missions that were canceled, had more than one injured and had unclear information was not included in the study.
Data were analyzed in SPSS software, version 21. Descriptive statistics were used to describe the participants’ demographic characteristics, and the times of service delivery. Chi-square test and independent t-test were used to analyze the quantitative data. The results of Kolmogorov–Smirnov test showed that the quantitative data did not have a normal distribution. Accordingly, we used the non-parametric Wilcoxon signed-rank test for between-groups comparisons. The significance level was set at 0.05.
Results
The characteristics of trauma patients in the first and second waves of the COVID-19 pandemic and in the two periods before the pandemic are shown in Table 1. The results of the Wilcoxon test showed no statistically significant difference in the age of patients between the first and second waves and the pre-COVID periods (P>0.05). The results of the chi-square test showed that the number of male patients was significantly higher in both first and second waves compared to the pre-COVID periods (P<0.05). The results of this test also showed that during the first and second waves, the number of traffic accidents and falls were significantly lower than in the pre-COVID periods (P<0.05). However, the number of burns was significantly higher in the first and second waves than in the pre-COVID periods (P<0.05).
The EMS provided to trauma patients during the pandemic and the pre-COVID periods are shown in Table 2. The results of the chi-square test showed that the number of trauma-related missions in first and second waves of the pandemic was significantly lower than in the pre-COVID periods (P<0.05). According to the results of the Wilcoxon test, there was no significant difference between the first and second waves and the pre-COVID periods in terms of response time (P>0.05). The results of this test also showed that the on-scene time was significantly longer during the first wave than in the pre-COVID period (P<0.05). However, there was no significant difference between the second wave and the pre-COVID period (P>0.05). Furthermore, during the second wave, the transportation time was significantly longer than in the pre-COVID period (P<0.05). However, there was no significant difference between the first wave and the pre-COVID period (P>0.05).
Conclusion
The trauma-related EMS missions decreased during the COVID-19 pandemic. The findings suggest that COVID-19 has led to real changes in the emergency services provided to trauma patients. Proper planning in terms of equipment and human resources should be considered for quality emergency service provision to these patients in the future pandemics.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Qom University of Medical Sciences (Code: IR.MUQ.REC.1401.113).
Funding
This study was financially supported by Qom University of Medical Sciences.
Authors contributions
All authors equally contributed to preparing this article.
Conflicts of interest
The authors declared no conflict of interest.
One of the causes related to changes in the number of EMS missions are pandemics. There is limited information about the impact of the COVID-19 pandemic on the EMS especially for trauma patients. Some studies showed that, during the COVID-19 pandemic, the total number of EMS missions decreased. Sabrian et al. [4] showed that, although the total number of EMS missions increased significantly during the pandemic, the increase was mostly related to patients with fever and respiratory problems; the number of trauma-related missions decreased compared to the pre-COVID period. Azbel et al. [11] argued that restrictions due to measures such as quarantine and social distancing during the pandemic led to a reduction in the number of trauma-related EMS missions.
Moreover, there is limited information about how EMS provides services to emergency patients during the COVID-19 pandemic. Jarvis showed that the transportation time for trauma patients was significantly shorter during the pandemic, while other EMS times were not significantly affected by the pandemic. On the contrary, Elmer et al. reported that the on-scene time in the post-COVID period was significantly longer; however, their study included non-traumatic patients who experienced an out-of-hospital cardiac arrest. Ageta et al. [14] argued that the pandemic affected EMS and delayed arrival/response even in a minimally affected region. Sabbaghi et al. [7] also concluded that the time-related indicators of EMS increased during the pandemic.
EMS performance plays an important role in the community health, especially in crises. Limited studies have examined the EMS performance during the COVID-19 pandemic in Iran. These limited studies have sometimes reported conflicting results. Therefore, this study aims to compare the EMS provided to trauma patients during the COVID-19 pandemic with those provided in the pre-COVID period in Qom, Iran.
Methods
This cross-sectional study was conducted from March 16 to June 11, 2023 in Qom, Iran. The data were obtained from among the data reported by the Statistics Unit of the Qom EMS Center. These data included the demographic information (such as age and gender), type of trauma and the time of service delivery. The time intervals in this study include response time, on-scene time and transportation time. Trained EMS personnel recorded the patients’ medical information during the first and second waves of the pandemic (from February 20 to April 3, 2020 and from September 5 to November 5, 2020, respectively) and two similar periods before the pandemic (from February 20 to April 3, 2019 and from September 5 to November 5, 2019, respectively) which were extracted from the Asayar database (Iranian pre-hospital information management system). The information related to urban trauma-related EMS missions was extracted. From each period, 615 missions were randomly selected and included in the study. The information of missions that were canceled, had more than one injured and had unclear information was not included in the study.
Data were analyzed in SPSS software, version 21. Descriptive statistics were used to describe the participants’ demographic characteristics, and the times of service delivery. Chi-square test and independent t-test were used to analyze the quantitative data. The results of Kolmogorov–Smirnov test showed that the quantitative data did not have a normal distribution. Accordingly, we used the non-parametric Wilcoxon signed-rank test for between-groups comparisons. The significance level was set at 0.05.
Results
The characteristics of trauma patients in the first and second waves of the COVID-19 pandemic and in the two periods before the pandemic are shown in Table 1. The results of the Wilcoxon test showed no statistically significant difference in the age of patients between the first and second waves and the pre-COVID periods (P>0.05). The results of the chi-square test showed that the number of male patients was significantly higher in both first and second waves compared to the pre-COVID periods (P<0.05). The results of this test also showed that during the first and second waves, the number of traffic accidents and falls were significantly lower than in the pre-COVID periods (P<0.05). However, the number of burns was significantly higher in the first and second waves than in the pre-COVID periods (P<0.05).
The EMS provided to trauma patients during the pandemic and the pre-COVID periods are shown in Table 2. The results of the chi-square test showed that the number of trauma-related missions in first and second waves of the pandemic was significantly lower than in the pre-COVID periods (P<0.05). According to the results of the Wilcoxon test, there was no significant difference between the first and second waves and the pre-COVID periods in terms of response time (P>0.05). The results of this test also showed that the on-scene time was significantly longer during the first wave than in the pre-COVID period (P<0.05). However, there was no significant difference between the second wave and the pre-COVID period (P>0.05). Furthermore, during the second wave, the transportation time was significantly longer than in the pre-COVID period (P<0.05). However, there was no significant difference between the first wave and the pre-COVID period (P>0.05).
Conclusion
The trauma-related EMS missions decreased during the COVID-19 pandemic. The findings suggest that COVID-19 has led to real changes in the emergency services provided to trauma patients. Proper planning in terms of equipment and human resources should be considered for quality emergency service provision to these patients in the future pandemics.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Qom University of Medical Sciences (Code: IR.MUQ.REC.1401.113).
Funding
This study was financially supported by Qom University of Medical Sciences.
Authors contributions
All authors equally contributed to preparing this article.
Conflicts of interest
The authors declared no conflict of interest.
Type of Study: Original Article |
Subject:
پرستاری-جراحی-ویژه-کودکان
Received: 2023/11/11 | Accepted: 2024/01/16 | Published: 2024/04/29
Received: 2023/11/11 | Accepted: 2024/01/16 | Published: 2024/04/29
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