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How the COVID-19 Epidemic Affected Prehospital Emergency Medical Services in Tehran, Iran
Peyman Saberian1,2, Joseph L Conovaloff3, Elnaz Vahidi1,4
1Tehran University of Medical Sciences, Prehospital and Hospital Emergency Research Center, Tehran, Iran.
Insights
Emergency medical services (EMS) in Tehran experienced a 347% surge in calls and a 21% rise in dispatches following the COVID-19 outbreak. Despite increased demand, EMS response times improved, demonstrating system adaptability.
Area of Science:
- Emergency Medicine
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly disrupted healthcare systems globally, including in Tehran, Iran.
- The first case of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Iran was reported on February 18, 2020, leading to a rapid increase in cases.
- Emergency Medical Services (EMS) faced challenges in managing increased patient volume and mitigating the risk of SARS-CoV-2 transmission among personnel.
Purpose of the Study:
- To evaluate the impact of the COVID-19 outbreak on the volume and nature of Emergency Medical Services (EMS) calls and dispatches in Tehran.
- To assess changes in EMS operational efficiency, including call hold times and call duration, post-outbreak.
- To identify trends in chief complaints related to the SARS-CoV-2 pandemic.
Main Methods:
- A comparative analysis of EMS data was conducted for 28-day periods before and after February 18, 2020.
- Data evaluated included the number of EMS calls, dispatches, chief complaints, average telephone hold time, and average call length.
- Statistical significance was determined using p-values.
Main Results:
- EMS calls increased by 347% (from 355,241 to 1,589,346) and dispatches by 21% (from 82,282 to 99,926) post-outbreak (p<0.001 for both).
- Average telephone hold time decreased by 7% (10.6 to 9.8 seconds) and average call length by 20% (1.32 to 1.06 minutes) (p<0.001 for both).
- Chief complaints of fever increased by 211% and respiratory symptoms by 245% (p<0.001).
Conclusions:
- Tehran's EMS system demonstrated resilience, managing a substantial increase in call volume and dispatches post-COVID-19 outbreak.
- Despite increased demand, EMS efficiency improved with reduced call hold times and lengths.
- System adaptations, including increased personnel, expanded call-center resources, and specific training, were crucial for managing the pandemic's impact.
Introduction:
Coronavirus disease 2019 (COVID-19) has substantially impacted the healthcare delivery system in Tehran, Iran. The country's first confirmed positive test for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was on February 18, 2020. Since then, the number of cases has steadily increased in Iran and worldwide. Emergency medical services (EMS) quickly adapted its operations to accommodate a greater number of patients, and it worked to decrease the risk of COVID-19 spread among EMS personnel, given the disease's high transmissibility.
Methods:
We evaluated the chief complaint as well as the pattern and number of EMS calls and dispatches during the 28-day intervals before and after the February 18, 2020, COVID-19 outbreak in Iran.
Results:
EMS calls increased from 355,241 in the pre-outbreak period to 1,589,346 in the post-outbreak period, a 347% increase (p<0.001). EMS dispatches rose more modestly from 82,282 to 99,926, a 21% increase (p<0.001). The average time on telephone hold decreased from 10.6 ± 12.7 seconds pre-outbreak to 9.8 ± 11.8 seconds post-outbreak, a 7% decrease (p<0.001). The average length of call also decreased from 1.32 ± 1.42 minutes pre-outbreak to 1.06 ± 1.28 minutes post-outbreak, a 20% decrease (p<0.001). The highest number of daily dispatches occurred during the second and third weeks of the four-week post-outbreak period, peaking at 4557 dispatches/day. After the first reported case of SARS-CoV-2, there were significant increases in chief complaints of fever (211% increase, p<0.001) and respiratory symptoms (245% increase, p<0.001).
Conclusion:
The number of EMS calls and dispatches in Tehran increased 347% and 20%, respectively, after the outbreak of COVID-19. Despite this, the time on hold for EMS response decreased. The Tehran EMS system accomplished this by increasing personnel hours, expanding call-center resources, and implementing COVID-19-specific training.
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