J Korean Med Sci.  2023 Mar;38(9):e69. 10.3346/jkms.2023.38.e69.

Increased Prehospital Emergency Medical Service Time Interval and Nontransport Rate of Patients With Fever Using Emergency Medical Services Before and After COVID-19 in Busan, Korea

• Lim YJ
• Park SY

• KMID: 2540127
• DOI: http://doi.org/10.3346/jkms.2023.38.e69

Abstract

Background
In Korea, patients with fever have been preemptively isolated to isolation beds in the emergency department (ED) since the coronavirus disease 2019 (COVID-19) pandemic began. However, isolation beds were not always available, and transport delays or failure (nontransport), especially for infants, were reported in the media. Few studies have focused on delays and failure in transporting fever patients to the ED. Therefore, this study aimed to examine and compare the emergency medical service (EMS) time interval and nontransport rate of patients with fever using EMSs before and after COVID-19.
Methods
This retrospective observational study analyzed the prehospital EMS time interval and nontransport rate of fever patients who contacted EMSs in Busan, South Korea, from March 1, 2019 to February 28, 2022, using emergency dispatch reports. All fever patients (≥ 37.5°C) who contacted EMSs during this study were included. The EMS time interval was defined as the time between the patient’s EMS call and ED arrival time. Nontransport was defined as a case recorded as not being transported in the emergency dispatch reports. The study population of 2019 was compared to the population of 2020 and 2021 with the independent t-test, Mann-Whitney U test, and χ ² test. As a subgroup, the EMS time intervals and nontransport rates of infants with fever were compared before and after COVID-19.
Results
A total of 554,186 patients accessed the EMS during the study period, and 46,253 patients with fever were included. The EMS time interval (mean ± standard deviation, minutes) of fever patients was 30.9 ± 29.9 in 2019, 46.8 ± 127.8 in 2020 (P < 0.001) and 45.9 ± 34.0 in 2021 ( P < 0.001). The nontransport rate (%) was 4.4 in 2019, 20.6 in 2020 (P < 0.001), and 19.5 in 2021 (P < 0.001). For infants with fever, the EMS time interval was 27.6 ± 10.8 in 2019, 35.1 ± 15.4 in 2020 (P < 0.001), and 42.3 ± 20.5 in 2021 (P < 0.001), and the nontransport rate (%) was 2.6 in 2019, 25.0 in 2020, and 19.7 in 2021.
Conclusion
After the emergence of COVID-19, in Busan, the EMS time interval of fever patients was delayed, and approximately 20% of fever patients were not transported. However, infants with fever had shorter EMS time intervals and higher nontransport rates than the overall study population. A comprehensive approach, including prehospital and hospital ED flow improvements, is required beyond increasing the number of isolation beds.

Keyword

Emergency Medical Services; Republic of Korea; COVID-19; Transportation; Fever; Infant

Figure

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  Fig. 1 EMS time interval.EMS = emergency medical service, ED = emergency department.

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  Fig. 2 Flowchart of the study population inclusion process.EMS = emergency medical service, BT = body temperature.aThe criterion for fever was 37.5°C or higher measured by a tympanic thermometer.

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  Fig. 3 The trends in the number of patients with fever using EMSs and confirmed COVID-19 patients.EMS = emergency medical service, COVID-19 = coronavirus disease 2019.

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  Fig. 4 Box plot of EMS time interval for patients with fever using EMSs before and after coronavirus disease 2019. Extremely delayed outliers were omitted.EMS = emergency medical service.

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  Fig. 5 EMS time interval intervals for patients with fever using EMSs before and after coronavirus disease 2019. The values (minutes) in the bar and outside the bar represent the mean time, and standard deviation spent for each time interval and the EMS time interval.EMS = emergency medical service.

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