Impact of the coronavirus disease 2019 (COVID-19) pandemic on the operational efficiency of emergency medical services and its association with out-of-hospital cardiac arrest survival rates: A population-based cohort study in Kobe, Japan

Jun Sugiyama; Shigeaki Inoue; Masami Inada; Yusuke Miyazaki; Nobuto Nakanishi; Yoshihisa Fujinami; Masafumi Saito; Yuko Ono; Kazushige Toyama; Futoshi Toda; Tohru Shirotsuki; Soushi Shiotani; Joji Kotani

doi:10.1002/ams2.865

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the operational efficiency of emergency medical services and its association with out-of-hospital cardiac arrest survival rates: A population-based cohort study in Kobe, Japan

Acute Med Surg. 2023 Jun 25;10(1):e00865. doi: 10.1002/ams2.865. eCollection 2023 Jan-Dec.

Authors

Affiliations

¹ Department of Disaster and Emergency and Critical Care Medicine Kobe University Graduate School of Medicine Kobe Japan.
² Emergency Medical Service Division Kobe City Fire Burau Kobe Japan.
³ Department of Emergency Medicine Kakogawa Central City Hospital Kakogawa Japan.

Abstract

Aim: To identify whether the coronavirus disease 2019 (COVID-19) pandemic affects the operational efficiency of emergency medical services (EMS) and the survival rate of out-of-hospital cardiac arrest (OHCA) in prehospital settings.

Methods: We conducted a population-based cohort study in Kobe, Japan, between March 1, 2020, and September 31, 2022. In study 1, the operational efficiency of EMS, such as the total out-of-service time for ambulances, the daily occupancy rate of EMS, and response time, was compared between the pandemic and nonpandemic periods. In study 2, the impacts of the changes in EMS operational efficiency were investigated among patients with OHCA, with 1-month survival as the primary outcome and return of spontaneous circulation, 24-h survival, 1-week survival, and favorable neurological outcomes as the secondary outcomes. Logistic regression analysis was conducted to identify the factors associated with survival among patients with OHCA.

Results: The total out-of-service time, occupancy rate, and response time significantly increased during the pandemic period (p < 0.001). The response time during the pandemic period increased significantly per pandemic wave. Regarding OHCA outcomes, 1-month survival rates during the pandemic period significantly decreased compared with those during the nonpandemic period (pandemic 3.7% vs. nonpandemic 5.7%; p < 0.01). Similarly, 24-h survival (9.9% vs. 12.8%), and favorable neurological outcomes significantly decreased during the pandemic period. In the logistic regression analysis, response time was associated with lower OHCA survival in all outcomes (p < 0.05).

Conclusion: The COVID-19 pandemic has been associated with reduced operational efficiency of EMS and decreased OHCA survival rates. Further research is required to improve the efficiency of EMS and OHCA survival rates.

Keywords: emergency medical services; operational efficiency; out‐of‐hospital cardiac arrest; prehospital; response time.