Changes in the epidemiological characteristics of prehospital emergency services before and during the COVID-19 pandemic, Chengdu, 2016–2021 – Scientific Reports

It is critical to comprehend the effects of significant public health events, such as the COVID-19 epidemic, on prehospital emergency medical services to ensure proper management of similar outbreaks in the future. Our research made a retrospective descriptive study that explored the changes in the epidemiological characteristics of prehospital emergency services to measure the effect of COVID-19 in the city proper of Chengdu. Our results showed that although there was no large-scale epidemic in Chengdu, people’s medical behaviors and willingness were still affected. The demand for prehospital EMSs, prehospital emergency commands and dispatches, ERTs and the disease spectrum changed under the influence of the epidemic. Although the postepidemic normalization period began, the relevant observed prehospital emergency indicators in 2021 were still different from those before the pandemic.

Our results showed a decline in prehospital emergency demand during and after the COVID-19 outbreak, with a marked decline in 2020. This decrease can be explained by the fact that people did not know about the virus and were afraid that going to the hospital would increase the chance of being infected and they could not be treated^{19,20,21,22,23}. Some studies pointed out that medical resources were redistributed to fight the virus during the outbreak, resulting in a decline in the ability to solve other medical problems during the outbreak, which in turn led to a decline in the utilization of health care services⁸. After in-depth analysis, we found that the stricter the epidemic prevention and control policy was, the lower the number of emergency calls people made. This may be because strict policies restricted people from going out, which in turn led to a reduction in the incidence of accidents such as traffic accidents, fights, and falls. Although the demand increased in 2021, it has yet to return to prepandemic levels, which means the impact of the outbreak on first aid will be prolonged²². In addition, we also found an increase in ERTs in 2020, when the outbreak began, but they were reduced to pre-epidemic levels in 2021. This change may be due to limitations imposed by lockdown restrictions. Moreover, since this was a novel coronavirus, both the general public and medical staff knew little about it, resulting in many protective measures at the time of admission, which may also be one of the reasons for the prolongation of ERTs. The divergent results of our study compared to similar studies may be attributed to organizational disparities in the public’s access to acute healthcare ²⁴. Additionally, the absence of a large-scale epidemic during the research period could also be a contributing factor. This could be mainly attributed to the prompt implementation of strict epidemic prevention measures by relevant departments, including comprehensive screening of close contacts and large-scale nucleic acid testing for all once infected individuals were identified. Furthermore, our country has stringent quality control indicators for pre-hospital emergency medical services. The Chengdu government mandates that every emergency medical hospital must depart for the accident site within five minutes of receiving the emergency call. Thus, doctors and nurses take measures to minimize the time spent on wearing protective equipment.

Our study also suggested that the pandemic influenced the ranking of the disease spectrum and the distribution of visit months. The overall volume of traffic accidents decreased in 2020 due to the serious and strict safer-at-home and lockdown policies implemented during the domestic epidemic^25,26. In addition, to reduce the risk of infection, people were more willing to stay at home²⁷. In 2021, the volume of traffic accidents increased, which may be attributed to the easing of outbreak restrictions, the lifting of lockdown policies and the return to normalized management of the pandemic. For epidemic prevention and control, people needed to stay at home; they reduced their exercise levels, had irregular diets and changed their way of life, which may have resulted in an increase in digestive system diseases²⁸. At the peak of the pandemic, the number of visits for cerebrovascular disease decreased, and it was reasonable for patients with transient/mild stroke symptoms to seek medical assistance less often, possibly because of fear of contracting the virus or declining health care capacity⁴. However, in 2021, after the epidemic leveled off, the number of patients with cerebrovascular disease increased substantially, possibly due to the interruption of regular follow-up visits, failure to take medicine on time and failure to comply with medical orders.

It is worth noting that during the outbreak, the demand for first aid for respiratory diseases decreased compared with that before the pandemic, which may be attributed to the fact that in the early days of the COVID-19 epidemic, China completely carried out social distancing, personal hygiene and masking measures. This finding is consistent with previous reports that showed a substantial decline in the incidence of respiratory diseases in other countries^{2,3,5,6,7,9,29}. However, some studies have also indicated that during the early stages of the outbreak, the number of respiratory disease emergency calls and cumulative incidence rate were higher than before the pandemic^13,29. This is different from our study, which may be attributed to the longer research period we conducted and partly due to the fact that various countries had not yet entered the strict control stage at the early stage of the pandemic. In addition, due to the demand for epidemic prevention and control and the fear of the virus, people were more willing to delay or avoid seeking medical services, which led us to find that the initial day of the peak distribution of both the visit months and disease were delayed in 2020 when performing the circular distribution analysis. In view of the further understanding of the virus and the effectiveness of epidemic prevention and control policies, people no longer refuse medical treatment for fear of being infected, so the initial daily occurrence of the peak period of diseases returned to normal in 2021 or even earlier.

Finally, this outbreak has not only affected people’s normal lives, resulting in a decline in the utilization of medical resources but also affected the epidemiological distribution of prehospital emergency resources. Therefore, our study suggests that relevant departments need to find ways to minimize interference with the treatment and prevention of nonepidemic-related health problems and develop plans on how to return to pre-epidemic levels as soon as possible to guide people to seek medical treatment.

As far as we know, our study is the first to investigate how the local COVID-19 epidemic uniquely affects pre-hospital emergency care in the southwest region of China. Additionally, our study’s large sample size and complete data are advantages that reduce statistical errors and improve the results’ reliability and authenticity. However, our study also has some limitations. First, some diseases were classified according to a certain system, so the impact of the COVID-19 epidemic on a certain disease could not be analyzed. Second, our study included only one center, resulting in poor generalizability of the conclusions. We hope that a later multicenter study can be conducted, which would add weight to our conclusions. Third, there was no large-scale epidemic in Chengdu, resulting in the impact of the outbreak on prehospital first aid being underestimated.