scholarly journals Emergency medical services evaluations for chest pain during first COVID-19 lockdown in Hollands-Midden, the Netherlands

2021 ◽  
Vol 29 (4) ◽  
pp. 224-229 ◽  
Author(s):  
E. R. de Koning ◽  
M. J. Boogers ◽  
J. Bosch ◽  
M. de Visser ◽  
M. J. Schalij ◽  
...  
Keyword(s):  
Chest Pain ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Cardiac Symptoms ◽  
Emergency Medical ◽  
Time Period ◽  
Number Of Patients ◽  
St Elevation ◽  
Pain Patients ◽  
Hospital Cardiac Arrest

Abstract Objective To assess whether the COVID-19 lockdown in 2020 had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods All emergency medical services (EMS) transports for chest pain or out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served > 800,000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and during the same time period in 2019. The primary endpoint was the number of evaluated chest pain patients in both cohorts. In addition, the number of EMS evaluations of ST-elevation myocardial infarction (STEMI) and OHCA were assessed. Results During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, age 62 ± 17 years) compared with 1041 patients (51% male, 63 ± 17 years) in the same period in 2019, which corresponded with a significant relative risk (RR) reduction of 0.88 (95% confidence interval (CI) 0.81–0.96). Similarly, there was a significant reduction in the number of STEMI patients (RR 0.52, 95% CI 0.32–0.85), the incidence of OHCA remained unchanged (RR 1.23, 95% CI 0.83–1.83). Conclusion During the first COVID-19 lockdown, there was a significant reduction in the number of patients with chest pain or STEMI evaluated by the EMS, while the incidence of OHCA remained similar. Although the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be paid to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.

scholarly journals Emergency medical service evaluations for chest pain during the COVID-19 lockdown in Hollands-Midden, the Netherlands

2020 ◽  
Author(s):  
Enrico de Koning ◽  
Mark Boogers ◽  
Jan Bosch ◽  
Matthijs de Visser ◽  
Martin Schalij ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Relative Risk Reduction ◽  
Cardiac Symptoms ◽  
Emergency Medical ◽  
St Elevation ◽  
Pain Patients ◽  
Hospital Cardiac Arrest

Abstract Objective: To assess whether the COVID-19 lockdown might have had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods: All emergency medical service (EMS) rides for chest pain and out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served >800.000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and compared to the same period in 2019 in two cohorts. The primary end-point was the incidence of evaluated chest pain patients during the COVID-19 lockdown. In addition, the incidence of EMS evaluations of ST elevation myocardial infarction (STEMI) and OHCA were assessed.Results: During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, 62±17 years) as compared to 1041 patients (51% male, 63±17 years) in the same period in 2019 corresponding with a significant relative risk reduction of 0.88 (95% CI 0.81-0.96; P=0.006). Similarly, there was a significant reduction in the incidence of STEMI patients (RR 0.52; P=0.009) whereas the incidence of OHCA (RR 1.23; P=0.29) remained unchanged. Conclusion: During the COVID-19 lockdown, there was a significant decrease in patients with chest pain evaluated by the EMS paralleled by a reduction in STEMIs, while the incidence of OHCA remained similar. While the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be drawn to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.

scholarly journals Diurnal, weekly and seasonal variations of chest pain in patients transported by emergency medical services

2019 ◽  
Vol 36 (10) ◽  
pp. 601-607 ◽  
Author(s):  
Ziad Faramand ◽  
Stephanie O Frisch ◽  
Christian Martin-Gill ◽  
Parker Landis ◽  
Mohammad Alrawashdeh ◽  
...  
Keyword(s):  
Chest Pain ◽  
Infarct Size ◽  
Emergency Medical Services ◽  
Independent Predictor ◽  
Healthcare Providers ◽  
Medical Services ◽  
Emergency Medical ◽  
Acute Mi ◽  
St Elevation ◽  
Pain Patients

ObjectivesChest pain is among the leading causes for emergency medical services (EMS) activation. Acute myocardial infarction (MI) is not only one of the most critical aetiologies of chest pain, but also one of few conditions encountered by EMS that has been shown to follow a circadian pattern. Understanding the diurnal relationship between the inflow of chest pain patients and the likelihood of acute MI may inform prehospital and emergency department (ED) healthcare providers regarding the prediction, and hence prevention, of dire outcomes.MethodsThis was a secondary analysis of previously collected data from an observational prospective study that enrolled consecutive chest pain patients transported by a large metropolitan EMS system in the USA. We used the time of EMS call to determine the time-of-day of the indexed encounter. Two independent reviewers examined available medical data to determine our primary outcome, the presence of MI, and our secondary outcomes, infarct size and 30-day major adverse cardiac events (MACE). We estimated infarct size using peak troponin level.ResultsWe enrolled 2065 patients (age 56±17, 53% males, 7.5% with MI). Chest pain encounters increased from 9:00 AM to 2:00 PM, with a peak at 1:00 PM and a nadir at 6:00 AM. Acute MI had a bimodal distribution with two peaks: 10 AM in ST-elevation MI, and 10 PM in non-ST-elevation MI. ST-elevation MI with afternoon onset was an independent predictor of infarct size. Acute MI with winter and early spring presentation was an independent predictor of 30-day MACE.ConclusionsEMS-attended chest pain calls follow a diurnal pattern, with the most vulnerable patients encountered during afternoons and winter/spring seasons. These data can inform prehospital and ED healthcare providers regarding the time of presentation where patients are more likely to have an underlying MI and subsequently worse outcomes.

scholarly journals Symptoms reported in calls to emergency medical services 24 hours prior to out-of-hospital cardiac arrest

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Gnesin ◽  
E H A Mills ◽  
A L Moeller ◽  
B Jensen ◽  
N Zylyftari ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Pain ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Funding Source ◽  
Prodromal Symptoms ◽  
Emergency Calls ◽  
Funding Sources ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Abstract Background and purpose It remains unknown whether patients with out-of-hospital cardiac arrest (OHCA) experience prodromal symptoms. We aimed to investigate symptoms reported by patients with OHCA contacting emergency medical services (EMS) within 24 hours prior to arrest. Methods We linked OHCAs occurring from 2016 through 2018 to corresponding emergency calls occurring within 24 hours prior to arrest (defined as “pre-arrest calls”). These calls were included and evenly split and evaluated by authors. Results Among 4071 patients with OHCA, 481 patients (11.8%) had pre-arrest calls (59.9% males, median age 74 years) with a total of 539 calls. Figure 1 shows the reported symptoms across calls. The most commonly reported symptoms were breathing problems (59.4%), confusion (23.0%), unconsciousness (20.2%), chest pain (19.5%) and paleness (19.1%). The most common co-occurring symptom pairs were breathing problems in combination with paleness (14.5%), confusion (14.1%), unconsciousness (13.5%), sweating (13.0%) and chest pain (11.9%), respectively. An urgent response was dispatched in 68.7% of calls containing breathing problems compared to 83.0% of calls containing chest pain. Conclusion Among patients with OHCA, 11.8% had a call to EMS within 24 hours prior to arrest and breathing problems was the most commonly reported symptom occurring in 59.4% of calls. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Danish Heart FoundationResearch Grant from Nordsjællands Hospital Figure 1

scholarly journals Demographic, Belief, and Situational Factors Influencing the Decision to Utilize Emergency Medical Services Among Chest Pain Patients

Circulation ◽  
2000 ◽  
Vol 102 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Adam L. Brown ◽  
N. Clay Mann ◽  
Mohamud Daya ◽  
Robert Goldberg ◽  
Hendrika Meischke ◽  
...  
Keyword(s):  
Chest Pain ◽  
Emergency Medical Services ◽  
Situational Factors ◽  
Medical Services ◽  
Factors Influencing ◽  
Emergency Medical ◽  
Pain Patients

Triage Ability of Emergency Medical Services Providers and Patient Disposition: A Prospective Study

1999 ◽  
Vol 14 (3) ◽  
pp. 67-72 ◽  
Author(s):  
John R. Richards ◽  
Stephen J. Ferrall
Keyword(s):  
Chest Pain ◽  
Emergency Medical Services ◽  
Patient Characteristics ◽  
University Hospital ◽  
Medical Services ◽  
Shortness Of Breath ◽  
Study Objective ◽  
Patient Disposition ◽  
Emergency Medical ◽  
Respiratory Complaints

AbstractStudy objective:To determine the ability of emergency medical services (EMS) providers to subjectively triage patients with respect to hospital admission and to determine patient characteristics associated with increased likelihood of admission.Methods:A prospective, cross-sectional study of a consecutive sample of patients arriving by ambulance during the month of February 1997 at an urban, university hospital, Emergency Department. Emergency medical services providers completed a questionnaire asking them to predict admission to the hospital and requested patient demographic information. Predictions were compared to actual patient disposition.Results:A total of 887 patients were included in the study, and 315 were admitted to the hospital (36%). With respect to admission, emergency medical services providers had an accuracy rate of 79%, with a sensitivity of 72% and specificity of 83% (kappa = 0.56). Blunt traumatic injury and altered mental status were the most common medical reasons for admission. Variables significantly associated with high admission rates were patients with age > 50 years, chest pain or cardiac complaints, shortness of breath or respiratory complaints, Medicare insurance, and Hispanic ethnicity. The emergency medical services providers most accurately predicted admission for patients presenting with labor (kappa = 1.0), shortness of breath / respiratory complaints (kappa = 0.84), and chest pain (kappa = 0.77).Conclusion:Emergency medical services providers can predict final patient disposition with reasonable accuracy, especially for patients presenting with labor, shortness of breath, or chest pain. Certain patient characteristics are associated with a higher rate of actual admission.

scholarly journals Temperature and age–gender effects on out-of-hospital cardiac arrest cases

2018 ◽  
Vol 25 (2) ◽  
pp. 83-90
Author(s):  
Chien Tat Low ◽  
Poh Chin Lai ◽  
Paul Sai Shun Yeung ◽  
Axel Yuet Chung Siu ◽  
Kelvin Tak Yiu Leung ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hong Kong ◽  
Emergency Medical Services ◽  
Large Scale ◽  
Gender Effects ◽  
Medical Services ◽  
Curvilinear Relationship ◽  
Elderly Age ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Introduction: Temperature is a key factor influencing the occurrence of out-of-hospital cardiac arrest, yet there is no equivalent study in Hong Kong. This study reports results involving a large-scale territory-wide investigation on the impacts of ambient temperature and age–gender differences on out-of-hospital cardiac arrest outcome in Hong Kong. Methods: This study included 25,467 out-of-hospital cardiac arrest cases treated by the Hong Kong Fire Services Department between December 2011 and November 2016 inclusive. Simple correlation and regression analyses were used to examine the relationships between out-of-hospital cardiac arrest cases and temperature, age and gender. Calendar charts were used to visualise temporal patterns of pre-hospital emergency medical services related to out-of-hospital cardiac arrest cases. Results: A strong negative curvilinear relationship was found between out-of-hospital cardiac arrest and daily temperature (r2 > 0.9) with prominent effects on elderly people aged ≥85 years. For each unit decrease in mean temperature in °C, there was a maximum of 5.6% increase in out-of-hospital cardiac arrest cases among all age groups and 7.3% increase in the ≥85 years elderly age group. Men were slightly more at risk of out-of-hospital cardiac arrest compared with women. The demand for out-of-hospital cardiac arrest–related emergency medical services was highest between 06:00 and 11:00 in the wintertime. Conclusion: This study provides the first local evidence linking weather and demographic effects with out-of-hospital cardiac arrest in Hong Kong. It offers empirical evidence to policymakers in support of strengthening existing emergency medical services to deal with the expected increase in out-of-hospital cardiac arrest in the wintertime and in regions with a large number of elderly population.

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