The Impact of the COVID-19 Pandemic on Utilization of Emergency Medical Services (EMS) in New York City (NYC)

Author(s):
Megan Donnelly; Kate Kirby; Anthony Chau; Sebastian Schubl; Philip Barie

Background:

During the early coronavirus disease 2019 (COVID-19) pandemic, utilization of both elective and emergency health care services decreased. Public health advocates advised patients to defer elective care in order to manage inflows of infected patients, whereas other patients avoided acute-care facilities for fear of becoming infected. Stay-at-home orders, closures of businesses, and curtailment of surgical services correlated with fewer emergency department visits, particularly for injury care. This study evaluates patterns in utilization of EMS in NYC, the “epicenter” of the first “wave” of the pandemic (March 20-June 15, 2020), in 2019 (pre-pandemic) and afterward.

Hypothesis:

We hypothesize that EMS call volumes decreased overall in NYC during the early phase of the pandemic, specifically with respect to trauma/injury calls. By contrast, we posit that calls for “sick” events (i.e., fever, nausea, rash, or cough) increased, given rising fear of virus transmission.

Methods:

Retrospective NYC EMS calls data (1/1/2019-7/31/2020) were obtained from NYC Open Data/EMS Incident Dispatch, an open-access database that is maintained by the Fire Department of NYC. Total EMS calls, trauma/injury calls, and sick event calls were collected for NYC overall and for all five boroughs (Bronx, Brooklyn, Manhattan, Queens and Staten Island). United States Census data for each borough were used to weight daily EMS calls per 100,000 individuals. Mann-Whitney U tests were used to compare pre-pandemic (2019-March 2020) vs. pandemic (4/1/2020-7/31/2020) EMS call volumes, α=0.05.

Results:

Median daily EMS calls decreased 21.8% overall at the start of the pandemic (pre-pandemic: 3,262 calls; pandemic: 2,556 calls, p<0.001), and similarly when stratified by borough and indexed per population median daily total EMS calls per 100,000 individuals decreased during the COVID-19 pandemic (all p<0.001) (Table).

Locale	NYC	Bronx	Brooklyn	Manhattan	Queens	Staten Island
Pre-Pandemic	39.1	55.4	35.3	49.0	27.9	28.8
Pandemic	31.8	46.3	28.4	37.0	23.6	23.5

Median daily trauma/injury and sick event calls per 100,000 also decreased in NYC and the five boroughs from pre-pandemic to pandemic time periods (all p<0.001).

Conclusions:

These data reflect an unprecedented window into EMS utilization during an infectious disease pandemic. Call volumes in NYC changed considerably in the wake of the pandemic. Surprisingly, even calls for sick events decreased, which may be attributed to patients avoiding accessing the 911 system due to a perceived risk of COVID-19 disease acquisition. Decreased EMS utilization for multiple conditions likely reflects delayed or impeded access to care for many patients. Utilization data have important implications for provision of acute care services during possible future disruptions related to the pandemic.