Decline in emergency medical service missions during the COVID-19 pandemic: results from the fifth largest city in Germany (original) (raw)
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Open Access Emergency Medicine, 2021
Introduction: This retrospective cohort analysis examines the impact of the COVID-19 pandemic in the prehospital setting in Germany. The data of two emergency physician response units of a northern German region with 1.2 million citizens was analyzed retrospectively. Materials and Methods: We analyzed the period March 16 to April 16 for the year 2020 when the lockdown took place in Germany and compare the results for the same period for the year 2019 and 2018. 1004 patients were included. Demographic data, the type of rescue missions, the number of missions per day, the National Advisory Committee for Aeronautics Score (NACA-score), the frequency of respiratory emergencies (COVID-19 and non-COVID-19 associated), as well as the number of deaths were documented. Results: Mean age was 62.3±24.8 years and 576 (56.5%) were male. Number of missions were 397, 403 and 333 in 2018, 2019 and 2020 respectively. The control room registered a 22% reduction of rescue missions for the year 2020. Even the amount of emergency calls via the emergency number 112 was reduced by 17.4% between 2018 and 2020. 150 (14.9%) missions were due to respiratory emergencies. In 2020 10 missions (28.6% of respiratory emergencies) were COVID-19 related. In 2020 the NACA score increased significantly. Conclusion: We found a decreasing effect of the COVID-19 pandemic in Germany on the number of emergency calls as well as missions, and an increase of the severity of cases in preclinical care for a northern German region with 1.2 million citizens. The effect of these findings caused by COVID-19 on the health care system remains to be seen.
BMC Public Health, 2023
Background During the COVID-19 pandemic and associated public health and social measures, decreasing patient numbers have been described in various healthcare settings in Germany, including emergency care. This could be explained by changes in disease burden, e.g. due to contact restrictions, but could also be a result of changes in utilisation behaviour of the population. To better understand those dynamics, we analysed routine data from emergency departments to quantify changes in consultation numbers, age distribution, disease acuity and day and hour of the day during different phases of the COVID-19 pandemic. Methods We used interrupted time series analyses to estimate relative changes for consultation numbers of 20 emergency departments spread throughout Germany. For the pandemic period (16-03-2020-13-06-2021) four different phases of the COVID-19 pandemic were defined as interruption points, the pre-pandemic period (06-03-2017-09-03-2020) was used as the reference. Results The most pronounced decreases were visible in the first and second wave of the pandemic, with changes of − 30.0% (95%CI: − 32.2%; − 27.7%) and − 25.7% (95%CI: − 27.4%; − 23.9%) for overall consultations, respectively. The decrease was even stronger for the age group of 0-19 years, with − 39.4% in the first and − 35.0% in the second wave. Regarding acuity levels, consultations assessed as urgent, standard, and non-urgent showed the largest decrease, while the most severe cases showed the smallest decrease. Conclusions The number of emergency department consultations decreased rapidly during the COVID-19 pandemic, without extensive variation in the distribution of patient characteristics. Smallest changes were observed for the most severe consultations and older age groups, which is especially reassuring regarding concerns of possible long-term complications due to patients avoiding urgent emergency care during the pandemic. † Annette Aigner and Alexander Ullrich contributed equally to this work.
International Journal of Engineering Research and Technology (IJERT), 2021
https://www.ijert.org/determining-the-preparedness-of-the-german-government-and-medical-authorities-in-handling-covid-19-crisis https://www.ijert.org/research/determining-the-preparedness-of-the-german-government-and-medical-authorities-in-handling-covid-19-crisis-IJERTCONV9IS02005.pdf In this paper, we try and analyse the trends in the spread of COVID-19 in the German population. We look into the statistical significance of the lockdown enforced by the German authorities in curbing the spread of the virus across the German population. We also try to develop a forecasting model to predict the number of infected patients & fatalities arising out of the infection. As part of this study, we obtained the dataset from 2 sources, namely Kaggle & Institute of Health Metrics & Evaluation (IHME). The datasets had data like number of cases, age-group of patient, number of available beds, number of tests done on a given day across the 2 datasets & the datasets were merged based different criterion like State, County, Date of Infection, etc. The dataset had data from 24-Jan-2020 up till 3-June-2020, and the same was obtained from across the 16 German states & their individual counties. Statistical methods like t-Test & ANOVA resulted in extremely low p-values, based on which we can say with 99% confidence level that the different measures undertaken by German authorities, especially the imposition of a nationwide lockdown, had a statistically significant impact on controlling the spread of the SARS-CoV-2 virus in Germany. Visually we saw that the SARS-CoV-2 virus spread rose significantly in the pre-lockdown period (which we have assumed to be till 07-April-2020) and then started slowly tapering off. This also helped avoid severe stress on the medical institutions & we once again saw visually that the hospital admission rate was always below the rate at which new hospital beds were being added daily. This was also vindicated in our time-series forecasting model using Prophet, an open-source forecasting library from Facebook. Based on the above, we could statistically prove that the timely measures and steps taken by German authorities, like imposition of the lockdown, helped in both controlling the spread of COVID-19 across Germany, as well as kept the rate of fatalities due to the same at a relatively low rate.
Collateral damage of COVID-19-lockdown in Germany: decline of NSTE-ACS admissions
Clinical Research in Cardiology
The SARS-CoV-2-Pandemic reaching Germany in March 2020 led to a nationwide lockdown with serious restrictions on public life. Based on the experiences of the tsunami-like waves of infections in other European countries, Germany was preparing for a massive load of severe COVID-19-cases by increasing the number of intensive-care-beds and by cancelling the majority of elective medical procedures to provide as many hospital beds as possible. We conducted a retrospective review of ACS-admissions to the Heart Center Ludwigshafen, an academic tertiary heart center in Germany (using ICD-codes I20.0; I21.0, I21.1 and I21.4). We compared the period March 1st to April 21st in 2020 with the same time period in the years 2017-2019 as reference. We did the same analysis for January and February 2017-2020 to show average numbers of ACS cases over the years. During the COVID-19 lockdown in Germany in March/ April 2020, we observed unchanged numbers for STEMIadmissions, but a significant 50% reduction in NSTE-ACS, in both UA and NSTEMI (Fig. 1). Similar findings were previously reported in Austria and Italy [1, 2]. We compared patient characteristics of ACS patients during the COVID-lockdown with the same time period of the year 2019 (Table 1). We did not find any relevant differences in the patient characteristics during the COVID-lockdown as compared to the year before. The current data do not provide any indication of who of the ACS population was not admitted to the hospital during the COVID-lockdown. We provide data on troponin values of all NSTEMI patients for the two time periods in 2019 and 2020 in the table. The troponin values reported are the maximal values on the first 2 days * A. K.
Public Health in Europe during the Covid-19 Emergency
International journal of business and social science, 2020
In line with what has happened in other sectors of the Public Administration, where the change process has, as an objective, the search for efficiency and efficacy, in Italy, the awareness that an efficient, effective and equal healthcare service is a major success factor for the socioeconomic development of each is growing. The healthcare system is at the centre of great attention, having to demonstrate the adequate use of constantly decreasing available resources against a growing healthcare demand. This entails an incentive oriented toward the ability to improve services. Such need has been consolidating in the overall corporatization process, leading to a growing orientation toward performance and to the use of programming tools. In this context must be considered the diseases characterized by the length of the healthcare assistance plan and high complexities in terms of treatments and complications. Such diseases are relevant in epidemiological terms and also in terms of resources employed and improvement potential from the point of view of intervention policies, of public healthcare offer and of efficiency. The above may refer to the healthcare emergency still in place following the spread of the COVID-19 virus, employing an enormous amount of resources from both a human and a financial point of view. SARS-CoV-2, a serious threat to sustainable development prospects, is spreading within countries at varying speeds, among other things depending on their population density, behavioural responses, cultural factors, personal hygiene practices and habits. This has led to significant variation in countries' policy responses aimed at stemming the proliferation of the virus. Using crisp-set qualitative comparative analysis, we conducted a comparative study at the European level to study the performance of different combinations of COVID-19 containment measures along with the response speeds. A set of configurations for two different scenarios (above-and below-median death rates) helps to illustrate how specific containment measures in each examined European country are related to the number of deaths. The main observation arising from the analysis is that the speed of response along with the decision to suspend international flights might determine the epidemic outbreak's impact on fatality. The results also imply that several different combinations of containment measures are associated with death rates across Europe. The outcome of this analysis can assist in identifying which set of containment measures in the event of an epidemic outbreak is beneficial/detrimental.This work considers combining theoretical considerations and empirical evidence related to the treatment of COVID-19, within what it is the success of public health measures in Europe during the COVID-19 emergency.
Frontiers in Public Health, 2021
The COVID-19 pandemic has caused strains on health systems worldwide disrupting routine hospital services for all non-COVID patients. Within this retrospective study, we analyzed inpatient hospital admissions across 18 German university hospitals during the 2020 lockdown period compared to 2018. Patients admitted to hospital between January 1 and May 31, 2020 and the corresponding periods in 2018 and 2019 were included in this study. Data derived from electronic health records were collected and analyzed using the data integration center infrastructure implemented in the university hospitals that are part of the four consortia funded by the German Medical Informatics Initiative. Admissions were grouped and counted by ICD 10 chapters and specific reasons for treatment at each site. Pooled aggregated data were centrally analyzed with descriptive statistics to compare absolute and relative differences between time periods of different years. The results illustrate how care process adop...
Disaster Medicine and Public Health Preparedness
Objective An unprecedented wave of patients with acute respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) hit Emergency Departments (EDs) in Lombardy, starting in the second half of February 2020. This study describes the direct and indirect impacts of the SARS-CoV-2 outbreak on an urban major-hospital ED. Methods Data regarding all patients diagnosed with COVID-19 presenting from February 1st to March 31st 2020 were prospectively collected, while data regarding non-COVID patients presenting within the same period were retrospectively retrieved. Results ED attendance dropped by 37% in 2020. Two-thirds of this reduction occurred early after the identification of the first autochthonous COVID-19 case in Lombardy, before lockdown measures were enforced. Hospital admissions of non-COVID patients fell by 26%. During the peak of COVID-19 attendance, the ED faced an extraordinary increase in: patients needing oxygen (+239%) or NIV (+7...
BMC Emergency Medicine, 2021
Background Recent studies have shown a decrease of admissions to accident and emergency (A&E) departments after the local outbreaks of COVID-19. However, differential trends of admission counts, for example according to diagnosis, are less well understood. This information is crucial to inform targeted intervention. Therefore, we aimed to compare admission counts in German A&E departments before and after 12th march in 2020 with 2019 according to demographic factors and diagnosis groups. Methods Routine data of all admissions between 02.12.2019–30.06.2020 and 01.12.2018–30.06.2019 was available from six hospitals in five cities from north-western, eastern, south-eastern, and south-western Germany. We defined 10 diagnosis groups using ICD-10 codes: mental disorders due to use of alcohol (MDA), acute myocardial infarction (AMI), stroke or transient ischemic attack (TIA), heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), cholelithiasis or cholecystitis, back pain,...
International Journal on Integrated Education
This research investigates the Impact of Health Facilities and low death rate of COVID-19-in Germany compare to other European Countries. Data were collected from various secondary sources COVID-19 data base. According to results German health system with its up to 4 fold higher number regional public hospitals and topic of many political discussions might have been one factor to keep mortality rate -according to the given database- low. However German doctors, without out any medicine like colleges all over the world were as helpless as everywhere.One essential fact according the statements of reputed virologists might be an early discovery of Corona infection by sincere attention, focussed testing and early start of treatment. In Germany with its the easy access to health service in combination with the large number of hospitals might be the reason for the „lower“ death rate. Not to forget the tremendous engagement of highly qualified doctors and nurses who were willing and able t...
Clinical Research in Cardiology
Background In this retrospective routine data analysis, we investigate the number of emergency department (ED) consultations during the COVID-19 pandemic of 2020 in Germany compared to the previous year with a special focus on numbers of myocardial infarction and acute heart failure. Methods Aggregated case numbers for the two consecutive years 2019 and 2020 were obtained from 24 university hospitals and 9 non-university hospitals in Germany and assessed by age, gender, triage scores, disposition, care level and by ICD-10 codes including the tracer diagnoses myocardial infarction (I21) and heart failure (I50). Results A total of 2,216,627 ED consultations were analyzed, of which 1,178,470 occurred in 2019 and 1,038,157 in 2020. The median deviation in case numbers between 2019 and 2020 was − 14% [CI (− 11)–(− 16)]. After a marked drop in all cases in the first COVID-19 wave in spring 2020, case numbers normalized during the summer. Thereafter starting in calendar week 39 case number...