In a province with a relatively low incidence of COVID-19, we demonstrate that all-cause EMS utilization decreased by 15% when compared with a historical control; while trauma, stroke, and STEMI decreased by 9%, and cardiac arrests did not decrease. Importantly, EMS calls for respiratory complaints and anxiety increased significantly during this time, similar to Israeli data . Our findings extend to all health regions, and patient decisions to contact the ambulance were not associated with local COVID-19 incidence.
Studies have shown an apparent short-term decrease in EHS encounters [1, 9], or hospital visits for chest pain or myocardial infarction , stroke,  but a potential increase in OHCA . These data have arisen from regions with higher incidences of COVID-19. Despite BCs low incidence, our results indicate significantly decreased EHS encounters across a broad spectrum of complaints, including critical illness. Patients might be reluctant to seek help due to concerns about contacting COVID-19, or a desire to not “burden” the health care system, perhaps bolstered by reports from regions that have been dramatically affected.
The reasons for decreased EHS encounters is unclear, illustrated by the disconnect between regional COVID-19 incidence and changes in encounters. Different health regions may have a different population age and comorbidity profile, and older, sicker patients may contact EHS at different rates. Furthermore, patients may have contacted EHS due to lack of primary care, and this may have been different between regions.
These findings are important to EHS and ED planners and clinicians. While some might defer calling EHS or attending an ED without consequence, critical illness cannot be deferred, and such patients will need to eventually attend an ED. For example, delayed STEMI could lead to severe complications such as heart failure, arrhythmia, or valve dysfunction, as observed in Italy . Furthermore, with the corresponding increase in anxiety-related complaints, EHS and ED planners should ensure that mental health capacity is increased.
This analysis has limitations common to similar recent studies [1,2,3,4,5, 9, 10] including a short time frame at the start of the pandemic and unclear future directions. Inclusion of years prior to 2019 may have provided a different baseline. Paramedics classified all codes and interobserver reliability is unknown, but there is no evidence to suspect systematically different coding during the pandemic. Data are aggregated and results, therefore, unadjusted for age, comorbidity, illness severity, availability of primary care, or repeat visits; it is possible certain groups of patients are over- or underrepresented in our population.