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Background: The COVID-19 pandemic has resulted in unique pressures on the emergency services system. This study describes changes in the presentation, presenting severity and disposition of patients accessing emergency services in Calgary, Alberta, during the first wave of the pandemic. Methods: In this descriptive study, we constructed a population cohort of all patients who accessed emergency services by calling emergency medical services (EMS) (ambulance service that provides prehospital treatment and transport to medical facilities) or presenting directly to an emergency department (4 adult and 1 pediatric) or 2 urgent care centres in Calgary during the exposure period (December 2019 to June 2020) compared to 2 historical control periods (December to June, 2017–2018 and 2018–2019) combined. Outcomes included frequency of presentation, system flow indicators, patient severity, disposition and mortality. We used a locally estimated scatterplot smoothing function to visualize trends. We described differences at the maximum and minimum point of the exposure period compared to the control period. Results: A total of 1 127 014 patient encounters were included. Compared to the control period, there was a 61% increase in the number of patients accessing EMS and a 35% decrease in the number of those presenting to an adult emergency department or urgent care centre in the COVID-19 period. The proportion of EMS calls for the highest-priority patients remained stable, whereas the proportion of patients presenting to an emergency department or urgent care centre with the highest-priority triage classification increased transiently by 0.9 percentage points (increase of 89%). A smaller proportion of patients were transported by EMS (decrease of 21%), and a greater proportion of emergency department patients were admitted to hospital (increase of 25%). After the first case was reported, the mortality rate among EMS patients increased by 265% (3.4 v. 12.4 per 1000 patient encounters). Interpretation: The first wave of the COVID-19 pandemic was associated with substantial changes in the frequency and disposition of patients accessing emergency services. Further research examining the mechanism of these observations is important for mitigating the impact of future pandemics.

Introduction The spread of COVID-19 has challenged the paramedic community's ability to provide health care, maintain personal safety, and implement evidence informed decisions and programs. The study objective was to examine the published literature related to paramedicine and pandemics. Methods A rapid review of research derived from an existing broad database of literature generated between 2006 and 2019 was used. We conducted a targeted secondary search of this database to identify studies of pandemics in paramedicine contexts and included three levels of screening. We used content analysis to identify broad themes and subthemes, and provide summaries and descriptions of each. Results From 54,638 citations, our search identified 24 citations representing eight countries. The most common method of enquiry was cross-sectional survey (n=10). Five broad themes (and 15 subthemes) were identified: general planning and preparedness (impact to paramedic service operations, roles and responsibilities, communication centre preparedness, paramedic service preparedness, training); workforce (availability of personal protective equipment, safety of family, perception of risk, trust in the organisation); ethics (duty, resource allocation); (triage (needless exposure to infection, transmission of disease); and vaccination (vaccination information, organisational readiness). Conclusion The evidence base describes the importance of pandemic planning and preparedness for emergency medical services and integrating these activities into broader public health and healthcare system plans. Although this rapid review provides a foundation to support response plans and research, it is considered ‘just in time’ for the evolving pandemic, and further work understanding research in paramedicine and pandemics is recommended.

BackgroundA recent mixed-methods study on the state of emergency medical services (EMS) research in Canada led to the generation of nineteen actionable recommendations. As part of the dissemination plan, a survey was distributed to EMS stakeholders to determine the anticipated impact and feasibility of implementing these recommendations in Canadian systems.MethodsAn online survey explored both the implementation impact and feasibility for each recommendation using a five-point scale. The sample consisted of participants from the Canadian National EMS Research Agenda study (published in 2013) and additional EMS research stakeholders identified through snowball sampling. Responses were analysed descriptively using median and plotted on a matrix. Participants reported any planned or ongoing initiatives related to the recommendations, and required or anticipated resources. Free text responses were analysed with simple content analysis, collated by recommendation.ResultsThe survey was sent to 131 people, 94 (71.8%) of whom responded: 30 EMS managers/regulators (31.9%), 22 researchers (23.4%), 15 physicians (16.0%), 13 educators (13.8%), and 5 EMS providers (5.3%). Two recommendations (11%) had a median impact score of 4 (of 5) and feasibility score of 4 (of 5). Eight recommendations (42%) had an impact score of 5, with a feasibility score of 3. Nine recommendations (47%) had an impact score of 4 and a feasibility score of 3.ConclusionsFor most recommendations, participants scored the anticipated impact higher than the feasibility to implement. Ongoing or planned initiatives exist pertaining to all recommendations except one. All of the recommendations will require additional resources to implement.

Understanding the energy consumption and emissions associated with health services is important for minimizing their environmental impact and guiding their adaptation to a low-carbon economy. In this post-hoc analysis, we characterize the energy burden of North American emergency medical services (EMS) agencies and estimate the potential marginal damage costs arising from their emissions as an example of how and why health services matter in environmental and energy policy, and how and why environmental and energy policy matter to health services. We demonstrate EMS systems are energy intensive, and that vehicle fuels represent 80% of their energy burden while electricity and natural gas represent 20%. We also demonstrate that emissions from EMS operations represent only a small fraction of estimated health sector emissions, but for EMS systems in the United States the associated marginal damage costs are likely between $2.7 million and $9.7 million annually. Significant changes in the supply or price of energy, including changes that arise from environmental and energy policy initiatives designed to constrain fossil fuel consumption, could potentially affect EMS agencies and other health services. We encourage cross disciplinary research to proactively facilitate the health system's adaptation to a low-carbon economy.

[Extract] Background. With mounting insecurity over domestic fuel supplies and public pressure to reduce environmental pollution, it is essential that emergency medical services (EMS) systems have valid energy use data to make evidence-based decisions on system sustainability and fuel shortage contingency planning. Previous research has demonstrated that EMS systems routinely collect energy consumption data needed to calculate greenhouse gas emissions directly produced by their operations (a Tier 2 carbon footprint), and has quantified emissions from a sample of North American EMS systems. Those previous efforts, however, depended in part on estimated data. Objective. The purpose of this secondary analysis was to explore the extent to which the previously reported carbon footprint data relied on estimated energy consumption, which may have artificially inflated reported greenhouse gas emissions. Methods. Fifteen diverse North American EMS systems previously provided energy consumption data, with 10 systems providing complete Tier 2 carbon footprint data for a full year. Data forms were reviewed to determine the proportion of overall emissions produced from estimated versus directly measured energy consumption among the 10 systems providing complete Tier 2 data. Results. Of the 30,627,046 pounds of carbon dioxide equivalents (CO2e) produced by the 10 services, 96.5%% arose from measured energy consumption and 1.8%% arose from estimated energy consumption; the nature of the source data for 1.8%% of the reported energy consumption could not be determined. Emission sources that contributed most to the EMS carbon footprint were also the sources with the highest proportion of direct measurement, including diesel fuel (99.5%% measured), natural gas (98.7%% measured), gasoline (90.1%% measured), and electricity (88.4%% measured). Liquid propane (31.3%% measured), business air travel (23.5%% measured), and compressed natural gas (0.0%% measured) were the most frequently estimated energy sources, but these accounted for less than 1%% of the previously reported EMS carbon footprint. Conclusion. A high proportion of the energy consumption data incorporated into the previously reported EMS carbon footprint are directly measured, not estimated. This suggests that data informing the calculated EMS-related greenhouse gas emissions are valid, and that estimated energy consumption more likely resulted in underrepresentation, rather than overrepresentation, of the carbon footprint of North American EMS systems.

Objective. In this proof-of-concept study, we evaluated the availability of emergency medical services (EMS) system energy consumption data required to calculate a carbon footprint. Methods. Two diverse North American EMS systems with more than 125,000 combined annual unit responses agreed to report their energy consumption for the last fiscal or calendar year using a data-collection tool based on Carbon Trust recommendations. They also identified the source of information (e.g., bills, logs, receipts), whether the amounts reported were directly measured or estimated, and whether any of the amounts were prorated from shared facilities (e.g., electricity for a shared office building). For this proof-of-concept study, we report only descriptive data about the availability of data and aggregate carbon emissions. Results. Both systems reported diesel fuel, gasoline, and electricity consumption. One system used natural gas; one system used aviation fuel. Direct measurement of consumption using utility bills and statements was possible for these energy types. One system prorated natural gas and electricity usage; one system was able to estimate commercial air travel. Annual carbon dioxide (CO2) emissions for these two systems totaled 11.1 million pounds of CO2. The largest source of CO2 emissions was diesel fuel (39%), followed by electricity (23%). Conclusion. These EMS systems were able to provide the data necessary to determine their carbon footprints. Future research could include broader study to establish EMS-specific norms for carbon emissions, benchmarking of these metrics between different EMS systems, and the assessment of programs designed to reduce EMS carbon emissions.