The Impact of the Coronavirus Disease 2019 (Covid-19) Pandemic on the Use of Emergency Medical Services System in Bangkok, Thailand

"Smart Emergency Call Point" Enhancing Emergency Medical Services on University Campuses

INTRODUCTION

The "Smart Emergency Call Point" is a device designed for requesting assistance and facilitating rapid responses to emergencies. The functionality of smart emergency call points has evolved to include features as real-time photo transmission and communication capabilities for both staff and emergency personnel. These devices are being used to request Emergency Medical Services (EMS) on university campuses. Despite these developments, there has been a lack of previous studies demonstrating significant advantages of integrating smart emergency call points into EMS systems.

STUDY OBJECTIVE

The primary goal of this study was to compare the response times of EMS between traditional phone calls and the utilization of smart emergency call points located on university campuses. Additionally, the study aimed to provide insights into the characteristics of smart emergency call points as a secondary objective.

METHODS

This retrospective database analysis made use of information acquired from Thailand's EMS at Srinagarind Hospital. The data were gathered over a period of four years, specifically from January 2019 through January 2022. The study included two groups: the first group used the phone number 1669 to request EMS assistance, while the second group utilized the smart emergency call point. The primary focus was on the response times. Additionally, the study documented the characteristics of the smart emergency call points that were used in the study.

RESULTS

Among the 184 EMS operations included in this study, 60.9% (N = 56) involved females in the smart emergency call point group. Notably, the smart emergency call point group showed a higher frequency of operations between the hours of 6:00am and 6:00pm when compared to the 1669 call group (P = .020). In dispatch triage, the majority of emergency call points were categorized as non-urgent, in contrast to the phone group for 1669 which were primarily cases categorized as urgent (P = .010). The average response time for the smart emergency call point group was significantly shorter, at 6.01 minutes, compared to the phone number 1669 group, which had an average response time of 9.14 minutes (P <.001).

CONCLUSION

In the context of calling for EMS on a university campus, the smart emergency call points demonstrate a significantly faster response time than phone number 1669 in Thailand. Furthermore, the system also offers the capability to request emergency assistance.

Utilisation of and factors associated with non-COVID-19 healthcare services in public facilities amongst cross-border migrants in Thailand, 2019-2022

BACKGROUND

It is believed that the COVID-19 pandemic might disrupt routine healthcare services. A vulnerable group such as cross-border migrants is of critical concern if the pandemic affects their service utilisation. In this study, we aim to explore the impact of COVID-19 and other related factors on non-COVID-19 service amongst cross-border migrants in Thailand.

METHODS

We conducted an ecological time-series cross-sectional analysis using secondary data from 2019 to 2022, focusing on insured and non-insured migrants in a unit of a provincial monthly quarter. We obtained data on registered migrants from the Ministry of Labour and inpatient visits from the Ministry of Public Health (MOPH). Our analysis involved descriptive statistics and a random-effects negative binomial regression, considering variables such as COVID-19 cases, number of hospital beds, registered regions, and COVID-19 waves. We assessed inpatient utilisation number and rate as our primary outcomes.

RESULTS

The admission numbers for insured and non-insured migrants in all regions increased 1.3-2.1 times after 2019 despite a decrease in the numbers of registered migrants. The utilisation of services for selected communicable and non-communicable diseases and obstetric conditions remained consistent throughout 2019-2022. The admission numbers and rates were not associated with an increase in COVID-19 incidence cases but significantly enlarged as time passed by compared to the pre-COVID-19 period (44.5-77.0% for insured migrants and 15.0-26.4% for non-insured migrants). Greater Bangkok saw the lowest admission rate amongst insured migrants, reflected by the incidence rate ratio of 5.7-27.5 relative to other regions.

CONCLUSION

The admission numbers and rates for non-COVID-19 healthcare services remained stable regardless of COVID-19 incidence. The later pandemic waves (Delta and Omicron variants) were related to an increase in admission numbers and rates, possibly due to disruptions in outpatient care, leading to more severe cases seeking hospitalisation. Lower admission rates in Greater Bangkok may be linked to the fragmentation of the primary care network in major cities and the disintegration of service utilisation data between private facilities and the MOPH. Future research should explore migrant healthcare-seeking behaviour at an individual level, using both quantitative and qualitative methods for deeper insights.

Characteristics and Outcomes of Patient Transport to the Hospital by Emergency Medical Services (EMS); a Cross-sectional Study

Introduction

To enhance the efficiency, it is essential to understand the patterns of service users and develop policies that facilitate effective personnel and resource management. This study aimed to compare the characteristic and outcomes of patients who were transferred to emergency department (ED) by emergency medical services (EMS) and patients transported by other means.

Methods

This retrospective cross-sectional study was conducted at Srinagarind Hospital, Thailand, over a 5-year period from 2017-2021. The baseline characteristics, treatment modalities, and outcomes of patients who were transported to ED using EMS and Non-EMS were gathered and compared using STATA software.

Results

The study included 15,501 patients with the median age of 51 (interquartile range (IQR): 23-71) years who were referred by EMS over the five-year period (51.72% male). EMS patients had significantly higher median age (51 (23 - 71) vs. 37 (21 - 60); p < 0.001) with male preference (p < 0.001). In the EMS group, the triage level 1 (need for resuscitation) was higher than the non-EMS group (p < 0.001), most of the patients referred following trauma (p < 0.001), and the frequency of cardiac arrest was considerably higher than non-EMS group (2.54% vs 0.05%; p < 0.001). Patients in the EMS group received a higher number of blood tests (p < 0.001), plain radiographic exams (p < 0.001), computerized tomography (CT) scans (p < 0.001), and complex procedures (p < 0.001) than the non-EMS group. The EMS group had a greater number of hospital admissions (p < 0.001) and intensive care unit (ICU) admissions (p < 0.001) compared to the non-EMS group. The EMS group exhibited a significantly higher mortality rate compared to the non-EMS group (p < 0.001).

Conclusion

The population utilizing EMS services had higher median age, higher frequency of emergency cases and trauma related complaint, higher need for treatment interventions and imaging procedures, higher rate of hospital and ICU admissions, as well as higher rate of mortality compared to the non-EMS group.

Effect of the pandemic on prehospital management of patients with mental and behavioral disorders: a retrospective cohort study

The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection and the accompanying coronavirus disease (Covid-19) have shifted the priority of human and technical resources toward their handling, thus affecting the usual standards of care for populations diagnosed with other clinical entities. The phenomenon becomes even more apparent in patients with presenting symptoms of mental and behavioral disorders, a category already vulnerable and underrepresented in regard to its prehospital approach and management. For the purposes of the current retrospective cohort study, we used records of the Polish National Emergency Medical Service Command Support System for the time period between April 1, 2019 and April 30, 2021, the official register of medical interventions delivered in Poland by Emergency Medical Services (EMS). We aimed to examine the potential impact of the COVID-19 pandemic across the Masovian Voivodeship on individuals seeking medical care for mental and behavioral disorders pertaining in the "F" category of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). We examined the individuals' baseline characteristics, prehospital vital parameters and EMS processing times in a population of 59,651 adult patients (04/2019-03/2020, 28,089 patients, 04/2020-03/2021, 31,562 patients) handled by EMS teams. Compared to pre-COVID-19, EMS personnel handled fewer patients, but more patients required mental and behavioral care. Throughout the duration of the pandemic, all prehospital time periods were significantly delayed due to the increased time needed to prepare crew, vehicles, and technical equipment to ensure COVID-19 prevention and overcrowding in Emergency Departments (EDs).