ESO COVID-19 EMS Surveillance Data

The following data were obtained from the ESO database consisting of more than 2,600 EMS agencies across the US. Prior to April 3, reported COVID-19 measures exclude data from the state of California. *

After climbing for virtually all of March it appears that the number of calls with COVID-19 Primary/Secondary impressions may be leveling off.  This could represent an actual decrease in EMS responses, or a change in EMS provider use of the COVID-19 primary impressions for some other reason.

Takeaways

• Continue to reinforce screening procedures and appropriate use of COVID-19 primary/secondary impressions.
• Monitor this information and the use of PPE.  If this leveling truly represents a reduction in COVID-related EMS calls we would expect to see some shift in the use of PPE, particularly surgical and N95 masks.

Given that we are facing a novel coronavirus, adding context using existing influenza and viral respiratory illness surveillance methods may provide additional insight. To put this surveillance data in a historical context, we’ve combined two groups of records based on EMS provider primary and secondary impressions: 1) COVID-19 and 2) Influenza-Like Illnesses (ILI).
This graph displays records with COVID-19 or ILI EMS provider impressions as a proportion of all 911 records.

It is important to note that these data are for ALL 911 responses, not just records with COVID-19 EMS provider impressions. So, the total number of uses is significantly higher than the number of suspected COVID-19 responses.  Like the primary impression graph above we’ve seen a steady rise in the use of all PPE during the month of March, with the greatest increases in N95 and eye protection.  However, like with primary/secondary impressions, there may be evidence of a leveling off of PPE use in early April.

Takeaways

• CDC recommendations for respiratory PPE for patients who do NOT require “aerosolizing procedures” (high flow nasal oxygen, advanced invasive airway insertion, CPR) are “Facemasks are an acceptable alternative until the supply chain is restored.”  Additional recommendations include eye protection, surgical mask, gloves, and gown.  The guidelines recommend reserving the use of (scarce) N95 respirators for patients requiring aerosolizing procedures.  Although there are some signs that pandemic spread is slowing, all predictions suggest that PPE will be required for respiratory symptoms at least through mid-summer, so it will be important to continue reinforcing appropriate PPE use with crews.

On March 27 “new” and “reused” options were activated for documentation of N95 use in order to better track actual N95 utilization.   A reminder that this graph represents N95 use for ALL 911 patients.

Takeaways

• In alignment with several other apparent trends, the total use of N95s appears to be leveling off since April 3, but additional data will be required to confirm.
• It does appear that reuse of N95s is increasing to nearly 50%. We’d encourage leaders to review their own reuse rates and to compare them with inventory figures to determine whether this document reflects an actual change in practice that could help to conserve N95 resources.

Although information from the CDC and WHO continue to indicate that most patients with COVID-19 have fairly minor complaints, these data suggest that, to date, most (60-90%) patients encountered by EMS have been transported to a medical facility.

Takeaways

• Share these data (and the disposition rates) with your receiving facilities to help them plan their COVID-19 staffing and PPE requirements.
• Anticipate that in light of this information many communities will begin to draft revised EMS guidelines to reduce hospital transports either through enhanced “treat and release” protocols or transport to alternative destinations.

EMS responses for patients with suspected COVID-19 cover the entire lifespan, with 46% of patients in the highest risk group over the age of 60.

Takeaways

• While CDC and WHO data clearly suggest that patients > 60 are most likely to develop severe complications and die, they are NOT the only patients at risk for COVID-19.
• Share these data with crews as a reminder that patients of any age may develop COVID-19 and require that crews don appropriate PPE. A presumption that younger patients are less likely to have the disease may result in unnecessary crew exposure and quarantine.

Approximately 2% of all patients with suspected COVID-19 required BLS or ALS airway interventions.

Takeaways

• These data are consistent with reports that the vast majority of patients are not experiencing severe symptoms and do not require ALS interventions of any kind.
• However, it is important to NOT become complacent during assessment. Impaired ventilation and/or oxygenation may require invasive airway management with increased risk for droplet exposure for crews. It’s noteworthy that most airways are managed without intubation, a practice you may choose to consider.

Approximately 8% of all patients with suspected COVID-19 received at least one medication. The most frequently used drug classes included antiemetics, bronchodilators, and drugs to reduce fever/manage pain.

Takeaways

• The majority of patients with suspected COVID-19 have not required medications. However, the patterns of medication administration suggest patients with airway compromise, inadequate cardiac output, ventilatory insufficiency, fever, and discomfort.
• Careful assessment of patients with suspected COVID-19 is necessary to distinguish between those with non-severe signs and symptoms and those who need critical care interventions.

*This page will be updated daily Monday through Friday. Data are published with a 48-hour delay to allow adequate time for providers to complete and lock records.

The following reports include records with an EMS provider primary or secondary impression of:

COVID-19 – Confirmed by testing
COVID-19 – Exposure to confirmed patient
COVID-19 – Suspected – no known exposure

Because these reports are based on EMS provider impression and information available in the out-of-hospital setting, these records may or may not represent confirmed COVID-19 cases.