[Evaluation of measures to reduce the number of emergency physician missions in Tyrol during the COVID-19 pandemic]

BACKGROUND: During the peak of the COVID-19 pandemic in spring 2020, the entire emergency rescue system was confronted with major challenges Starting on 15 March, all tourists were asked to leave the State of Tyrol, Austria The main goal of the efforts was to ensure the usual quality of emergency medical care while reducing the physical contact during emergency interventions on site METHODS: The Austrian Emergency Medical Service is physician-based, meaning that in addition to an ambulance team, an emergency physician (EP) is dispatched to every potential life-threatening emergency call In Tyrol and starting on 17 March 2020, 413 types of emergency call dispatches, which were addressed with an ambulance crew as well as an EP crew before COVID-19, were now dispatched only with an ambulance crew This procedure of dispatching differently as well as the general development of emergency calls during this period were analyzed from 15 March to 15 May 2020 and compared to the data from the same time period from 2017 to 2019 RESULTS: Despite the reduction of the population of around 30% because of absent tourists and foreign students staying in Tyrol, emergency calls with the operational keyword "difficulty in breathing/shortness of breath" rose by 18 7% (1533 vs 1291), while calls due to traffic incidents decreased by 26 4% (2937 vs 2161) Emergency calls with the dispatch of teams with an EP were reduced by 38 5% (1511 vs 2456 3), whereby the NACA scores III and IV were the ones with the significant reduction of 40% each For the reduced dispatchs, the additional dispatch of an EP team by the ambulance team amounted to 14 5%;however, for the keywords "unconscious/fainting" and "convulsions/seizures" the additional dispatch was significantly higher with over 40% each DISCUSSION: There was an overall reduction of emergency calls Considering, that the reduced dispatches would have led to an EP team dispatch the overall emergency doctor dispatches would have been higher than in the years before Our study was not able to find the reasons for this increase Only considering the additional dispatching of EPs, was this reduction in dispatching EP teams highly accurate, except for the symptoms of "unconscious/fainting" and "convulsions/seizures";however, the actual diagnoses that the hospitals or GPs made could not be collected for this study Therefore, it cannot be said for sure that there was equality in the quality of emergency medical care CONCLUSION: It was possible to achieve the primary goal of reducing the physical contact with patients;however, before keeping these reductions of the dispatching order regarding EPs for the routine operation, adaptions in these reductions as well as deeper evaluations under consideration of the data from hospitals and GPs would be necessary Also, different options to reduce physical contact should be evaluated, e g building an EMT-led scout team to evaluate the patient's status while the EP team is waiting outside