Incidence and Mortality in Emergency Patients Transported by Emergency-Medical-Service Personnel During the First Surge COVID-19 Pandemic in Osaka Prefecture, Japan; A Population-Based Study

Background: Novel corona virus (COVID-19) outbreaks have spread worldwide. Although the COVID-19 pandemic affects the emergency medical service (EMS) system, which is one factor of primary care, little is known about its impact. This study aimed to reveal the impact of the COVID-19 pandemic on the EMS system and outcome of emergency patients transported by ambulance in Osaka Prefecture, Japan. Methods: This was a retrospective study with a study period from 1 January 2020 to 31 May 2020. We included patients transported by ambulance who were registered in a population-based registry of emergency patients transported by ambulance. The primary endpoints of this study were the incident number of patients transported by ambulance each month and the number of deaths among emergency patients admitted to hospital each month. We calculated the incidence rate ratio (IRR) and 95% confidence interval (CI) using a Poisson regression model with year 2019 as the reference. Findings: From January to May 2019, 205,195 patients were transported, whereas from January to May 2020, 180,362 patients were transported, indicating a significant decrease in the number of emergency patients transported by ambulance (IRR: 0.88, 95% CI: 0.87–0.88). The number of deaths among emergency patients admitted to hospital was 5237 in January-May 2019 and remained unchanged at 5172 in January-May 2020 (IRR: 0.99, 95% CI: 0.95–1.03). Interpretation: The first surge of the COVID-19 pandemic had no adverse effect on the EMS system in Osaka Prefecture, Japan. Funding: Japanese Society of the Promotion of Science KAKENHI (grant no. JP18H02902). Declaration of Interests: All authors of this manuscript declared that they have no conflicts of interest that relate to the content of this manuscript. Ethics Approval Statement: This study was approved by the Ethics Committee of Osaka University Graduate School of Medicine (approval no. 15003).