How the COVID-19 Epidemic Affected Prehospital Emergency Medical Services in Tehran, Iran

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has substantially impacted the healthcare delivery system in Tehran, Iran The country's first confirmed positive test for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was on February 18, 2020 Since then, the number of cases has steadily increased in Iran and worldwide Emergency medical services (EMS) quickly adapted its operations to accommodate a greater number of patients, and it worked to decrease the risk of COVID-19 spread among EMS personnel, given the disease's high transmissibility METHODS: We evaluated the chief complaint as well as the pattern and number of EMS calls and dispatches during the 28-day intervals before and after the February 18, 2020, COVID-19 outbreak in Iran RESULTS: EMS calls increased from 355,241 in the pre-outbreak period to 1,589,346 in the post-outbreak period, a 347% increase (p<0 001) EMS dispatches rose more modestly from 82,282 to 99,926, a 21% increase (p<0 001) The average time on telephone hold decreased from 10 6 ± 12 7 seconds pre-outbreak to 9 8 ± 11 8 seconds post-outbreak, a 7% decrease (p<0 001) The average length of call also decreased from 1 32 ± 1 42 minutes pre-outbreak to 1 06 ± 1 28 minutes post-outbreak, a 20% decrease (p<0 001) The highest number of daily dispatches occurred during the second and third weeks of the four-week post-outbreak period, peaking at 4557 dispatches/day After the first reported case of SARS-CoV-2, there were significant increases in chief complaints of fever (211% increase, p<0 001) and respiratory symptoms (245% increase, p<0 001) CONCLUSION: The number of EMS calls and dispatches in Tehran increased 347% and 20%, respectively, after the outbreak of COVID-19 Despite this, the time on hold for EMS response decreased The Tehran EMS system accomplished this by increasing personnel hours, expanding call-center resources, and implementing COVID-19-specific training