Author/Authors :
Kalani, Navid Research Center for Social Determinants of Health - Jahrom University of Medical Sciences - Jahrom, Iran , Hatami, Naser Jahrom University of Medical Sciences - Jahrom, Iran , Ali, Sajed Department of Biotechnology - University of Management and Technology - Sialkot, Pakistan , Mehramiz, Neema John Department of Psychiatry Neurology - Banner University Medical Center - Tucson - Arizona, USA , Rahmanian, Fatemeh Department of Emergency Medicine - Jahrom University of Medical sciences - Jahrom, Iran , Raeyat Doost, Esmaeil Department of Emergency Medicine - Jahrom University of Medical sciences - Jahrom, Iran , Haghbeen, Marzieh Women’s Health and Disease Research Center - Jahrom University of Medical Sciences - Jahrom, Iran , Abiri, Samaneh Department of Emergency Medicine - Jahrom University of Medical sciences - Jahrom, Iran , Foroughian, Mahdi Department of Emergency Medicine - Mashhad University of Medical sciences - Mashhad, Iran , Ebrahimi, Mohsen Department of Emergency Medicine - Mashhad University of Medical sciences - Mashhad, Iran
Abstract :
To compare the characteristics of the emergency medical services (EMS) brought COVID-19
patients versus self-referred walk-in patients.
Methods: This was a Cross-sectional study of COVID-19 infected cases in Jahrom, south of Iran. Age,
sex, the symptoms of beginning days’ passing, respiratory distress, PO2 at arrival, admission length and inhospital
death were retrieved for confirming COVID-19 cases in the whole 2020 year. Respiratory distress was
considered as the sign that agitates the patient to call EMS care. Survival analysis was used to evaluate the
possible difference of the hospitalization outcome in EMS brought or Self-referred walk-in (SRW) patients.
Results: There was 704 (27.1%) registries patients transfer to the hospital by EMS and 1895 (72.9%) cases
with SRW referred to the hospital. The survival distributions for the EMS group were statistically significant
and lower than SRW group (p<0.05). Despite the SRW patients, respiratory distress was associated with lower
survival in EMS group (p<0.05). Days passing the symptom’s beginning was significantly different between
EMS group (6.1±5.3 days) and SRW group (6.9±4.6 days). Cox regression showed higher mortality rate in
patients higher than 75 years old in both groups (p<0.05). Higher PO2 at arrival was associated with lower
mortality rate of Hazard Ratio of 0.959 (p<0.001) and 0.903 (p<0.001) in EMS and SRW groups, respectively.
The history of heart disease and hypertension were associated with 1.011 and 1.088 times more than mortality
risk in EMS group; while cancer history was associated with 2.74 times more of mortality risk in SRW group.
Conclusion: It seems that severe acute respiratory syndrome occurs soon in some patients that lead to the need
for an ambulance to transfer the patient to the hospital. Therefore, EMS transfer patients should be considered
for more risk of severe COVID-19; considering comorbidities of heart disease and hypertension as red flags.
Keywords :
COVID-19 , Self-referral , Prehospital emergency care , Emergency medical services
