Coronavirus, International

Study: During the Coronavirus Outbreak in Israel, Almost Half of EMS Patients Refuse Treatment or Transportation to Hospital

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Oren Wacht1,2 EMT-P, PhD, Uriel Goldberg EMT-P1

  1. Department of emergency medicine, Ben Gurion University of the Negev
  2. Magen David Adom, Israeli national EMS

While responding to an emergency call during the coronavirus outbreak in Israel, Jamie, a Magen David Adom (MDA) paramedic from the Sharon region, related that an asthma patient he was treating, who was suffering a severe attack, refused to be evacuated to an emergency room despite the danger of deterioration in her condition.

The same day, he reported of a 73-year-old woman who felt chest pain and continued to refuse treatment, even after he told her that it was a cardiac emergency that required catheterization.

During the coronavirus pandemic, a new challenge in the world of emergency medical services (EMS) has arisen, explained Jamie, namely, patients (or family) who deny transportation to the hospital out of fear of contracting the corona virus.

On occasions in which patients refuse treatment, he emphasized, “your sense of responsibility as a paramedic towards the patient is even greater and you realize that you are in a struggle for awareness and that every passing minute might contribute to the condition of your patient.”

“It took a lot of patience and compassion to explain to her that the danger of not being treated was greater than the exposure to the virus in the hospital,” he continued.

In a recently published in the American Journal of Emergency Medicine, a team of researchers from MDA investigated this emerging trend, finding a 16% decrease in emergency cardiac calls and a 38% increase in refusal for transportation to the hospital. Among them, 16% more of those with cardiovascular disease either didn’t call or refused transport, compared to last year.

Throughout the outbreak of the coronavirus, Israel’s national EMS organization (MDA) was in constant public focus as the main gateway to the healthcare system – as its traditional role as an EMS service and also the organization providing testing for COVID 19 at homes and in drive in centers. The study analyzed the numbers of ambulance calls for 136 diagnosis codes used during 121 days between January 1, and April 30, 2020. 

Through analyzing this data, Israel’s EMS organizations hoped to better understand the preparations and response needed during a pandemic outbreak. These indications could be used for a future preparedness.

The study also found a 12% increase in mental and psychiatric calls, noting that compared to other disasters, which are met with social convergence, “the exact opposite is demanded (isolation, separation), and the interruption of such community and family rituals, norms, and values may diminish individual resilience, worsen mental health and increase the potential for adverse reactions.”

This trend highlights the importance of home care, noted MDA personal conducting the research. MDAs soon-to-be-launched program “MDA in the Community”, has been in planning stages for years, aiming to use telemedicine to help medics and paramedics treat patients at home. Now it is the perfect time to start this initiative.

If hospitalization is not necessary, or the patient refuses transport, the paramedic will check the vitals signs of the patient, virtually linking in a physician using the ‘MDA teams’ application on a tablet. The physician, from anywhere with an internet connection, is able to listen to the patient’s lungs, check his or her heart or look into his or her throat – all from afar. The results of in-house blood tests can come back quickly enough for the physician to decide on a course of treatment on the spot. After doing so, the physician may prescribe antibiotics or medications, which are sometimes given out by the paramedic.

The program represents an effective solution to the challenge of patients refraining from seeking care at a hospital (which occurs even during normal times), and now, also prevents infected patients from leaving their homes, thereby potentially preventing the spread of the virus.

Fear of contracting coronavirus during treatment of other ailments, explained the study, is likely the greatest factor in avoidance of medical care, and during epidemics, such behaviors were associated with misconceptions regarding the severity of other prevalent diseases.

“Understanding these correlations may allow better preparedness of the EMS and a better response towards the public needs in the period of an epidemic or a pandemic,” concluded the report.