• Maya Siman-Tov, Refael Strugo, Timna Podolsky, and Oren Blushtein.
• Magen David Adom, Tel Aviv, Israel; Sackler Faculty, Public Health School, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: mayas@mda.org.il.
• Am J Emerg Med. 2021 Jun 1; 44: 454945-49.

BackgroundCOVID-19 created lifestyle changes, and induced a fear of contagion affecting people's decisions regarding seeking medical assistance. Concern surrounding contagion and the pandemic has been found to affect the number and type of medical emergencies to which Emergency Medical Services (EMS) have responded.AimTo identify, categorize, and analyze Magen David Adom (MDA), Israel's national EMS, pre-hospital activities including patients' refusal to hospital transport, during the COVID-19 pandemic crises.MethodsA comparative before and after design study of MDA incidents during March/April 2019 and March/April 2020. Medical type, frequency, demographic, location, and transport refusal proportions and outcomes were analyzed.ResultsA decrease of 2.6% in the total volume of incidents was observed during March and April 2020 compared with the equivalent period in 2019. This contrasted with the retrospective trend of annually increase observed through 2016-2019. Medical categories showing increase in 2020 were infectious disease, cardiac arrest, psychiatric, and labor and deliveries, with out-of-hospital deliveries increasing by 14%. Decreases in 2020 were seen in neurology and trauma, with trauma incidents occurring at home showing an 8.6% increase. Patients' refusal to transport rose from 13.4% in 2019 to 19.9% in 2020. Cases of refusals followed by death within 8 days were more prevalent in 2020.ConclusionEMS must be prepared for changes in patients' behavior due to COVID concerns. Targeting populations at risk for refraining or refusing hospital transport and implementing diverse models of EMS, especially during pandemic times, will allow EMS to assist patients safely, either by reducing truly unnecessary ED visits minimizing contagion or by increasing hospital transports for patients in urgent or emergent conditions.Copyright © 2021. Published by Elsevier Inc.

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