Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-21T08:30:18.606Z Has data issue: false hasContentIssue false
  • English
  • Français

911 EMS Activations by Pregnant Patients in Maryland (USA) during the COVID-19 Pandemic

Published online by Cambridge University Press:  14 July 2021

Megan E. Hadley Open the ORCID record for Megan E. Hadley [Opens in a new window] ,
Arthur J. Vaught ,
Asa M. Margolis ,
Timothy P. Chizmar ,
Teferra Alemayehu ,
Torre Halscott ,
J. Lee Jenkins  and
Matthew J. Levy
Megan E. Hadley*
Affiliation:
Johns Hopkins School of Medicine, Baltimore, Maryland USA
Arthur J. Vaught
Affiliation:
Maternal-Fetal Medicine and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland USA
Asa M. Margolis
Affiliation:
Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland USA
Timothy P. Chizmar
Affiliation:
Maryland Institute for Emergency Medical Services Systems, Baltimore, Maryland USA
Teferra Alemayehu
Affiliation:
Maryland Institute for Emergency Medical Services Systems, Baltimore, Maryland USA
Torre Halscott
Affiliation:
Maternal-Fetal Medicine and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland USA
J. Lee Jenkins
Affiliation:
Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland USA
Matthew J. Levy
Affiliation:
Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland USA Maryland Institute for Emergency Medical Services Systems, Baltimore, Maryland USA
*
Correspondence: Megan E. Hadley Johns Hopkins University School of Medicine 511 S Ann St, Baltimore, Maryland, 21231 USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

In the early phase of the coronavirus disease 2019 (COVID-19) pandemic, United States Emergency Medical Services (EMS) experienced a decrease in calls, and at the same time, an increase in out-of-hospital deaths. This finding led to a concern for the implications of potential delays in care for the obstetric population.

Hypothesis/Problem:

This study examines the impact of the pandemic on prehospital care amongst pregnant women.

Methods:

A retrospective observational study was conducted comparing obstetric-related EMS activations in Maryland (USA) during the pandemic (March 10-July 20, 2020) to a pre-pandemic period (March 10-July 20, 2019). Comparative analysis was used to analyze the difference in frequency and acuity of calls between the two periods.

Results:

There were fewer obstetric-related EMS encounters during the pandemic compared to the year prior (daily average during the pandemic 12.5 [SD = 3.8] versus 14.6 [SD = 4.1] pre-pandemic; P <.001), although the percent of total female encounters remained unchanged (1.6% in 2020 versus 1.5% in 2019; P = .091). Key indicators of maternal status were not significantly different between the two periods. African-American women represented a disproportionately high percentage of obstetric-related activations (36.2% in 2019 and 34.8% in 2020).

Conclusions:

In this state-wide analysis of EMS calls in Maryland early in the pandemic, no significant differences existed in the utilization of EMS by pregnant women. Prehospital EMS activations amongst pregnant women in Maryland only decreased slightly without an increase in acuity. Of note, over-representation by African-American women compared to population statistics raises concern for broader systemic differences in access to obstetric care.

Keywords

Emergency Medical Servicesmaternal healthpandemicspregnancy complications
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 5 , October 2021 , pp. 570 - 575
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

World Health Organization. Rolling updates on coronavirus disease (COVID-19). https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen. Accessed November 3, 2020.Google Scholar
World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. https://covid19.who.int/?gclid=Cj0KCQiA0fr_BRDaARIsAABw4Eu3F2X7gjRWFOiP8SqMhyLBUG1AF5Avpvr6IIUHKq06rtvAZ2qiSnwaAmbIEALw_wcB. Accessed January 10, 2021.Google Scholar
Ellington, S, Strid, P, Tong, VT, et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status – United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):769–775.CrossRefGoogle ScholarPubMed
Matar, R, Alrahmani, L, Monzer, N, et al. Clinical presentation and outcomes of pregnant women with COVID-19: a systematic review and meta-analysis. Clin Infect Dis. 2021;72(3):521–533.CrossRefGoogle ScholarPubMed
Sentilhes, L, De Marcillac, F, Jouffrieau, C, et al. Coronavirus disease 2019 in pregnancy was associated with maternal morbidity and preterm birth. Am J Obstet Gynecol. 2020;223(6):914.CrossRefGoogle ScholarPubMed
Hessami, K, Homayoon, N, Hashemi, A, Vafaei, H, Kasraeian, M, Asadi, N. COVID-19 and maternal, fetal and neonatal mortality: a systematic review. J Matern Fetal Neonatal Med. 2020. Epub ahead of print.CrossRefGoogle Scholar
Takemoto, ML, Menezes, MO, Andreucci, CB, et al. Maternal mortality and COVID-19. J Matern Fetal Neonatal Med. 2020. Epub ahead of print.CrossRefGoogle Scholar
Kc, A, Gurung, R, Kinney, MV, et al. Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study. Lancet Glob Health. 2020;8(10):e1273–e1281.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Clinical Care Guidance for Healthcare Professionals about Coronavirus (COVID-19). National Center for Immunization and Respiratory Disease. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care.html. Accessed November 25, 2020.Google Scholar
Maryland Institute for Emergency Medical Services. Maryland Institute for Emergency Medical Services Systems COVID-19 EMS Guidance. https://www.miemss.org/home/Portals/0/Docs/Infectious_Diseases/Guidance-COVID-19-EMS-Guidance-20201006.pdf?ver=2020-10-06-140048-197. Accessed November 25, 2020.Google Scholar
Lerner, EB, Newgard, CD, Mann, NC. Effect of the coronavirus disease 2019 (COVID-19) pandemic on the US Emergency Medical Services system: a preliminary report. Acad Emerg Med. 2020;27(8):693–699.CrossRefGoogle Scholar
World Population Review. Maryland Population 2020. Maryland State Data Center. https://worldpopulationreview.com/states/maryland-population. Accessed January 19, 2021.Google Scholar
National EMS Information System. 2014 National Emergency Medical Services Information System. Salt Lake City, Utah USA: National EMS Information System; 2014.Google Scholar
Aldujeli, A, Hamadeh, A, Briedis, K, et al. Delays in presentation in patients with acute myocardial infarction during the COVID-19 pandemic. Cardiol Res. 2020;11(6):386–391.CrossRefGoogle ScholarPubMed
de Freytas-Tamura, K. Pregnant and Scared of ‘Covid Hospitals,’ They’re Giving Birth at Home. New York Times. ~ʼʼ’https://www.nytimes.com/2020/04/21/nyregion/coronavirus-home-births.html#:~:text=home%2Dbirths.html-,Pregnant%20and%20Scared%20of%20ʼCovid%20Hospitals%2Cʼ%20They’re,home%20or%20in%20birthing%20centers. Accessed January 19, 2021.Google Scholar
Haruna, M, Nishi, D. Perinatal mental health and COVID-19 in Japan. Psychiatry Clin Neurosci. 2020;74(9):502–503.CrossRefGoogle ScholarPubMed
Taubman-Ben-Ari, O, Chasson, M, Abu Sharkia, S, Weiss, E. Distress and anxiety associated with COVID-19 among Jewish and Arab pregnant women in Israel. J Reprod Infant Psychol. 2020;38(3):340–348.CrossRefGoogle ScholarPubMed
Kotabagi, P, Fortune, L, Essien, S, Nauta, M, Yoong, W. Anxiety and depression levels among pregnant women with COVID-19. Acta Obstet Gynecol Scand. 2020;99(7):953–954.CrossRefGoogle ScholarPubMed
Corbett, GA, Milne, SJ, Hehir, MP, Lindow, SW, O’Connell, MP. Health anxiety and behavioral changes of pregnant women during the COVID-19 pandemic. Eur J Obstet Gynecol Reprod Biol. 2020;249:96–97.CrossRefGoogle Scholar
Glover, V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):25–35.CrossRefGoogle Scholar
Martini, J, Knappe, S, Beesdo-Baum, K, Lieb, R, Wittchen, HU. Anxiety disorders before birth and self-perceived distress during pregnancy: associations with maternal depression and obstetric, neonatal and early childhood outcomes. Early Hum Dev. 2010;86(5):305–310.CrossRefGoogle ScholarPubMed
Takemoto, MLS, Menezes, MO, Andreucci, CB, et al. Maternal mortality and COVID-19. J Matern Fetal Neonatal Med. 2020. Epub ahead of print.CrossRefGoogle Scholar
Galea, S, Blaney, S, Nandi, A, et al. Explaining racial disparities in incidence of and survival from out-of-hospital cardiac arrest. Am J Epidemiol. 2007;166(5):534–543.CrossRefGoogle ScholarPubMed
Hewes, HA, Dai, M, Mann, NC, Baca, T, Taillac, P. Prehospital pain management: disparity by age and race. Prehosp Emerg Care. 2018;22(2):189–197.CrossRefGoogle Scholar