Emergency Medical Services Calls During Italy’s COVID-19 Lockdown

To the Editor:

In the United Kingdom, there was no significant reduction in ambulance calls for heart attack and stroke during the coronavirus disease 2019 (COVID-19) lockdown period, indicating that people were not reluctant to call for such serious conditions.¹ To determine how Italian citizens behaved, we analyzed calls to the emergency medical services (EMS) call center in the 1,200,000-inhabitant Italian Region Friuli Venezia Giulia from January 2018 to May 2020, with a focus on periods March to May which, in 2020, corresponded to Italy’s COVID-19 lockdown area. Despite the activation of national and regional dedicated toll-free numbers, through which contacting a person manning the telephone could be difficult, regional EMS call center numbers (112 or 118) could be used for advice on COVID-19.²

From March to May, the overall number of calls to EMS call centers was smaller in 2020 (N=19,176) than in 2018 (N=28,186) and 2019 (N=28,630), with analogous distribution of priority codes. In examining the 17 macro groups of call causes of the regional dispatching system (trauma, cardiac, respiratory, neurologic, psychiatric, oncologic, toxicologic, metabolic, gastroenterologic, urologic, eye, ear/nose/throat, dermatologic, obstetric/gynecologic, infectious, other, and undefined), in March to May 2020 there was a decrease in the proportion of calls for trauma (17.7% versus 21.8% in 2018 and 22.5% in 2019) and neurologic causes (15.6% versus 19.0% and 19.4%) and an increase in calls for cardiac (16.7% versus 14.6% and 13.9%), infectious (1.1% versus 0.13% and 0.11%), and respiratory causes (17.0% versus 13.7% and 12.9%; P<.001 for the χ² test). The same trend was observed when analyses were restricted to calls followed by EMS vehicle responses.

The Figure shows the time series of daily EMS calls with vehicle response for those macro groups. In interrupted time series analyses (ARIMA models through SAS PROC AUTOREG) (version 9.4; SAS Institute, Inc., Cary, NC) choosing as the break-point date February 24, 2020 (ie, the Monday after the first Italian autochthonous COVID-19 case was detected), a significant change in trend slope of daily calls was observed for trauma (pre–COVID-19 start 0.0112, P<.001; post –0.8779, P<.001), neurologic (pre–COVID-19 start 0.0042, P=.03; post –0.5159, P=.004), and infectious causes (pre–COVID-19 start –0.0001, P=.77; post 0.0895, P<.001). No significant change in slope was observed for cardiac (pre–COVID-19 start –0.0002, P=.84; post –0.0893, P=.45) and respiratory causes (pre–COVID-19 start –0.0018, P=.64; post –0.0204, P=.94).

Figure.

Time trend of daily EMS calls for macro categories of causes, Region Friuli Venezia Giulia, Italy, January 1, 2108, to May 31, 2020. The dashed line is the beginning of the COVID-19 outbreak in Italy.

In the Region Friuli Venezia Giulia, COVID-19 determined a reduction of EMS calls. The decrease did not regard all health conditions. Calls for trauma strongly decreased. This was expected because lockdown minimized opportunities to have unintentional injuries. The increase of calls for infectious diseases was also expected because the population called 118 for COVID-19–related emergencies. The number of calls for cardiac causes was unchanged, indicating that citizens kept referring to EMS for serious cardiac events. Further research is needed to assess whether EMS response was modified by COVID-19. The decrease in calls for neurologic causes should also be further investigated.