Emergency medical services utilization during an outbreak of severe acute respiratory syndrome (SARS) and the incidence of SARS-associated coronavirus infection among emergency medical technicians

Patrick Chow-In Ko, Wen Jone Chen, Matthew Huei-Ming Ma, Wen Chu Chiang, Chan Ping Su, Chien Hua Huang, Tsung Chien Lu, Fuh Yuan Shih, Fang Yue Lin

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives This was a study to evaluate the utilization of emergency medical services (EMS) systems during the outbreak of severe acute respiratory syndrome (SARS), and to assess the incidence of infection among emergency medical technicians (EMTs). Methods This was a prospective, observational study conducted in the EMS system of Taipei, Taiwan. Probable/suspect cases of SARS were defined by World Health Organization criteria. SARS-related transports were categorized into 1) requests from hospitals for probable/suspect cases of SARS, 2) quarantined individuals, and 3) febrile persons. City ambulances were organized into teams A, B, and C for transports of different perceived risks. Data on the EMS volume, the transport category, the final SARS status of patients, and the EMT responsible for the transports were collected. The EMS projected volume was computed by previous years' data and compared with that collected. The SARS incidence among EMTs was assessed by investigating probable SARS (P-SARS) and by surveying the seroprevalence of SARS-associated coronavirus (SARS-CoV) antibody. Results From March 18 to June 19, 2003, there were 7,961 EMS transports, similar to the volume projected from previous years (7,506) (95% CI = 6,688 to 8,324). Of these, 1,760 (22.1%) were SARS-related. When SARS-related transports were excluded, there was a 12.2% decrease (95% CI = 11.4% to 12.9%) in EMS activities. Requests from hospitals, quarantined individuals, and febrile citizens accounted for 23%, 18%, and 59% of SARS-related transports. Among the 397 P-SARS cases in the city of 2.65 million people (incidence 0.01%, 95% CI = 0.01% to 0.02%), 138 (35%) required EMS transports. Two EMTs working in team C, the team with the lowest risk, developed P-SARS. One of them died soon thereafter. The incidence of P-SARS was 0.6% (95% CI = 0.2% to 2.2%), or 0.1% (95% CI = 0.03% to 0.4%) per transport. SARS-CoV serology was available in 74.1% of EMTs who were alive. In addition to the surviving P-SARS EMT, one EMT from team A, the team with the highest risk, was seropositive. Combining P-SARS and the seropositive case, three EMTs were infected (incidence 1.3%, 95% CI = 0.4% to 3.6%). No patient transported by the infected EMTs developed SARS. The hospitals serving EMS by the infected EMTs had been involved in a clustered outbreak prior to the EMTs' infections. Conclusions During the outbreak of SARS, the overall EMS volume did not change significantly, but the non-SARS EMS activities decreased. Compared with the general population, EMS providers are at higher risk of contracting the SARS virus regardless of different perceived levels of risk. Standard protections and procedures for infection control should be strictly followed during transport and within the hospital environment.

Original languageEnglish
Pages (from-to)903-911
Number of pages9
JournalAcademic Emergency Medicine
Volume11
Issue number9
DOIs
Publication statusPublished - Sep 1 2004
Externally publishedYes

Fingerprint

Emergency Medical Technicians
Coronavirus Infections
Severe Acute Respiratory Syndrome
Emergency Medical Services
Disease Outbreaks
Incidence
Fever
SARS Virus
Coronavirus
Ambulances

Keywords

  • emergency medical services
  • emergency medical technicians
  • incidence
  • severe acute respiratory syndrome
  • utilization

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Emergency medical services utilization during an outbreak of severe acute respiratory syndrome (SARS) and the incidence of SARS-associated coronavirus infection among emergency medical technicians. / Chow-In Ko, Patrick; Chen, Wen Jone; Huei-Ming Ma, Matthew; Chiang, Wen Chu; Su, Chan Ping; Huang, Chien Hua; Lu, Tsung Chien; Shih, Fuh Yuan; Lin, Fang Yue.

In: Academic Emergency Medicine, Vol. 11, No. 9, 01.09.2004, p. 903-911.

Research output: Contribution to journalArticle

Chow-In Ko, Patrick ; Chen, Wen Jone ; Huei-Ming Ma, Matthew ; Chiang, Wen Chu ; Su, Chan Ping ; Huang, Chien Hua ; Lu, Tsung Chien ; Shih, Fuh Yuan ; Lin, Fang Yue. / Emergency medical services utilization during an outbreak of severe acute respiratory syndrome (SARS) and the incidence of SARS-associated coronavirus infection among emergency medical technicians. In: Academic Emergency Medicine. 2004 ; Vol. 11, No. 9. pp. 903-911.
@article{06d4e9df10074b6bae8a97349ea7c76e,
title = "Emergency medical services utilization during an outbreak of severe acute respiratory syndrome (SARS) and the incidence of SARS-associated coronavirus infection among emergency medical technicians",
abstract = "Objectives This was a study to evaluate the utilization of emergency medical services (EMS) systems during the outbreak of severe acute respiratory syndrome (SARS), and to assess the incidence of infection among emergency medical technicians (EMTs). Methods This was a prospective, observational study conducted in the EMS system of Taipei, Taiwan. Probable/suspect cases of SARS were defined by World Health Organization criteria. SARS-related transports were categorized into 1) requests from hospitals for probable/suspect cases of SARS, 2) quarantined individuals, and 3) febrile persons. City ambulances were organized into teams A, B, and C for transports of different perceived risks. Data on the EMS volume, the transport category, the final SARS status of patients, and the EMT responsible for the transports were collected. The EMS projected volume was computed by previous years' data and compared with that collected. The SARS incidence among EMTs was assessed by investigating probable SARS (P-SARS) and by surveying the seroprevalence of SARS-associated coronavirus (SARS-CoV) antibody. Results From March 18 to June 19, 2003, there were 7,961 EMS transports, similar to the volume projected from previous years (7,506) (95{\%} CI = 6,688 to 8,324). Of these, 1,760 (22.1{\%}) were SARS-related. When SARS-related transports were excluded, there was a 12.2{\%} decrease (95{\%} CI = 11.4{\%} to 12.9{\%}) in EMS activities. Requests from hospitals, quarantined individuals, and febrile citizens accounted for 23{\%}, 18{\%}, and 59{\%} of SARS-related transports. Among the 397 P-SARS cases in the city of 2.65 million people (incidence 0.01{\%}, 95{\%} CI = 0.01{\%} to 0.02{\%}), 138 (35{\%}) required EMS transports. Two EMTs working in team C, the team with the lowest risk, developed P-SARS. One of them died soon thereafter. The incidence of P-SARS was 0.6{\%} (95{\%} CI = 0.2{\%} to 2.2{\%}), or 0.1{\%} (95{\%} CI = 0.03{\%} to 0.4{\%}) per transport. SARS-CoV serology was available in 74.1{\%} of EMTs who were alive. In addition to the surviving P-SARS EMT, one EMT from team A, the team with the highest risk, was seropositive. Combining P-SARS and the seropositive case, three EMTs were infected (incidence 1.3{\%}, 95{\%} CI = 0.4{\%} to 3.6{\%}). No patient transported by the infected EMTs developed SARS. The hospitals serving EMS by the infected EMTs had been involved in a clustered outbreak prior to the EMTs' infections. Conclusions During the outbreak of SARS, the overall EMS volume did not change significantly, but the non-SARS EMS activities decreased. Compared with the general population, EMS providers are at higher risk of contracting the SARS virus regardless of different perceived levels of risk. Standard protections and procedures for infection control should be strictly followed during transport and within the hospital environment.",
keywords = "emergency medical services, emergency medical technicians, incidence, severe acute respiratory syndrome, utilization",
author = "{Chow-In Ko}, Patrick and Chen, {Wen Jone} and {Huei-Ming Ma}, Matthew and Chiang, {Wen Chu} and Su, {Chan Ping} and Huang, {Chien Hua} and Lu, {Tsung Chien} and Shih, {Fuh Yuan} and Lin, {Fang Yue}",
year = "2004",
month = "9",
day = "1",
doi = "10.1197/j.aem.2004.03.016",
language = "English",
volume = "11",
pages = "903--911",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - Emergency medical services utilization during an outbreak of severe acute respiratory syndrome (SARS) and the incidence of SARS-associated coronavirus infection among emergency medical technicians

AU - Chow-In Ko, Patrick

AU - Chen, Wen Jone

AU - Huei-Ming Ma, Matthew

AU - Chiang, Wen Chu

AU - Su, Chan Ping

AU - Huang, Chien Hua

AU - Lu, Tsung Chien

AU - Shih, Fuh Yuan

AU - Lin, Fang Yue

PY - 2004/9/1

Y1 - 2004/9/1

N2 - Objectives This was a study to evaluate the utilization of emergency medical services (EMS) systems during the outbreak of severe acute respiratory syndrome (SARS), and to assess the incidence of infection among emergency medical technicians (EMTs). Methods This was a prospective, observational study conducted in the EMS system of Taipei, Taiwan. Probable/suspect cases of SARS were defined by World Health Organization criteria. SARS-related transports were categorized into 1) requests from hospitals for probable/suspect cases of SARS, 2) quarantined individuals, and 3) febrile persons. City ambulances were organized into teams A, B, and C for transports of different perceived risks. Data on the EMS volume, the transport category, the final SARS status of patients, and the EMT responsible for the transports were collected. The EMS projected volume was computed by previous years' data and compared with that collected. The SARS incidence among EMTs was assessed by investigating probable SARS (P-SARS) and by surveying the seroprevalence of SARS-associated coronavirus (SARS-CoV) antibody. Results From March 18 to June 19, 2003, there were 7,961 EMS transports, similar to the volume projected from previous years (7,506) (95% CI = 6,688 to 8,324). Of these, 1,760 (22.1%) were SARS-related. When SARS-related transports were excluded, there was a 12.2% decrease (95% CI = 11.4% to 12.9%) in EMS activities. Requests from hospitals, quarantined individuals, and febrile citizens accounted for 23%, 18%, and 59% of SARS-related transports. Among the 397 P-SARS cases in the city of 2.65 million people (incidence 0.01%, 95% CI = 0.01% to 0.02%), 138 (35%) required EMS transports. Two EMTs working in team C, the team with the lowest risk, developed P-SARS. One of them died soon thereafter. The incidence of P-SARS was 0.6% (95% CI = 0.2% to 2.2%), or 0.1% (95% CI = 0.03% to 0.4%) per transport. SARS-CoV serology was available in 74.1% of EMTs who were alive. In addition to the surviving P-SARS EMT, one EMT from team A, the team with the highest risk, was seropositive. Combining P-SARS and the seropositive case, three EMTs were infected (incidence 1.3%, 95% CI = 0.4% to 3.6%). No patient transported by the infected EMTs developed SARS. The hospitals serving EMS by the infected EMTs had been involved in a clustered outbreak prior to the EMTs' infections. Conclusions During the outbreak of SARS, the overall EMS volume did not change significantly, but the non-SARS EMS activities decreased. Compared with the general population, EMS providers are at higher risk of contracting the SARS virus regardless of different perceived levels of risk. Standard protections and procedures for infection control should be strictly followed during transport and within the hospital environment.

AB - Objectives This was a study to evaluate the utilization of emergency medical services (EMS) systems during the outbreak of severe acute respiratory syndrome (SARS), and to assess the incidence of infection among emergency medical technicians (EMTs). Methods This was a prospective, observational study conducted in the EMS system of Taipei, Taiwan. Probable/suspect cases of SARS were defined by World Health Organization criteria. SARS-related transports were categorized into 1) requests from hospitals for probable/suspect cases of SARS, 2) quarantined individuals, and 3) febrile persons. City ambulances were organized into teams A, B, and C for transports of different perceived risks. Data on the EMS volume, the transport category, the final SARS status of patients, and the EMT responsible for the transports were collected. The EMS projected volume was computed by previous years' data and compared with that collected. The SARS incidence among EMTs was assessed by investigating probable SARS (P-SARS) and by surveying the seroprevalence of SARS-associated coronavirus (SARS-CoV) antibody. Results From March 18 to June 19, 2003, there were 7,961 EMS transports, similar to the volume projected from previous years (7,506) (95% CI = 6,688 to 8,324). Of these, 1,760 (22.1%) were SARS-related. When SARS-related transports were excluded, there was a 12.2% decrease (95% CI = 11.4% to 12.9%) in EMS activities. Requests from hospitals, quarantined individuals, and febrile citizens accounted for 23%, 18%, and 59% of SARS-related transports. Among the 397 P-SARS cases in the city of 2.65 million people (incidence 0.01%, 95% CI = 0.01% to 0.02%), 138 (35%) required EMS transports. Two EMTs working in team C, the team with the lowest risk, developed P-SARS. One of them died soon thereafter. The incidence of P-SARS was 0.6% (95% CI = 0.2% to 2.2%), or 0.1% (95% CI = 0.03% to 0.4%) per transport. SARS-CoV serology was available in 74.1% of EMTs who were alive. In addition to the surviving P-SARS EMT, one EMT from team A, the team with the highest risk, was seropositive. Combining P-SARS and the seropositive case, three EMTs were infected (incidence 1.3%, 95% CI = 0.4% to 3.6%). No patient transported by the infected EMTs developed SARS. The hospitals serving EMS by the infected EMTs had been involved in a clustered outbreak prior to the EMTs' infections. Conclusions During the outbreak of SARS, the overall EMS volume did not change significantly, but the non-SARS EMS activities decreased. Compared with the general population, EMS providers are at higher risk of contracting the SARS virus regardless of different perceived levels of risk. Standard protections and procedures for infection control should be strictly followed during transport and within the hospital environment.

KW - emergency medical services

KW - emergency medical technicians

KW - incidence

KW - severe acute respiratory syndrome

KW - utilization

UR - http://www.scopus.com/inward/record.url?scp=4344694643&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=4344694643&partnerID=8YFLogxK

U2 - 10.1197/j.aem.2004.03.016

DO - 10.1197/j.aem.2004.03.016

M3 - Article

VL - 11

SP - 903

EP - 911

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 9

ER -