COVID-19 has overwhelmed health services across the world; its global death toll has exceeded 5.3 million and continues to grow. There have been almost 15 million cases of COVID-19 in the UK. The need for rapid accurate identification, appropriate clinical care and decision making, remains a priority for UK ambulance service. To support identification and conveyance decisions of patients presenting with COVID-19 symptoms the Scottish Ambulance Service introduced the revised Medical Priority Dispatch System Protocol 36, enhanced physician led decision support and prehospital clinical guidelines. This study aimed to characterise the impact of these changes on the pathways and outcomes of people attended by the SAS) with potential COVID-19. A retrospective record linkage cohort study using National Data collected from NHS Scotland over a 5 month period (April–August 2020). The SAS responded to 214,082 emergency calls during the study time period. The positive predictive value of the Protocol 36 to identify potentially COVID-19 positive patients was low (17%). Approximately 60% of those identified by Protocol 36 as potentially COVID-19 positive were conveyed. The relationship between conveyance and mortality differed between Protocol 36 Covid-19 positive calls and those that were not. In those identified by Protocol 36 as Covid-19 negative, 30 day mortality was higher in those not conveyed (not conveyed 9.2%; conveyed 6.6%) but in the Protocol 36 Covid-19 positive calls, mortality was higher in those conveyed (not conveyed 4.3% conveyed 8.8%). Thirty-day mortality rates of those with COVID-19 diagnosed through virology was between 28.8 and 30.2%. The low positive predictive value (17%) of Protocol 36 in identifying potential COVID-19 in patients emphasises the importance of ambulance clinicians approaching each call as involving COVID-19, reinforcing the importance of adhering to existing policy and continued use of PPE at all calls. The non-conveyance rate of people that were categorised as COVID-19 negative was higher than in the preceding year in the same service. The reasons for the higher rates of non-conveyance and the relationship between non conveyance rates and death at 3 and 30 days post index call are unknown and would benefit from further study.

中文翻译：

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苏格兰与 COVID-19 相关的紧急救护车服务呼叫的流行病学：国家记录关联研究


COVID-19 已使世界各地的卫生服务不堪重负；全球死亡人数已超过 530 万人，并且还在继续增长。英国已有近 1500 万例 COVID-19 病例。快速准确的识别、适当的临床护理和决策的需求仍然是英国救护车服务的首要任务。为了支持出现 COVID-19 症状的患者的识别和转运决策，苏格兰救护车服务引入了修订后的医疗优先调度系统协议 36，增强了医生主导的决策支持和院前临床指南。本研究旨在描述这些变化对 SAS 参与的潜在 COVID-19 患者的路径和结果的影响。一项回顾性记录关联队列研究，使用 5 个月期间（2020 年 4 月至 8 月）从苏格兰 NHS 收集的国家数据。在研究期间，SAS 响应了 214,082 个紧急呼叫。方案 36 识别潜在的 COVID-19 阳性患者的阳性预测价值较低 (17%)。协议 36 确定的潜在 COVID-19 阳性人员中约有 60% 已被转送。根据议定书 36，Covid-19 阳性呼叫和非阳性呼叫之间的运输和死亡率之间的关系有所不同。在《议定书 36》确定为 Covid-19 阴性的人员中，未转达的人员 30 天死亡率较高（未转达的为 9.2%；转达的为 6.6%），但在《规程 36》Covid-19 呈阳性的人员中，转达的人员的死亡率较高（未转达的为 9.2%；已转达的为 6.6%）。传达 4.3% 传达 8.8%）。通过病毒学诊断出的 COVID-19 患者的 30 天死亡率在 28.8% 至 30.2% 之间。 第 36 号议定书在识别患者中潜在的 COVID-19 方面的阳性预测值较低（17%），强调了救护车临床医生接听涉及 COVID-19 的每个呼叫的重要性，强调了遵守现有政策和继续使用个人防护装备的重要性来电。在同一服务中，被归类为 COVID-19 阴性的人员的未运送率高于上一年。未转移率较高的原因以及未转移率与指数调用后 3 天和 30 天死亡率之间的关系尚不清楚，进一步研究将有益于该问题。