Impact of the COVID-19 Pandemic on Patients’ Refusal of Emergency Medical Services (EMS) Transport

Background Emergency Medical Services (EMS) activations declined during the coronavirus disease 2019 (COVID-19) pandemic. The reasons patients accept or decline EMS evaluation and transport are multifactorial. This study examined changes in EMS transport refusal rates during the early COVID-19 pandemic compared with the prior year. Methodology Run reports were obtained from a single ground ambulance service (SouthStar EMS, North Augusta, South Carolina, USA). Calls during the first 90 days following the U.S. national emergency declaration for COVID-19 (March 13-June 11, 2020) were compared with the same period in 2019. A total of 1,889 calls occurred in 2019, and 1,707 calls occurred in 2020. Runs were categorized as emergent (911) or non-emergent scheduled transports. Outcomes were analyzed using Fisher’s exact test. Results Emergent calls increased from 1,148/1,889 (60.8%) in 2019 to 1,301/1,707 (76.2%) in 2020 (p < 0.00001). Refusal of EMS-recommended transport after evaluation increased from 66/1,148 (5.7%) in 2019 to 113/1,301 (8.7%) in 2020 (p = 0.0021). The combined proportion of patients refusing evaluation or refusing recommended transport increased from 189/1,148 (16.5%) to 249/1,301 (19.1%) (p = 0.0376). Conclusions During the early COVID-19 pandemic, refusal of EMS-recommended transport increased significantly in this EMS system. These findings suggest that pandemic-related concerns may have influenced patient decision-making regarding prehospital care. Further multi-system studies are needed to better characterize contributing factors and clinical outcomes.