Impact of the COVID-19 Pandemic on Emergency Medical Services: A Three-Year Analysis

Introduction: The COVID-19 pandemic disrupted emergency healthcare worldwide, heavily impacting Japan’s emergency services from early 2020. Reflecting on its effects is essential for future pandemic preparedness. Methods: This study analyzed data from the Aichi Medical Association’s annual survey of emergency patients at 26 tertiary emergency hospitals in Aichi Prefecture, Japan. Over the three pandemic years (2020-2022), we examined trends in ambulance transports, hospitalization rates, and severe cases by age group: pediatric (0-14), non-elderly (15- 64), early elderly (65-74), and late elderly (75+). Results: Across the three years, age distribution remained constant: pediatric 9%, non-elderly 30%, early elderly 15%, and late elderly 46%. In 2020, ambulance transports dropped sharply (2019: 198,607 cases; 2020: 173,329), particularly in pediatric and non-elderly groups, while hospitalization rates rose (40.2%→44.0%). Surprisingly, severe cases declined (63,382→52,782). In 2021, ambulance transports for pediatric and late elderly patients began increasing, with hospitalization rates continuing to rise (44.5%) and moderate (90,444 cases) and severe cases (62,732) increasing in all age groups. By 2022, ambulance transports had returned to pre-pandemic levels (197,539), but children and non-elderly mild cases increased markedly, and hospitalization rates declined slightly (42.0%). The number of severe cases (72,031) also increased. Conclusion: In 2020, the number of severe cases as well as mild cases likely decreased due to the restricted outings due to fears of infection. In 2021, virulent variants (Alpha, Delta) contributed to more severe cases. By 2022, increased transmissibility, decreased virulence (Omicron), vaccine distribution, and “pandemic fatigue” contributed to a surge in mild cases. Additionally, while restrictions on movement out and the spread of infection prevention measures led to a decrease in severe cases and non-coronavirus epidemic infections, stress and weakened immunity may have contributed to the increase in moderate and severe cases in subsequent years moderate and severe cases in later years.