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{
    "pk": 14124,
    "title": "How the COVID-19 Epidemic Affected Prehospital Emergency Medical Services in Tehran, Iran",
    "subtitle": null,
    "abstract": "Introduction:\n Coronavirus disease 2019 (COVID-19) has substantially impacted the healthcare delivery system in Tehran, Iran. The country’s first confirmed positive test for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was on February 18, 2020. Since then, the number of cases has steadily increased in Iran and worldwide. Emergency medical services (EMS) quickly adapted its operations to accommodate a greater number of patients, and it worked to decrease the risk of COVID-19 spread among EMS personnel, given the disease’s high transmissibility.\nMethods:\n We evaluated the chief complaint as well as the pattern and number of EMS calls and dispatches during the 28-day intervals before and after the February 18, 2020, COVID-19 outbreak in Iran.\nResults:\n EMS calls increased from 355,241 in the pre-outbreak period to 1,589,346 in the post-outbreak period, a 347% increase (p<0.001). EMS dispatches rose more modestly from 82,282 to 99,926, a 21% increase (p<0.001). The average time on telephone hold decreased from 10.6 ± 12.7 seconds pre-outbreak to 9.8 ± 11.8 seconds post-outbreak, a 7% decrease (p<0.001). The average length of call also decreased from 1.32 ± 1.42 minutes pre-outbreak to 1.06 ± 1.28 minutes post-outbreak, a 20% decrease (p<0.001). The highest number of daily dispatches occurred during the second and third weeks of the four-week post-outbreak period, peaking at 4557 dispatches/day. After the first reported case of SARS-CoV-2, there were significant increases in chief complaints of fever (211% increase, p<0.001) and respiratory symptoms (245% increase, p<0.001).\nConclusion:\n The number of EMS calls and dispatches in Tehran increased 347% and 20%, respectively, after the outbreak of COVID-19. Despite this, the time on hold for EMS response decreased. The Tehran EMS system accomplished this by increasing personnel hours, expanding call-center resources, and implementing COVID-19-specific training.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "SARS-CoV-2"
        },
        {
            "word": "COVID-19"
        },
        {
            "word": "emergency medical service"
        },
        {
            "word": "Mission"
        },
        {
            "word": "CALL"
        },
        {
            "word": "Pandemic"
        }
    ],
    "section": "International Medicine",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/90w3d0p2",
    "frozenauthors": [
        {
            "first_name": "Peyman",
            "middle_name": "",
            "last_name": "Saberian",
            "name_suffix": "",
            "institution": "Tehran University of Medical Sciences",
            "department": "None"
        },
        {
            "first_name": "Joseph",
            "middle_name": "L.",
            "last_name": "Conovaloff",
            "name_suffix": "",
            "institution": "UC Irvine School of Medicine, Department of Emergency Medicine, Orange, CA, United States of America",
            "department": "None"
        },
        {
            "first_name": "Elnaz",
            "middle_name": "",
            "last_name": "Vahidi",
            "name_suffix": "",
            "institution": "Tehran University of Medical Sciences, Prehospital and Hospital Emergency Research Center, Tehran, Iran\nTehran University of Medical Sciences, Shariati Hospital, Department of Emergency Medicine, Tehran, Iran",
            "department": "None"
        },
        {
            "first_name": "Parisa",
            "middle_name": "",
            "last_name": "Hasani-Sharamin",
            "name_suffix": "",
            "institution": "Tehran Emergency Medical Service Center, Tehran, Iran",
            "department": "None"
        },
        {
            "first_name": "Pir-Hossein",
            "middle_name": "",
            "last_name": "Kolivand",
            "name_suffix": "",
            "institution": "Iranian Emergency Medical Service Organization, Tehran, Iran Khatamol Anbia Hospital, Shefa Neuroscience Research Center, Tehran, Iran",
            "department": "None"
        }
    ],
    "date_submitted": "2020-06-12T16:07:47+05:30",
    "date_accepted": "2020-06-12T16:07:47+05:30",
    "date_published": "2020-11-04T13:30:00+05:30",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/14124/galley/7310/download/"
        }
    ]
}