Transformation of the ambulance service during the COVID-19 pandemic: correlation and thematic analysis

BACKGROUND: Ensuring the availability and quality of an ambulance service, including specialized ambulance, medical care, and specialized medical care in emergency and emergency form for fatal diseases, accidents, injuries, poisoning, and other conditions that require urgent medical intervention is an integral part of the national security system and one of the most important areas of health development in the Russian Federation. During the COVID-19 pandemic, such tasks appeared in the organization of emergency and emergency medical care for patients as a prompt distribution to inpatient departments, considering the severity of the patients’ condition, their covid status, and the availability of free places in medical organizations in a specific region, compliance with the waiting time prescribed for emergency medical care, and cutting off the «non-core» calls.

AIM: To determine the optimal organizational structure of the ambulance service in the subject of the Russian Federation.

MATERIALS AND METHODS: Collection and statistical processing of information regarding the work of ambulance services in a specific region were carried out. Correlation-thematic analysis using the Pearson’s coefficient was performed.

RESULTS: During the «under covid» period from 2016 to 2019, the overall mortality rate showed a clear downward trend. However, during the pandemic, even without taking into account the excess mortality, there was an increase, while, in 2020, when compared with 2019, the increase was >12%. Moreover, despite the increase in excess mortality in 2021 relative to that in 2020 by almost four times, the total mortality (excluding COVID) remained almost at the same level. In addition, it should be noted that, in regions where the ambulance service was represented by a single legal entity during the epidemic, excess mortality was lower in comparison with that in the regions where ambulance service was represented by departments within the Central District hospitals.

CONCLUSION: The period of the coronavirus epidemic has largely transformed the healthcare system. The presence of a Unified Dispatching Service or a unified ambulance service in a region has a positive effect on the quality indicators of its healthcare system. In addition, the formation of new units in the structure of the ambulance service, such as a department for remote counseling, allows not only to ensure more accessibility to patients but also to effectively use the financial resources of an institution.