On-scene time delays for epileptic seizures in developed community-based integrated care system regions

• Published in: Epilepsy & behavior Vol. 151; p. 109612
• Main Authors: Yamada, Hidetada, Neshige, Shuichiro, Nonaka, Megumi, Takebayashi, Yoshiko, Ishibashi, Haruka, Motoda, Atsuko, Aoki, Shiro, Yamazaki, Yu, Maruyama, Hirofumi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2024
• Subjects: Emergency medical service; EMS response time; Local medical resource; People with epilepsy; Super-aged society; N/A; CI; EMS response time; EMS; Emergency medical service; COVID-19; SD; People with epilepsy; n.s; Super-aged society; Local medical resource; PWE; ED
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2023.109612

[Display omitted] •A multi-regional study with EMS database for epileptic seizures.•The pandemic led to on-scene time delays in acute bed-scarce regions.•EMS demand increased, impacting on-scene time delay for seizures.•Clinicians face challenges treating seizures due to EMS demand surges.•Optimal coordination is crucial for a Community-based Integrated Care System. Delayed on-scene time by emergency medical services (EMS) can have detrimental effects on critical cases for people with epilepsy (PWE). In preparation for a super-aged society, a Community-based Integrated Care System is crucial to manage healthcare costs. However, sufficient coordination irrespective of sociomedical changes among medical providers is challenging. This study aimed to evaluate on-scene time delays in the treatment of PWE, identify factors associated with such delays, and clarify regional differences. The focus was on the volume of acute care beds in regions with a developed Community-based Integrated Care System. This population-based observational study evaluated on-scene time delays in the treatment of PWE across six major cities in western Japan between 2017 and 2021. In addition, we also evaluated the association between regional differences focusing on volume of acute care beds (“Reduced region” and “Preserved region”, as cities with numbers of acute care beds per 1,000 people below and above the national average, respectively) along with sociomedical factors associated with on-scene time delays. This study included 8,737 PWE transported by EMS, with a mean on-scene time for EMS ranging from 12.9 ± 6.8 min to 21.7 ± 10.6 min. On-scene time delays were evident in Reduced regions, with an increase of 1.45 min (95 % confidence interval 0.86–2.03 min, p < 0.001). A high total EMS call volume independently influenced on-scene time delays during the middle period of the pandemic in Reduced regions. Optimal coordination must be facilitated to ensure the effective functioning of the Community-based Integrated Care System, particularly during unusual circumstances.