BACKGROUND: During the 2014–2016 Ebola outbreak in West Africa, CDC issued guidance for EMS providers on appropriate PPE. We analyzed EMS data to determine if PPE use by Illinois EMS providers increased during the time of heightened concern regarding domestic Ebola transmission (October 2014–June 2015). We hypothesized that for ambulance runs involving patients with infectious symptoms, there would be a greater increase in reported PPE usage than for patients without infectious symptoms.
METHODS: Illinois EMS data from ambulance runs during January 1, 2013–December 31, 2015 were utilized. Ambulance runs where the patient was not found, no treatment was required, care was refused or the run was cancelled were excluded. Patients were classified as infectious or non-infectious based on primary symptoms reported by EMS providers. Joinpoint regression software was used to examine trends in PPE usage by quarter.
RESULTS: Data were entered into the statewide EMS system by 496 different EMS agencies with a range of 1–699,235 ambulance runs per agency (median=1,331 runs) and 2,644,970 eligible runs. Patient primary symptoms were missing or marked as not reported for 25% of runs and, for an additional 12%, the field was completed as “no symptoms.” These runs were excluded from the infectious and non-infectious sub-group analyses. For 41% of runs, no PPE use was reported (the PPE use field was marked as not applicable (20.2%), not available (8.1%), not known (0.01%), not recorded (2.4%), not reporting (0.84%) or left blank (9.3%)). When ambulance runs by agencies that reported no variation in PPE usage (54 agencies reported no PPE usage and 45 agencies reported PPE usage for each run) were excluded (17.3% of runs), an overall increase in reported PPE use was observed. For infectious patients the modeled average percent change (APC) was 0.39% per quarter (p<0.05) and for non-infectious patients, the modeled APC was 0.63% per quarter (p <0.05). However, there was no break in the linear trend corresponding to the time of highest concern of domestic Ebola transmission for runs involving either patient type.
CONCLUSIONS: Although reported usage of PPE increased in Illinois during 2013–2015, we did not find a change in the trend during the time of heightened concern of domestic Ebola transmission. However, reporting quality for personnel PPE use varied among EMS agencies. As a result of this analysis, changes were made to the Illinois EMS reporting system to improve PPE use reporting.