The Impact of the UK National Lockdown on Trauma Patterns and the Prehospital Advanced Trauma Team Response within Metropolitan London
PDF

Keywords

injuries
air ambulances
EMS
pandemics
COVID-19
epidemiology

How to Cite

1.
Milne A, Saggers R, Hurst T, Henry C, Christian M. The Impact of the UK National Lockdown on Trauma Patterns and the Prehospital Advanced Trauma Team Response within Metropolitan London. Australasian Journal of Paramedicine [Internet]. 2022Mar.22 [cited 2023Mar.26];19. Available from: https://ajp.paramedics.org/index.php/ajp/article/view/985

Abstract

Introduction

The societal changes triggered by the COVID-19 pandemic and resultant lockdowns have the potential to alter the incidence and nature of injuries within affected populations. We aimed to investigate these changes within Metropolitan London and the impact lockdown had on London’s Air Ambulance’s (LAA) response to incidents.

Methods

This retrospective cohort study compared data from all LAA missions in the two-month period following instigation of the 1st UK national lockdown in 2020 to the equivalent period in 2019. Patient demographics, nature and severity of injuries, incident details and LAA mission parameters were assessed.

Results

LAA saw a significant reduction in the mean (standard deviation) of activations per week under lockdown (32.75 [4.95] versus 54.25 [4.53], p<0.001). The distribution of patients across different trauma aetiologies differed significantly under lockdown, with proportionately more injuries resulting from domestic violence (0.7% versus 3.8%) and deliberate self-harm (DSH [16.5% versus 12.4%]), although the absolute number of DSH fell. Significantly fewer incidents occurred in central areas of London, but injury severity was unaffected by lockdown. After adjustment for confounders, lockdown was associated with shorter drive times, but not overall response times. There was no association between lockdown and aetiology or severity of injuries.

Conclusion

The COVID-19 pandemic and ensuing UK national lockdown had a substantial impact on major trauma patterns within London and the subsequent LAA response. The feared rise in suicide was not observed, but there was a notable increase in domestic violence frequency.

https://doi.org/10.33151/ajp.19.985
PDF

References

Prime Minister’s Office. Prime Minister’s statement on coronavirus (COVID-19): 23 March 2020. Available from: https://www.gov.uk/government/speeches/pm-address-to-the-nation-on-coronavirus-23-march-2020.

NHS England. A&E attendances and emergency admissions. NHS England, 2020. Available from: https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/.

Hughes HE, Hughes TC, Morbey R, Challen K, Oliver I, Smith GE, et al. Emergency department use during COVID-19 as described by syndromic surveillance. Emerg Med J 2020;37:600–4.

Nuñez JH, Sallent A, Lakhani K, Guerra-Farfan E, Vidal N, Ekhtiari S, et al. Impact of the COVID-19 pandemic on an emergency traumatology service: experience at a tertiary trauma centre in Spain. Injury 2020;51:1414–8.

Hernigou J, Morel X, Callewier A, Bath O, Hernigou P. Staying home during ‘COVID-19’ decreased fractures, but trauma did not quarantine in one hundred and twelve adults and twenty-eight children and the ‘tsunami of recommendations’ could not lockdown twelve elective operations. Int Orthop 2020;44:1473–80.

DiFazio LT, Curran T, Bilaniuk JW, Adams JM, Durling-Grover R, Kong K, et al. The impact of the COVID-19 pandemic on hospital admissions for trauma and acute care surgery. Am Surg 2020;86:901–3.

Slagman A, Behringer W, Greiner F, Klein M, Weismann D, Erdmann B, et al. Medical emergencies during the COVID-19 pandemic. Dtsch Arztebl Int 2020;117:545–52.

Ojetti V, Covino M, Brigida M, Petruzziello C, Saviano A, Migneco A, et al. Non-COVID diseases during the pandemic: where have all other emergencies gone? Medicina 2020;56:512. Available from: https://doi.org/10.3390/medicina56100512.

Green S, Miles R. The burden of disease and illness in the UK. London. Available from: https://webarchive.nationalarchives.gov.uk/20130124042847/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_085152.pdf.

Hatchimonji JS, Swendiman RA, Seamon MJ, Nance ML. Trauma does not quarantine: violence during the COVID-19 pandemic. Ann Surg 2020;272:e53–4.

Lubbe RJ, Miller J, Roehr CA, Allenback G, Nelson KE, Bear J, et al. Effect of statewide social distancing and stay-at-home directives on orthopaedic trauma at a southwestern level 1 trauma center during the COVID-19 pandemic. J Orthop Trauma 2020;34:e343–8.

Qasim Z, Sjoholm LO, Volgraf J, Sailes S, Nance ML, Perks DH, et al. Trauma center activity and surge response during the early phase of the COVID-19 pandemic – the Philadelphia story. J Trauma Acute Care Surg 2020;89:821–8.

Nomura S, Kawashim T, Yoneoka D, Tanoue T, Eguchie A, Gilmour S, et al. Trends in suicide in Japan by gender during the COVID-19 pandemic, up to September 2020. Psychiat Res 2021;295:113622.

Bradbury-Jones C, Isham L. The pandemic paradox: the consequences of COVID-19 on domestic violence. J Clin Nurs 2020;29:2047–9.

Lerner EB, Newgard CD, Mann NC. Effect of the coronavirus disease 2019 (COVID‐19) pandemic on the US emergency medical services system: a preliminary report. Acad Emerg Med 2020;27:693–9.

Fothergill, RT, Smith, AL, Wrigley, F, Perkins, GD. Out-of-hospital cardiac arrest in London during the COVID-19 pandemic. Resuscitation Plus 2021;5:100066.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007;335:806–8.

Jeffrey B, Walters CE, Ainslie KEC, et al. Anonymised and aggregated crowd level mobility data from mobile phones suggests that initial compliance with COVID-19 social distancing interventions was high and geographically consistent across the UK. Wellcome Open Res 2020;5:170.

Jackson J, Posch C, Bradford B, Hobson Z, Kyprianides A, Yesberg J. The lockdown and social norms: why the UK is complying by consent rather than compulsion. Available from: https://blogs.lse.ac.uk/politicsandpolicy/lockdown-social-norms/.

MacKenzie EJ. Epidemiology of injuries: current trends and future challenges. Epidemiol Rev 2000;22:112–9.

Kamine TH, Rembisz A, Barron RJ, Baldwin C, Kromer M. Decrease in trauma admissions with COVID-19 pandemic. West J Emerg Med 2020;21:819–22.

Rhodes H, Petersen K, Biswas S. Trauma trends during the initial peak of the COVID-19 pandemic in the midst of lockdown: experiences from a rural trauma center. Cureus 2020;12:e9811.

Wasserman IM. The impact of epidemic, war, prohibition and media on suicide: United States, 1910–1920. Suicide Life Threat Behav 1992;22:240–54. PMID: 1626335.

Gunnell D, Appleby L, Arensman E, Hawton K, John A, Kapur N, et al. Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiat 2020;7:468–1.

Brookman, A, Windsor-Shellard, B. Quarterly suicide death registrations in England: 2001 to 2019 registrations and quarter 1 (Jan to Mar) to quarter 2 (Apr to June) 2020 provisional data. Office of National Statistics. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/quarterlysuicidedeathregistrationsinengland/2001to2019registrationsandquarter1jantomartoquarter2aprtojune2020provisionaldata#quarterly-suicides.

National Confidential Inquiry into Suicide and Safety in Mental Health. Suicide in England since the COVID-19 pandemic – early figures from real-time surveillance. 2020. Available from: http://documents.manchester.ac.uk/display.aspx?DocID=51861.

Victoria Coroners Court. Coroners court: monthly suicide data report: report 1–27 August 2020. Available from: https://www.coronerscourt.vic.gov.au/sites/default/files/2020-08/Coroners%20Court%20Monthy%20Suicide%20Data%20Report%20-%20Report%201%20-%2027082020.pdf.

John A. Trends in suicide during the covid-19 pandemic. BMJ 2020;371:m4352.

Refuge. Refuge reports further increase in demand for its National Domestic Abuse Helpline services during lockdown. Available from: https://www.refuge.org.uk/refuge-reports-further-increase-in-demand-for-its-national-domestic-abuse-helpline-services-during-lockdown/.

Davidge S. A perfect storm: the impact of the COVID-19 pandemic on domestic abuse survivors and the services that support them. Available from: https://www.womensaid.org.uk/wp-content/uploads/2020/08/A-Perfect-Storm-August-2020-1.pdf.

Greater London Authority. Gang crime and serious youth violence dashboard. Available from: https://www.london.gov.uk/what-we-do/mayors-office-policing-and-crime-mopac/data-and-statistics/crime%20/gangs-dashboard.

Rajput K, Sud A, Rees M, Rutka O. Epidemiology of trauma presentations to a major trauma centre in the North West of England during the COVID-19 level 4 lockdown. Eur J Trauma Emerg Surg 2021;47:631–6.

Emerson G. Please help us to help you – only call 999 as a last resort. Available from: https://www.londonambulance.nhs.uk/2020/03/26/please-help-us-to-help-you-only-call-999-as-a-last-resort/.

Prezant DJ, Lancet EA, Zeig‐Owens R, Lai PH, Appel DA, Webber MP, et al. System impacts of the COVID‐19 pandemic on New York City’s emergency medical services. JACEP Open 2020;1:1205–13.

UK Government. Transport use during the coronavirus (COVID-19) pandemic. Available from: https://www.gov.uk/government/statistics/transport-use-during-the-coronavirus-covid-19-pandemic.