Impact of the COVID-19 pandemic on hypoglycemic cases: a retrospective study of prehospital EMS treat-and-release practices and hospital refusal rates

INTRODUCTION: Hypoglycemia is a common condition frequently encountered in emergency medical services (EMS). While many cases require hospital transfer, the low morbidity and mortality rates in non-transferred cases have prompted discussions about the implementation of ‘treat and release’ protocols. The COVID-19 pandemic introduced unprecedented challenges to healthcare systems globally, significantly altering the management of chronic conditions such as diabetes. During this period, lockdowns and restrictions disrupted routine medical care, influencing patients’ decisions to seek hospital services and impacting EMS operations. Previous studies have reported changes in hypoglycemia-related EMS cases during the pandemic, with increased hospital transfer refusals and adaptations in treatment protocols. Understanding these changes is crucial for optimizing EMS responses, improving patient outcomes, and reducing healthcare system burdens. This retrospective study aimed to evaluate the impact of the COVID-19 pandemic on hospital refusal and treat and release of hypoglycemia cases in prehospital emergency medical services. MATERIAL AND METHODS: The population of this retrospective cross-sectional study consisted of hypoglycemic patients who received services from the Manisa Provincial Directorate of Health 112 Emergency Medical Services between 2018 and 2022 (n = 5196). These five years were divided into three phases for analysis: I. Pre-pandemic period (2018–2019), II. Pandemic period (2020), and III. Pandemic period with vaccination (2021–2022). RESULTS: Over the five years, the proportion of hypoglycemia cases among total cases was 0.74%, and when the number of hypoglycemia cases is compared by years, it was found to be significantly lower in 2020 (0.57%) and 2021 (0.64%) (p < 0.05). It was further observed that 74.80% (n = 3884) of hypoglycemia cases were transferred to the hospital, 19.10% (n = 993) refused hospital transfer, and 2.70% (n = 143) were treated and released. It was also found that within prehospital emergency medical services, 6.20% (n = 322) of all hypoglycemia cases experienced recurrent hypoglycemic episodes within 48 hours. CONCLUSIONS: There has been an increase in hospital transfer refusal and treat and release rates among hypoglycemia patients in prehospital emergency medical services during the COVID-19 pandemic. Despite the increase in the number of patients left at the scene, especially in 2020 when the pandemic effects were intense, it is noteworthy that there was a slight decrease in the recurrence rates of hypoglycemic episodes. The results of this study are encouraging for the promotion of treat and release practices in hypoglycemia cases.