Changes in prehospital emergency medical services dispatch mission patterns and their public health implications during the COVID-19 pandemic in Beijing, China

The COVID-19 pandemic placed unprecedented strain on global prehospital emergency medical services (EMS), particularly in megacities, acting as a stress test for health system resilience. However, comprehensive analyses of its impact on EMS dispatch patterns, mission types, and patient demographics in megacities like Beijing remain limited. This study aims to evaluate how the pandemic reshaped EMS operations in Beijing across multiple dimensions. This population-based retrospective cohort study analysed 452,824 dispatch tasks from the Beijing Prehospital Emergency Centre during matched periods (20 January–20 July) in 2019 (pre-pandemic) and 2020 (pandemic). Using chi-square tests and multivariable Poisson regression models with interaction terms, we examined changes in dispatch volume, mission type distribution, patient demographics, and call locations before and during the pandemic. Among the 452,824 tasks (pre-pandemic: 225,318; pandemic: 227,506), significant changes were observed. Overall EMS dispatch volume decreased during the pandemic (IRR = 0.69, 95% CI: 0.69–0.69), though monthly variability increased significantly (χ² = 25.59, P < 0.001). Mission types underwent substantial restructuring: conventional emergency responses declined by 4.2% points, while infectious disease transfers increased over 100-fold and non-emergency transports quadrupled (1.18% to 4.40%). Significant demographic shifts occurred, with increased service demands from elderly populations (interaction IRR up to 2.24 for oldest age group) and a pronounced relocation of emergency incidents from public spaces to residential areas (50.14% to 56.42%). The COVID-19 pandemic fundamentally transformed Beijing’s EMS ecosystem, characterized by reduced overall volume but increased volatility, service type restructuring, and spatial redistribution toward residential areas serving older populations.