{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:33:35Z","timestamp":1789698815283,"version":"4.0.1"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The COVID-19 pandemic has impacted health systems globally, including emergency medical services (EMS). This study evaluates the absorptive and adaptive resilience of EMS in Jena, Germany, by analysing how the system managed significant pandemic-induced shocks to demand and operational workflows.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an observational, retrospective analysis of EMS missions in Jena from January 2018 to December 2021. Data on mission volumes, patient demographics, health issues, and dispatch and treatment intervals were analysed. Lockdown periods were compared to corresponding pre-pandemic reference periods to determine significant differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During first and second lockdown EMS mission volume decreased by 16% and 10% respectively, when comparing with reference periods. Patient age increased, with a mean age of 62.2 years during the first lockdown versus 58.9 years in the reference period. There was a notable rise in on-site treatments without hospital transport. Cardiovascular cases decreased during lockdown periods, while occurrence of psychiatric patients increased. Scene times and handover times extended significantly, contributing to longer total mission times.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The pandemic led to shift in demand patterns, characterized by reduced overall demand, extended mission times, and a change in treatment focus from cardiovascular to psychiatric and psychosocial issues, reflecting changes in healthcare-seeking behaviour and operational challenges. While regional studies have examined mission volumes, our study provides a higher-resolution analysis of the effects of the COVID-19 pandemic on pre-clinical EMS in Germany and provides important insights to be used for health care planning and policy decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0344992","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T17:34:27Z","timestamp":1773682467000},"page":"e0344992","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Health care system resilience - Evaluating the effect of the COVID-19 pandemic on emergency medical service demand in Germany: A case study from the city of Jena"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6703-2395","authenticated-orcid":true,"given":"Jonas","family":"Brock","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Lux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Lang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Winning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"Gratzias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Christoph","family":"Lewejohann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1521-3514","authenticated-orcid":true,"given":"Michael","family":"Bauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3282-7614","authenticated-orcid":true,"given":"Petra","family":"Dickmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"issue":"8","key":"pone.0344992.ref001","doi-asserted-by":"crossref","DOI":"10.3390\/jpm12081295","article-title":"Global 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