A Retrospective Analysis of Nearly 3,000,000 Non-COVID-19 Mid- and High-Priority Ambulance Activations Before and During COVID-19: A National Study from Saudi Arabia

Background/Objectives: Evidence regarding sustained changes in ambulance utilization during the COVID-19 pandemic is inconsistent, and long-term national evidence from Saudi Arabia is limited. This study assessed changes in the level and weekly trend of eligible non-COVID-19 mid-priority, potentially life-threatening, and life-threatening ambulance activations and EMS time intervals recorded by the Saudi Red Crescent Authority (SRCA) during the COVID-19 period relative to the pre-pandemic period. Methods: We retrospectively analyzed eligible SRCA activations recorded between 1 March 2018 and 28 February 2022. Weekly counts were evaluated using segmented negative-binomial interrupted time-series models. Exponentiated coefficients are reported as incidence rate ratios (IRRs) with 95% confidence intervals (CIs). EMS time intervals were compared between periods. Results: The analytical cohort comprised 2,837,523 eligible activations. At the interruption on 1 March 2020, the model estimated an immediate 19.0% level increase in weekly call volume (level-change IRR = 1.19; 95% CI: 1.06–1.33), followed by a relative decline in the post-interruption weekly trend (slope-change IRR = 0.996; 95% CI: 0.994–0.997). The largest complaint-specific immediate level-change IRRs were observed for penetrating injuries (IRR = 7.60; 95% CI: 5.40–10.70), pregnancy or obstetric emergencies (IRR = 3.59; 95% CI: 2.66–4.84), and allergic reactions (IRR = 3.21; 95% CI: 2.32–4.44); traffic-accident activations had a lower level (IRR = 0.59; 95% CI: 0.53–0.66). Median response, scene, transport, and total EMS intervals were longer by 1, 2, 2, and 4 min, respectively. Conclusions: Among the included non-COVID-19 mid- and high-priority activations, pandemic onset was associated with a higher immediate call level followed by a declining relative weekly trend and modestly longer EMS intervals. Complaint-specific differences may inform surveillance and service-capacity planning, but the observational design and exclusions preclude causal interpretation or inference about total SRCA workload.