Paramedics are often the first point of contact for patients who access emergency healthcare services and are faced with a myriad of situations from low acuity complaints to life-threatening emergencies. Paramedics have been at the forefront of the COVID-19 pandemic, responding to emergencies, often in uncontrolled, unpredictable, and austere environments.

During the pandemic, many paramedic services have reported significant changes to service utilization [1, 2]. In this issue of CJEM, Grunau and colleagues highlight some of these changes, the challenges in pandemic response planning, and the role that paramedics play in helping to care for patients. Grunau et al. identified a 15% decrease in overall call volume during the first few months of the pandemic, and a 9% decrease in calls for major trauma, ST-segment elevation myocardial infarction (STEMI), and stroke [3]. They also identified changes in the primary problem for patients who called 911. There was a higher incidence of calls for respiratory distress and anxiety and a decrease in all other primary complaints. Interestingly, the authors found no change in the incidence of cardiac arrest calls [3]. There are a multitude of potential explanations for the noted decrease in 911 calls. First, the decrease in calls could be due to changes in patient behaviour, perhaps motivated by fear of contracting COVID-19. It is conceivable that patients