Association Between Emergency Medical Service Response Time and Motor Vehicle Crash Mortality in the United States

Byrne, James P.; Mann, N. Clay; Dai, Mengtao; Mason, Stephanie; Karanicolas, Paul J.; Rizoli, Sandro; Nathens, Avery B.

doi:10.1001/jamasurg.2018.5097

Cited by 85 publications

(96 citation statements)

References 34 publications

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“…It is known that the characteristics of the rural crashes (more likely to be head-on crashes and single vehicle collisions with stationary objects [20]), rural drivers' demographics (larger proportion of older drivers in rural areas, with increased fragility and higher chances of dying [21]), their typical behaviours (their travelling speeds in rural areas may be greater [20], they are less likely to use seat belts [22], etc.) or the difficulty of obtaining timely medical assistance on rural roads [23,24], are contributing factors to the higher frequency of fatal accidents in rural than in urban areas. Given that it is estimated that approximately 20% of fatal accidents in E&W during 2017 were drink-drive accidents [25], the rise in the number of fatal accidents on Friday and Saturday nights might be due to the fact that alcohol consumption is higher on the weekends [26,27].…”

Section: Discussionmentioning

confidence: 99%

Uncovering the behaviour of road accidents in urban areas

2020

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Different patterns in the incidence of road accidents are revealed when considering areas with increased levels of urbanization. To understand these patterns, road accident data from England and Wales is explored. In particular, the data are used to (i) generate time series for comparison of the incidence of road accidents in urban as opposed to rural areas, (ii) analyse the relationship between the number of road accidents and the population size of a set of urban areas, and (iii) model the likelihood of suffering an accident in an urban area and its dependence with population size. It is observed that minor and serious accidents are more frequent in urban areas, whereas fatal accidents are more likely in rural areas. It is also shown that, generally, the number of accidents in an urban area depends on population size superlinearly, with this superlinear behaviour becoming stronger for lower degrees of severity. Finally, given an accident in an urban area, the probability that the accident is fatal or serious decreases with population size and the probability that it is minor, increases sublinearly. These findings promote the question as to why such behaviours exist, the answer to which will lead to more sustainable urban policies.

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Section: Discussionmentioning

confidence: 99%

Uncovering the behaviour of road accidents in urban areas

2020

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“…Although most admissions to the ED are not via EMS, those that are via EMS tend to be far more acute (eg, myocardial infarction) and for trauma such as motor vehicle collision, where timely response is a key determinant of survival. 12,15,16 Nationwide, service times are longer in rural ZIP codes, nearly double that of urban ZIP codes. 10 This disparity in timely access to care is likely a large driver of urban-rural mortality differences in emergency conditions, such as AMI and motor vehicle collision.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…The average distance from a closed hospital to the next closest hospital in rural areas was 12 miles, 19 which could lead to a considerable increase in time to care. Given evidence that minor delays in care for certain conditions can lead to a significant increase in mortality, 14,16 closures of rural hospitals could lead to mortality increases in affected communities. 20 Because of the importance of timely response, EMS records are designed to include granular details on the nature of the service.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…EMS are an important element of the health care system. Although most admissions to the ED are not via EMS, those that are via EMS tend to be far more acute (eg, myocardial infarction) and for trauma such as motor vehicle collision, where timely response is a key determinant of survival . Nationwide, service times are longer in rural ZIP codes, nearly double that of urban ZIP codes .…”

Section: Introductionmentioning

confidence: 99%

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The effect of rural hospital closures on emergency medical service response and transport times

Miller

James

Holmes

et al. 2020

Health Services Research

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Objective To examine the effect of rural hospital closures on EMS response time (minutes between dispatch notifying unit and arriving at scene); transport time (minutes between unit leaving the scene and arriving at destination); and total activation time (minutes between 9‐1‐1 call to responding unit returning to service), as longer EMS times are associated with worse patient outcomes. Data Sources/Study Setting We use secondary data from the National EMS Information System, Area Health Resource, and Center for Medicare & Medicaid Provider of Service files (2010‐2016). Study Design We examined the effects of rural hospital closures on EMS transport times for emergent 9‐1‐1 calls in rural areas using a pre‐post, retrospective cohort study with the matched comparison group using difference‐in‐difference and quantile regression models. Principal Findings Closures increased mean EMS transport times by 2.6 minutes (P = .09) and total activation time by 7.2 minutes (P = .02), but had no effect on mean response times. We also found closures had heterogeneous effects across the distribution of EMS times, with shorter response times, longer transport times, and median total activation times experiencing larger effects. Conclusions Rural hospital closures increased mean transport and total activation times with varying effects across the distribution of EMS response, transport, and total times. These findings illuminate potential barriers to accessing timely emergency services due to closures.

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“…Our results are also consistent with findings from other diseases, including rural-urban disparities in the quality of care and mortality rates for cardiopulmonary conditions including acute myocardial infarction, pneumonia, and congestive heart Original article | 1331 failure. (9,36) Disparities in care quality for inpatients in the rural setting reflect environmental considerations that extend beyond the hospital itself, (37) but key contributors within the health system framework are lesser engagement of multidisciplinary teams outside of teaching and high-volume centers, (38) less timely access to procedural specialists, such as interventional radiologists, (39) and even structural considerations, such as the size and experience of health care informatics and administrative staff. (40,41) Although the manifold drivers of rural disparity are challenging, they represent numerous domains in which quality improvement projects may identify and ameliorate excess risks in this population.…”

Section: Discussionmentioning

confidence: 99%

Rural‐Urban Differences in In‐Hospital Mortality Among Admissions for End‐Stage Liver Disease in the United States

et al. 2019

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Access to quality hospital care is a persistent problem for rural patients. Little is known about disparities between rural and urban populations regarding in‐hospital outcomes for end‐stage liver disease (ESLD) patients. We aimed to determine whether rural ESLD patients experienced higher in‐hospital mortality than urban patients and whether disparities were attributable to the rurality of the patient or the center. This was a retrospective study of patient admissions in the National Inpatient Sample, a population‐based sample of hospitals in the United States. Admissions were included if they were from adult patients who had an ESLD‐related admission defined by codes from the International Classification of Diseases, Ninth Revision, between January 2012 and December 2014. The primary exposures of interest were patient‐level rurality and hospital‐level rurality. The main outcome was in‐hospital mortality. We stratified our analysis by disease severity score. After accounting for patient‐ and hospital‐level covariates, ESLD admissions to rural hospitals in every category of disease severity had significantly higher odds of in‐hospital mortality than patient admissions to urban hospitals. Those with moderate or major risk of dying had more than twice the odds of in‐hospital mortality (odds ratio [OR] for moderate risk, 2.41; 95% confidence interval [CI], 1.62‐3.59; OR for major risk, 2.49; 95% CI, 1.97‐3.14). There was no association between patient‐level rurality and mortality in the adjusted models. In conclusion, ESLD patients admitted to rural hospitals had increased odds of in‐hospital mortality compared with those admitted to urban hospitals, and the differences were not attributable to patient‐level rurality. Our results suggest that interventions to improve outcomes in this population should focus on the level of the health system.

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Association Between Emergency Medical Service Response Time and Motor Vehicle Crash Mortality in the United States

Cited by 85 publications

References 34 publications

Uncovering the behaviour of road accidents in urban areas

Uncovering the behaviour of road accidents in urban areas

The effect of rural hospital closures on emergency medical service response and transport times

Rural‐Urban Differences in In‐Hospital Mortality Among Admissions for End‐Stage Liver Disease in the United States

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