Emergency Medical Services (EMS) Transportation of Trauma Patients by Geographic Locations and In-Hospital Outcomes: Experience from Qatar

Abstract

Background: Prehospital care provided by emergency medical services (EMS) plays an important role in improving patient outcomes. Globally, prehospital care varies across countries and even within the same country by the geographic location and access to medical services. We aimed to explore the prehospital trauma care and in-hospital outcomes within the urban and rural areas in the state of Qatar. Methods: A retrospective analysis was conducted utilizing data from the Qatar National Trauma Registry for trauma patients who were transported by EMS to a level 1 trauma center between 2017 and 2018. Data were analyzed and compared between urban and rural areas and among the different municipalities in which the incidents occurred. Results: Across the study duration, 1761 patients were transported by EMS. Of that, 59% were transported from an urban area and 41% from rural areas. There were significant differences in the on-scene time and total prehospital time as a function of urban and rural areas and municipalities; however, the response time across the study groups was comparable. There were no significant differences in blood transfusion, intubation, hospital length of stay, and mortality. Conclusion: Within different areas in Qatar, the EMS response time and in-hospital outcomes were comparable. This indicates that the provision of prehospital care across the country is similar. The prehospital and acute in-hospital care are accessible for everyone in the country at no cost. Understanding the differences in EMS utilization and prehospital times contributes to the policy development in terms of equitable distribution of healthcare resources.

Efficacy and safety of the second in-hospital dose of tranexamic acid after receiving the prehospital dose: double-blind randomized controlled clinical trial in a level 1 trauma center

“…In Qatar, most trauma cases are blunt (> 85%), primarily due to road traffic injuries and fall from height [ 38 ]. All severely injured patients in Qatar are transported and treated at no cost at the sole level 1 trauma center at HGH.…”

The Nature of Paramedic Practice in Rural and Remote Locations: A Scoping Review

“…The literature reviewed identified an increased mortality rate of rural out-of-hospital patients compared to urban patients. While one research study based in Qatar disagreed and did not find an increased mortality rate, (17) the majority of the research papers covering this topic did. (21,22,(25)(26)(27) The suspected causative factors of this varied, however some factors were presented as being unique to rural paramedicine.…”

“…(16,24) Paramedics in rural areas experience increased levels of fatigue when compared to their urban counterparts, reportedly due to pressures of working on-call and having extended transport times. (16,17,28) This can have detrimental effects on the pre-hospital care delivered, leading to impairment in decision making which can impact on fine motor skills, drug calculation, and driving competency. (19) This poses significant risk not only to the patient and wider community, but also to the paramedic themselves as it can result in motor vehicle accidents, incorrect drug administration and near misses.…”

“…(25)(26)(27) While the majority of articles supported this conclusion, one study conducted in Qatar conversely found that nil changes in mortality rates were noted when comparing rural and urban patient outcomes. (17) The literature also identified a number of factors associated with rurality that contributed to a positive perspective on patient care; a focus on community engagement was found to be beneficial for rural and remote paramedics as it allowed for improved health literacy of rural citizens, as well as a stronger community trust in the ambulance service. (27,28) Another concern posed by rural paramedics was the potential for skill erosion.…”

Prehospital Time Interval for Urban and Rural Emergency Medical Services: A Systematic Literature Review

“…Accordingly, different studies have investigated the impact of these factors, which can affect EMS in rural and urban communities [ 7 , 11 , 12 , 13 , 14 ]. For instance, previous investigations show that patients living in rural countries have longer waiting times for ambulances [ 12 , 15 , 16 , 17 , 18 ]. This is usually associated with severe health-related adverse events and worsens their survival rates [ 19 ].…”