Factors Impacting Patient Outcomes Associated with Use of Emergency Medical Services Operating in Urban Versus Rural Areas: A Systematic Review

Abstract

The goal of this systematic review was to examine the existing literature base regarding the factors impacting patient outcomes associated with use of emergency medical services (EMS) operating in urban versus rural areas. A specific subfocus on low and lower-middle-income countries was planned but acknowledged in advance as being potentially limited by a lack of available data. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed during the preparation of this systematic review. A comprehensive literature search of PubMed, EBSCO (Elton B. Stephens Company) host, Web of Science, ProQuest, Embase, and Scopus was conducted through May 2018. To appraise the quality of the included papers, the Critical Appraisal Skills Programme Checklists (CASP) were used. Thirty-one relevant and appropriate studies were identified; however, only one study from a low or lower-middle-income country was located. The research indicated that EMS in urban areas are more likely to have shorter prehospital times, response times, on-scene times, and transport times when compared to EMS operating in rural areas. Additionally, urban patients with out-of-hospital cardiac arrest or trauma were found to have higher survival rates than rural patients. EMS in urban areas were generally associated with improved performance measures in key areas and associated higher survival rates than those in rural areas. These findings indicate that reducing key differences between rural and urban settings is a key factor in improving trauma patient survival rates. More research in rural areas is required to better understand the factors which can predict these differences and underpin improvements. The lack of research in this area is particularly evident in low- and lower-middle-income countries.

Epidemiological profile of emergency medical services in Japan: a population‐based descriptive study in 2016

“…However, we observed that the overall median time from EMS call to EMS arrival on scene was similar to that of other developed countries as a recent systematic review to determine EMS response time showed that Asia, America, and Europe had median response times ranging from 7 to 11 min . A previous systematic review showed significantly shorter transport times in urban areas than rural areas, whereas the median time to hospital arrival in the most populated region in Japan, the Kanto region, was the longest . Multiple potential factors could affect the time to hospital arrival, such as patient age and the distribution of medical institutions and specialized hospitals, such as stroke centers …”

“…16 A previous systematic review showed significantly shorter transport times in urban areas than rural areas, whereas the median time to hospital arrival in the most populated region in Japan, the Kanto region, was the longest. 17 Multiple potential factors could affect the time to hospital arrival, such as patient age and the distribution of medical institutions and specialized hospitals, such as stroke centers. 18 Furthermore, combining prehospital data with external data resources could be beneficial in further investigations.…”

A comparison of pre-hospital emergency medical services’ response and duration times in urban versus rural areas of Saudi Arabia

“…This sample therefore does not appear representative of the Saudi citizen population which is approximately 51% male and 49% female (18), but an accurate gender breakdown via each region is difficult to ascertain from national data. It is also worth noting that while there is a significant gender imbalance in non-Saudi nationals (18), largely composed of male workers from other countries, this cohort may instead access an alternative EMS to Red Crescent (13,15). As this was a cross-sectional study, it was not possible to ascertain the precise reasons for this skew, however it is consistent with a previous study in Turkey that showed males use EMS at a higher rate than females (19).…”

Nontransported Cases after Emergency Medical Service Callout in the Rural and Urban Areas of the Riyadh Region

“…Similarly, little research has focused on rural EMS outside of the United States, Europe and Australia, with minimal focus on countries in Asia, Africa or the Middle-East. [ 12 ] This lack of research on rural EMS delivery in such locations is an area of need, as the significant service delivery, cultural, geographic and economic differences mean that findings from research in Western countries cannot necessarily be generalized to these settings.…”