Spatio-temporal Analysis of Cardiovascular Emergency Medical Requests: To Inform Policy and Practice

Abstract

Background:Response time to cardiovascular emergency medical requests is an important indicator in reducing cardiovascular disease (CVD) related mortality. This study aims to develop an index of response time and investigate potential clusters in the pattern of CVD-related calls over time and space.Methods:This cross-sectional study was conducted in Mashhad, north-eastern Iran, between August 2017 and December 2019. An emergency medical service (EMS) response time matrix to CVD-related calls was computed using spatial and classical statistical analyses. The Anselin Local Moran's I was performed to identify potential clusters in the patterns of CVD-related calls, response time, call-to-hospital arrival time, and scene-to-hospital arrival time at small area level (neighborhood level) in Mashhad, Iran.Results:There were 84,239 CVD-related emergency request calls, of which 60.21 percent were transported to clinical centers by EMS, and 2.62 percent (a total of 2203 persons) died before EMS arrival. The number of CVD-related emergency calls increased by almost 15% in 2018 and 20% in 2019. The peak in the number of calls occurred between 9 p.m. and 1 a.m., and the lowest number of calls were recorded between 3 a.m. and 9 a.m. Saturday was the busiest day of week in terms of call volume. There were statistically significant clusters in the pattern of CVD-related calls in the south-eastern region of Mashhad. Further, we found a large spatial variation in scene-to-hospital arrival time and call-to-hospital arrival time in the area under study.Conclusion:The use of geographical information systems and spatial analyses in modelling and quantifying EMS response time provides a new vein of knowledge for decision makers in emergency services management. This also enables policy makers to design tailored interventions to improve response time and reduce CVD-related mortality.