Citation

Lilley R, Davie G, Dicker B, Reid P, Ameratunga S, Branas C, Campbell N, Civil I, Kool B. West. J. Emerg. Med. 2024; 25(4): 602-613.

Copyright

(Copyright © 2024, California Chapter of the American Academy of Emergency Medicine)

DOI

10.5811/westjem.18366

PMID

39028247

Abstract

INTRODUCTION: The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the first component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health system of Aotearoa-New Zealand (NZ), little is known about inequities in EMS-delivered care and transport pathways to hospital-level care.

METHODS: This population-level cohort study on out-of-hospital care, based on national EMS data, included trauma patients <85 years in age who were injured in a road traffic crash (RTC). In this study we examined the combined relationship between ethnicity and geographical location of injury in EMS out-of-hospital care and transport pathways following RTCs in Aotearoa-NZ. Analyses were stratified by geographical location of injury (rural and urban) and combined ethnicity-geographical location (rural Māori, rural non-Māori, urban Māori, and urban non-Māori).

RESULTS: In a two-year period, there were 746 eligible patients; of these, 692 were transported to hospital. Indigenous Māori comprised 28% (196) of vehicle occupants attended by EMS, while 47% (324) of patients' injuries occurred in a rural location. The EMS transport pathways to hospital for rural patients were slower to reach first hospital (total in slowest tertile of time 44% vs 7%, P ≥ 0.001) and longer to reach definitive care (direct transport, 77% vs 87%, P = 0.001) compared to urban patients. Māori patients injured in a rural location were comparatively less likely than rural non-Māori to be triaged to priority transport pathways (fastest dispatch triage, 92% vs 97%, respectively, P = 0.05); slower to reach first hospital (total in slowest tertile of time, 55% vs 41%, P = 0.02); and had less access to specialist trauma care (reached tertiary trauma hospital, 51% vs 73%, P = 0.02).

CONCLUSION: Among RTC patients attended and transported by EMS in NZ, there was variability in out-of-hospital EMS transport pathways through to specialist trauma care, strongly patterned by location of incident and ethnicity. These findings, mirroring other health disparities for Māori, provide an equity-focused evidence base to guide clinical and policy decision makers to optimize the delivery of EMS care and reduce disparities associated with out-of-hospital EMS care.

Language: en

Keywords

Humans; Adult; Aged; Female; Male; Middle Aged; Adolescent; New Zealand; Cohort Studies; *Rural Population/statistics & numerical data; *Accidents, Traffic/statistics & numerical data; *Emergency Medical Services/statistics & numerical data; *Healthcare Disparities/ethnology/statistics & numerical data; *Wounds and Injuries/therapy/ethnology; Ethnicity/statistics & numerical data; Health Services Accessibility/statistics & numerical data; Native Hawaiian or Other Pacific Islander/statistics & numerical data; Transportation of Patients/statistics & numerical data; Urban Population/statistics & numerical data