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{ "pk": 18366, "title": "Rural and Ethnic Disparities in Out-of-hospital Care and Transport Pathways After Road Traffic Trauma in New Zealand", "subtitle": null, "abstract": "<p><strong>Introduction: </strong>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.</p>\n<p><strong>Methods:</strong> 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 M<!--StartFragment-->ā<!--EndFragment-->ori, rural non-M<!--StartFragment-->ā<!--EndFragment-->ori, urban M<!--StartFragment-->ā<!--EndFragment-->ori, and urban non-M<!--StartFragment-->ā<!--EndFragment-->ori).</p>\n<p><strong>Results:</strong> In a two-year period, there were 746 eligible patients; of these, 692 were transported to hospital. Indigenous M<!--StartFragment-->ā<!--EndFragment-->ori 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<br>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. M<!--StartFragment-->ā<!--EndFragment-->ori patients injured in a rural location were comparatively less likely than rural non-M<!--StartFragment-->ā<!--EndFragment-->ori 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).</p>\n<p><strong>Conclusion:</strong> 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 M<!--StartFragment-->ā<!--EndFragment-->ori, 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.</p>", "language": null, "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "emergency medical services" }, { "word": "out-of-hospital" }, { "word": "transport" }, { "word": "ambulance" }, { "word": "Trauma" }, { "word": "disparities" }, { "word": "Rural" }, { "word": "Indigenous." } ], "section": "Health Equity", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/61t0c674", "frozenauthors": [ { "first_name": "Rebbecca", "middle_name": "", "last_name": "Lilley", "name_suffix": "", "institution": "University of Otago, Dunedin School of Medicine, Department of Preventive and Social Medicine, Injury Prevention Research Unit, Dunedin, New Zealand", "department": "None" }, { "first_name": "Gabrielle", "middle_name": "", "last_name": "Davie", "name_suffix": "", "institution": "University of Otago, Dunedin School of Medicine, Department of Preventive and Social Medicine, Injury Prevention Research Unit, Dunedin, New Zealand", "department": "None" }, { "first_name": "Bridget", "middle_name": "", "last_name": "Dicker", "name_suffix": "", "institution": "Auckland University of Technology, Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland, New Zealand; Hato Hone St John, Mt Wellington, Auckland, New Zealand", "department": "None" }, { "first_name": "Papaarangi", "middle_name": "", "last_name": "Reid", "name_suffix": "", "institution": "Waipapa Taumata Rau-University of Auckland, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, Auckland, New Zealand", "department": "None" }, { "first_name": "Shanthi", "middle_name": "", "last_name": "Ameratunga", "name_suffix": "", "institution": "University of Auckland, School of Population Health, Section of Epidemiology and Biostatistics, Auckland, New Zealand; Te Whatu Ora (Health New Zealand) Counties Manukau, Population Health Directorate, Auckland, New Zealand; Monash University, Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia", "department": "None" }, { "first_name": "Charles", "middle_name": "", "last_name": "Branas", "name_suffix": "", "institution": "Columbia University Mailman School of Public Health, Department of Epidemiology, New York, New York", "department": "None" }, { "first_name": "Nicola", "middle_name": "", "last_name": "Campbell", "name_suffix": "", "institution": "University of Otago, Dunedin School of Medicine, Department of Preventive and Social Medicine, Injury Prevention Research Unit, Dunedin, New Zealand", "department": "None" }, { "first_name": "Ian", "middle_name": "", "last_name": "Civil", "name_suffix": "", "institution": "Auckland District Health Board, Trauma Services, Auckland, New Zealand", "department": "None" }, { "first_name": "Bridget", "middle_name": "", "last_name": "Kool", "name_suffix": "", "institution": "University of Auckland, School of Population Health, Section of Epidemiology and Biostatistics, Auckland, New Zealand", "department": "None" } ], "date_submitted": "2023-06-12T01:36:44+02:00", "date_accepted": "2023-06-12T01:36:44+02:00", "date_published": "2024-06-04T15:00:00+02:00", "render_galley": { "label": "Final Article", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/18366/galley/10904/download/" }, "galleys": [ { "label": "Layout", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/18366/galley/10089/download/" }, { "label": "Final Article", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/18366/galley/10904/download/" } ] }