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.
Highlights
Traumatic injuries are one of the leading causes of death around the world, with the WorldHealth Organization (WHO) [1] noting that the estimated five million traumatic injury-related deaths annually was equivalent to the combined deaths associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), malaria and tuberculosis
The research indicated that emergency medical services (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
The results showed that prehospital time was significantly shorter in urban locations than in rural areas
Summary
Health Organization (WHO) [1] noting that the estimated five million traumatic injury-related deaths annually was equivalent to the combined deaths associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), malaria and tuberculosis. It is known that one of the most significant factors affecting health outcomes in trauma patients is time [2], with the period before commencement of healthcare support and while transferring a patient from the original incident site to a health service considered critical to reducing mortality and improving recovery for the individual [3]. The concept of a ‘golden hour’, the length of time immediately after the trauma and until care is provided, is often used as a key performance measure for emergency medical care, the validity of the implied ‘60 minutes’ timeframe is open to question [4]. Public Health 2019, 16, 1728; doi:10.3390/ijerph16101728 www.mdpi.com/journal/ijerph
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: International Journal of Environmental Research and Public Health
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
