Spatiotemporal access to emergency medical services in Wuhan, China: accounting for scene and transport time intervals

Weicong Luo,Jing Yao,Richard Mitchell,Xiaoxiang Zhang

doi:10.1186/s12942-020-00249-7

Abstract

BackgroundAccess as a primary indicator of Emergency Medical Service (EMS) efficiency has been widely studied over the last few decades. Most previous studies considered one-way trips, either getting ambulances to patients or transporting patients to hospitals. This research assesses spatiotemporal access to EMS at the shequ (the smallest administrative unit) level in Wuhan, China, attempting to fill a gap in literature by considering and comparing both trips in the evaluation of EMS access.MethodsTwo spatiotemporal access measures are adopted here: the proximity-based travel time obtained from online map services and the enhanced two-step floating catchment area (E-2SFCA) which is a gravity-based model. First, the travel time is calculated for the two trips involved in one EMS journey: one is from the nearest EMS station to the scene (i.e. scene time interval (STI)) and the other is from the scene to the nearest hospital (i.e. transport time interval (TTI)). Then, the predicted travel time is incorporated into the E-2SFCA model to calculate the access measure considering the availability of the service provider as well as the population in need. For both access measures, the calculation is implemented for peak hours and off-peak hours.ResultsBoth methods showed a marked decrease in EMS access during peak traffic hours, and differences in spatial patterns of ambulance and hospital access. About 73.9% of shequs can receive an ambulance or get to the nearest hospital within 10 min during off-peak periods, and this proportion decreases to about 45.5% for peak periods. Most shequs with good ambulance access but poor hospital access are in the south of the study area. In general, the central areas have better ambulance, hospital and overall access than peripheral areas, particularly during off-peak periods.ConclusionsIn addition to the impact of peak traffic periods on EMS access, we found that good ambulance access does not necessarily guarantee good hospital access nor the overall access, and vice versa.

Highlights

Access as a primary indicator of Emergency Medical Service (EMS) efficiency has been widely studied over the last few decades
Travel time‐based spatiotemporal access to EMS For each time period of the day, travel times on the five weekdays were averaged for each shequ
Most shequs with good ambulance access but poor hospital access are in the south of the study area

Summary

Introduction

Access as a primary indicator of Emergency Medical Service (EMS) efficiency has been widely studied over the last few decades. Geographic access often refers to the travel impedance (e.g. travel distance or travel time) between health facilities (e.g. hospitals or clinics) and patients [18]. Numerous measures of potential geographic access to healthcare have been developed over the last few decades, which can be categorized as provider-to-population ratios, distance-based measures, and gravity-based models [4, 12, 16, 32]. Provider-to-population ratios are often calculated using data aggregated at certain spatial scales such as administrative units or catchment area of health facilities. Gravity-based models incorporate the above two methods and account for the interactions between health services and potential demand, which generally follows a distance-decay effect. All three aforementioned types of methods have been widely adopted to measure healthcare access in a variety of contexts (e.g. [5, 7, 17, 38])

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