Emergency Medical Services Utilization Research Articles

Racial Disparities in Utilization of Emergency Medical Services and Related Impact on Poststroke Disability.

Prompt seeking of emergency medical services (EMS) assistance at stroke onset is critical to minimize poststroke disability. The aim was to study how racial differences in EMS decision-relevant factors and EMS use impact stroke care and disability outcomes. A prospective observational study. A total of 1168 acute ischemic stroke patients discharged from April 2016 to October 2017 at a safety net hospital were included; 108 patients were surveyed before discharge. (1) Prehospital delay: EMS use, timely hospital arrival; (2) Stroke care: alteplase receipt and inpatient rehab; (3) Outcomes: Functional improvement at discharge (admission minus discharge scores on National Institutes of Health Stroke Scale), 90-day modified Rankin Scale; (4) EMS decision-relevant factors: Stroke symptom knowledge, source of knowledge, unfavorable past EMS/care experiences, and financial barriers to EMS use. Despite more Black patients using EMS than Whites/Asians (56% vs. 48%, P =0.003), their timely hospital arrival was 30% less likely. Adjusted for stroke severity, receipt of alteplase, and inpatient rehab were similar, but Black patients fared worse on functional improvement at discharge (among severe strokes, 2.4 National Institutes of Health Stroke Scale points less improvement, P <0.01), and on functional normalcy at 90 days (modified Rankin Scale score 0-1 being 60% less likely across severity categories) ( P <0.01). Fewer Black patients knew any stroke symptoms before the stroke (72% vs. 87%, P =0.03), and fewer learned about stroke from providers ( P =0.01). Financial barriers and provider mistrust were similar. Black patients had less knowledge of stroke symptoms, more care-seeking delay, and poorer outcomes. Including stroke education as a standard of chronic disease care may mitigate stroke outcome disparities.

Pre-Hospital Emergency Medical Services Utilization Amid COVID-19 in 2020: Descriptive Study Based on Routinely Collected Dispatch Data in Bavaria, Germany.

The COVID-19 pandemic affected the utilization of health care services and posed organizational challenges. While many previous studies focused on the misuse of pre-hospital EMS for low-urgency health problems, the pandemic has put more emphasis on the avoidance of medically necessary calls. To compare the utilization of pre-hospital emergency medical services before and after specific pandemic periods. This was a retrospective, descriptive analysis of routine data from 26 dispatch centers in Bavaria, Germany. We investigated the number of emergencies per 100,000 population, as well as the relative change in the emergency rates and transport rates in 2020, compared to the two previous years. Boxplots showed the distributions across the Bavarian districts per calendar week. The mean rates and standard deviations as well as the relative changes were presented for the specific periods. A paired samples t-test was used to compare the rates. Compared to the average of the two previous years, the emergency rates in 2020 were lower in 35 out of 52 calendar weeks. The strongest reductions were observed during the first wave, where the average emergency rate declined by 12.9% (SD 6.8, p < 0.001). There was no statistically significant difference in the overall emergency rate during the summer holidays. Lower transport rates were observed throughout the year, especially during the first wave. Utilization of pre-hospital emergency medical services decreased in 2020, especially during the periods with strict measures. This could be due to the lower morbidity from the behavioral changes during the pandemic, but also to the avoidance of medical services for both less urgent and severe conditions. While a reduction in unnecessary care would be beneficial, patients must be encouraged to seek necessary urgent care, even during a pandemic.

Effect of COVID-19 Pandemic Lockdown on Emergency Medical Service Utilisation, and Percutaneous Coronary Intervention (PCI) Volume—An Australian Perspective

Effect of COVID-19 Pandemic Lockdown on Emergency Medical Service Utilisation, and Percutaneous Coronary Intervention (PCI) Volume—An Australian Perspective

Determinants and barriers of prehospital emergency medical services utilization among general critical emergency patients in Thailand

This cross-sectional study identified the determinants and barriers of pre- hospital emergency medical services (EMS) utilization among general critical emergency patients in Thailand, using the data of general critical emergency patients (red zone) from the information technology for emergency medical system (ITEMS) of the National Emergency Medical Service Institute. The sample of 889 critical emergency patients was selected through multistage random sampling method. Data were analyzed by multiple logistic regression. The findings indicated that 41.51% of general critical emergency patients used EMS through the EMS rescue hotline system of the National Institute of Emergency Medicine in which most of them were diabetic patients (24.75%). The determinants relating to EMS utilization of general critical emergency patients consisted of level of knowledge on EMS system (AdjOR: 5.77; 95%CI: 2.8-11.87), confidence in the safety of service utilization (AdjOR: 5.04; 95%CI: 3.65-6.98), recognition in service and severity of illness (AdjOR: 3.22; 95%CI: 2.17-4.76), service adequacy (AdjOR: 1.92; 95%CI: 1.41-2.63), educational background (AdjOR:1.69; 95%CI: 1.13-2.53), and service satisfaction (AdjOR: 1.14; 95%CI: 1.07-1.21). Nearly half of the people were utilizing the EMS services in Thailand. However, required level of knowledge on EMS, confidence on safety on service utilization, service adequacy as well as patient’s educational background had tremendous role on the proper utilization of EMS.

Physical distancing and emergency medical services utilization after self-harm in Korea during the early COVID-19 pandemic: A nationwide quantitative study.

People experienced various stress and psychological responses to the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to examine the changes in emergency medical services (EMSs) utilization by self-harm patients in early pandemic and the impacts of physical distancing measures on the EMSs utilization by self-harm patients. Data for all patients presenting to emergency departments (EDs) after self-harm injuries including self-poisoning were collected from the National ED Information System (NEDIS). Characteristics of patients in two study regions (urban versus rural) were compared. Weekly and annual ED visit rates after self-harm (VRSH) per 100,000 population were calculated. Mobile phone mobility index (MPMI) was calculated by dividing a region's aggregated mobile phone mobility by mid-year population. Joinpoint regression analysis was conducted to assess changes in 2020 over pre-pandemic years. Test for presence of joinpoint at the end of 2019 was performed. A cross-correlation function was used to estimate the maximal morphological similarity and lag time between changes in MPMI and VRSH. In 2020, in early phases of the pandemic, there was a moderate decline in self-harm-related ED visits to 30,797 from a continuously increasing trend seen in previous years. However, proportions of young people (50.1%) and females (62.3%) increased over previous years. VRSHs among women and young people aged 15-34 years showed higher levels in 2020 than in previous five years. There was a significant decrease in the proportion of patients transported directly from the scene. In addition, there was a polarization of mental state upon ED arrival from alert and unresponsive. The median correlation coefficient between MPMI values and VRSH values was 0.601 (interquartile range [IQR]: 0.539-0.619) in urban regions and 0.531 (IQR: 0.454-0.595) in rural regions, showing no statistically significant difference between the two. Physical distancing measures adopted to prevent the spread of transmittable diseases following the pandemic had the effect of decreasing ED visits due to self-harm. When the pandemic has ended, and daily life has been restored, it will be particularly important to pay attention to the increased numbers of self-harm patients expected to visit EDs compared to during the pandemic.

Increasing emergency number utilisation is not driven by low-acuity calls: an observational study of 1.5 million emergency calls (2018–2021) from Berlin

BackgroundThe Emergency Medical Service (EMS) in Germany is increasingly challenged by strongly rising demand. Speculations about a greater utilisation for minor cases have led to intensive media coverage, but empirical evidence is lacking. We investigated the development of low-acuity calls from 2018 to 2021 in the federal state of Berlin and its correlations with sociodemographic characteristics.MethodsWe analysed over 1.5 million call documentations including medical dispatch codes, age, location and time using descriptive and inferential statistics and multivariate binary logistic regression. We defined a code list to classify low-acuity calls and merged the dataset with sociodemographic indicators and data on population density.ResultsThe number of emergency calls (phone number 112 in Germany) increased by 9.1% from 2018 to 2021; however, the proportion of low-acuity calls did not increase. The regression model shows higher odds of low-acuity for young to medium age groups (especially for age 0–9, OR 1.50 [95% CI 1.45–1.55]; age 10–19, OR 1.77 [95% CI 1.71–1.83]; age 20–29, OR 1.64 [95% CI 1.59–1.68] and age 30–39, OR 1.40 [95% CI 1.37–1.44]; p < 0.001, reference group 80–89) and for females (OR 1.12 [95% CI 1.1–1.13], p < 0.001). Odds were slightly higher for calls from a neighbourhood with lower social status (OR 1.01 per index unit increase [95% CI 1.0–1.01], p < 0.05) and at the weekend (OR 1.02 [95% CI 1.0–1.04, p < 0.05]). No significant association of the call volume with population density was detected.ConclusionsThis analysis provides valuable new insights into pre-hospital emergency care. Low-acuity calls were not the primary driver of increased EMS utilisation in Berlin. Younger age is the strongest predictor for low-acuity calls in the model. The association with female gender is significant, while socially deprived neighbourhoods play a minor role. No statistically significant differences in call volume between densely and less densely populated regions were detected. The results can inform the EMS in future resource planning.

The Impact of COVID-19 Incidence on Emergency Medical Services Utilization

The Impact of COVID-19 Incidence on Emergency Medical Services Utilization

Association Between Primary Care Availability and Emergency Medical Services Utilization

BackgroundEmergency medical services (EMS) contribute to the vital role of providing health care to an individual by delivering time-sensitive, episodic treatment to patients with acute illnesses. Understanding which factors impact EMS utilization can help guide policies and allocate resources more effectively. Increasing primary care access has often been touted to decrease unnecessary emergency care utilization. ObjectivesThis study seeks to determine whether a relationship exists between access to primary care and EMS utilization. MethodsUsing data from the National Emergency Medical Services Information System, Area Health Resources Files, and County Health Rankings and Roadmaps, U.S. county-level data were analyzed to determine whether increased access to primary care (and insurance coverage) was associated with decreased EMS utilization. ResultsHigher primary care availability is associated with less EMS utilization only when insurance coverage in the community surpassed 90%. ConclusionsInsurance coverage can play an important role in decreasing EMS utilization and may also impact the effect of increased primary care physician availability on EMS utilization in a region.

Challenges of Emergency Medical Services Utilization by Older Adults in Tabriz, Iran: Data from Health Status of Aged People in Tabriz (HSA-T Study)

Objectives: To evaluate the awareness of older adults in Tabriz of Emergency Medical Services (EMS) and the terms of services. Design: Cross-sectional study. Setting(s): Tabriz, the capital city of East Azerbaijan Province, in northwestern Iran. Participants: A representative sample of≥60 years old noninstitutionalized population containing 1071 participants (514 males and 557 females) in the health status of aged people in Tabriz (HSA-T) study was selected using the probability proportional to the size (PPS) sampling method. Out of all the participants in the HAS-T study, 1062 participants (514 males and 548 females) completed the questionnaire regarding the awareness and knowledge of EMS. Outcome Measures: Service awareness means being informed about the existence of the EMS. Knowledge about EMS is defined as knowing the EMS phone number and knowledge about its free and 24-hour services. Results: Forty-seven percent of the older adults were not familiar with the EMS system. The awareness of EMS in males was higher than that in females (63.4% vs. 44.4%, P&lt;0.001), and it was also higher among those born in cities than those in rural areas (61.2% vs. 46.1%, P&lt;0.001). Furthermore, individuals who hold primary, secondary, and higher education had a higher chance of awareness of EMS compared with illiterate people by more than 2, 4, and 12 times, respectively Odds ratio (OR)=2.53; 95% confidence interval (CI): 1.81–3.52, OR=4.69; 95% CI: 2.79–7.91, and OR=12.09; 95% CI: 4.88–29.94). Conclusions: Due to the high rate of illiteracy and low public awareness, older adults do not have appropriate knowledge about the facilities, conditions, and terms of using EMS and may not be able to demand some of their essential services; therefore, notifying and increasing the older adults’ awareness of the available services is necessary.

Prior Emergency Medical Services Utilization Among People Who Had an Accidental Opioid-Involved Fatal Drug Overdose-Rhode Island, 2018-2020.

To help understand whether decreased emergency medical services (EMS) utilization due to the COVID-19 pandemic contributed to increased accidental fatal drug overdoses, we characterized recent EMS utilization history among people who had an accidental opioid-involved fatal drug overdose in Rhode Island. We identified accidental opioid-involved fatal drug overdoses among Rhode Island residents that occurred from January 1, 2018, through December 31, 2020. We linked decedents by name and date of birth to the Rhode Island EMS Information System to obtain EMS utilization history. Among 763 people who had an accidental opioid-involved fatal overdose, 51% had any EMS run and 16% had any opioid overdose-related EMS run in the 2 years before death. Non-Hispanic White decedents were significantly more likely than decedents of other races and ethnicities to have any EMS run (P < .001) and any opioid overdose-related EMS run (P = .05) in the 2 years before death. Despite a 31% increase in fatal overdoses from 2019 through 2020, corresponding with the onset of the COVID-19 pandemic, EMS utilization in the prior 2 years, prior 180 days, or prior 90 days did not vary by time frame of death. In Rhode Island, decreased EMS utilization because of the COVID-19 pandemic was not a driving force behind the increase in overdose fatalities observed in 2020. However, with half of people who had an accidental opioid-involved fatal drug overdose having an EMS run in the 2 years before death, emergency care is a potential opportunity to link people to health care and social services.

Prehospital emergency medical service utilization and associated factors among critically ill COVID-19 patients treated at centers in Addis Ababa, Ethiopia.

The majority of populations in developing countries are living in areas of no access or limited access to prehospital emergency medical services (EMS). In Addis Ababa, the reported prehospital EMS utilization were ranging from zero to thirty-eight percent. However, there is limited research on reasons for the low utilization of prehospital resources in Ethiopia. This study aimed to assess factors associated with prehospital EMS utilization among critically ill COVID-19 patients in Addis Ababa, Ethiopia. A hospital-based cross-sectional study was conducted to collect primary data from 421 COVID-19 patients in Addis Ababa between May and July 2021. Logistic regression was used to identify factors associated with prehospital service utilization. Andersen's Behavioral Model was implemented to address independent variables, including predisposing, enabling, need, and health behaviors-related variables. The level of prehospital care utilization was 87.6%. Being married [AOR 2.6(95%; CI:1.24-5.58)], belief that self-transport is quicker than the ambulance [AOR 0.13(95%; CI: 0.05-0.34)], and perceptions that ambulance provides transportation service only [AOR 0.14(95%; CI:0.04-0.45)] were predisposing factors associated with prehospital service utilization while the source of referrals [AOR 6.9(95%; CI: 2.78-17.30)], and prior knowledge on the availability of toll-free ambulance calling numbers [AOR 0.14(95%; CI: 0.04-0.45)] were identified as enabling factors. Substantial proportions of critically ill COVID-19 patients used prehospital services to access treatment centers. Prehospital EMS utilization in this study varies by predisposing and enabling factors, particularly: marital status, source of referral, prior knowledge on the availability of toll-free ambulances, belief that self-transport is quicker than ambulances, and perceptions that ambulance provides transportation service only. Our findings call for further actions to be taken by policymakers including physical and media campaigns focusing on the identified factors.

The Epidemiology of Pre-Hospital EMS Treatment of Geriatric Patients in the City of Vienna-An Overview.

Background: The city of Vienna, Austria, has a gradually aging population. Elderly people, over 65 years old and living at home or in nursing homes, frequently use Emergency Medical Services (EMS). However, there is no previous data comparing the EMS utilization of elderly- and non-elderly patients in Vienna. Methods: We retrospectively analyzed all EMS incidents in Vienna from 2012 to 2019. Transport- and emergency physician treatment rates, annual fluctuations, and the number of non-transports were compared between elderly (≥65 years) and non-elderly (18−64 years) patients. Results: Elderly people accounted for 42.6% of the total EMS responses in adult patients, representing an annual response rate of 223 per 1000 inhabitants ≥ 65 years. Compared to 76 per 1000 inhabitants in patients 18−64 years old, this results in an incidence rate ratio (IRR) of 2.93 [2.92−2.94]. Elderly people were more likely (OR 1.68 [1.65−1.70]) to need emergency physicians, compared to 18−64 year-olds. Nursing home residents were twice (OR 2.11 [2.06−2.17]) as likely to need emergency physicians than the rest of the study group. Non-transports were more likely to occur in patients over 65 years than in non-elderlies (14% vs. 12%, p < 0.001). Conclusions: The elderly population ≥ 65 years in Vienna shows higher EMS response rates than younger adults. They need emergency physicians more often, especially when residing in nursing homes. The economical and organizational strain this puts on the emergency response system should trigger further research and the development of solutions, such as specific response units dedicated to elderly people.

Optimizing Trauma Systems: A Geospatial Analysis of the Victorian State Trauma System.

The aim of this study was to develop a data-driven approach to assessing the influence of trauma system parameters and optimizing the configuration of the Victorian State Trauma System (VSTS). Regionalized trauma systems have been shown to reduce the risk of mortality and improve patient function and health-related quality of life. However, major trauma case numbers are rapidly increasing and there is a need to evolve the configuration of trauma systems. A retrospective review of major trauma patients from 2016 to 2018 in Victoria, Australia. Drive times and flight times were calculated for transport to each of 138 trauma receiving hospitals. Changes to the configuration of the VSTS were modeled using a Mixed Integer Linear Programming algorithm across 156 simulations. There were 8327 patients included in the study, of which 58% were transported directly to a major trauma service (MTS). For adult patients, the proportion of patients transported directly to an MTS increased with higher transport time limit, greater probability of helicopter emergency medical service utilization, and lower hospital patient threshold numbers. The proportion of adult patients transported directly to an MTS varied from 66% to 90% across simulations. Across all simulations for pediatric patients, only 1 pediatric MTS was assigned. We have developed a robust and data-driven approach to optimizing trauma systems. Through the use of geospatial and mathematical models, we have modeled how potential future changes to trauma system characteristics may impact on the optimal configuration of the system, which will enable policy makers to make informed decisions about health service planning into the future.

A Multi-objective Mathematical Programing Model for the Problem of P-envy Emergency Medical Service Location.

To prevent the great dangers caused by emergency situations, providing rapid and high-quality emergency aid highly depends on the location of emergency medical centers. The purpose of this research is to present a multi-objective mathematical programing model based on the minimum P-envy algorithm to locate and construct emergency medical services (EMS). Maximizing the coverage in order to increase the probability of survival of different categories of patients, minimizing the costs of constructing EMS and optimizing the ratio of regions having the right to emergency medical services is one of the fundamental challenges in the health care system of countries. In this paper, a model for maximum utilization of EMS considering budget limitations is presented. In this study, since the problem is NP-Hard, the Genetic Algorithm (GA) and Simulated Annealing (SA) algorithm were used to solve this problem. The parameters of the metaheuristic algorithms were tuned using the Taguchi method. Several instance problems were solved to compare the performance of 2 algorithms. The results demonstrate that the validity of the proposed model. Also, the mean of the solutions obtained by GA for small, medium, and large-size problems are better than the SA algorithm. Also, the GA algorithm obtained more efficient solutions than the SA algorithm.

A Mixed Methods Analysis of Patient Utilization and Trust of Emergency Medical Services (EMS)

Background: Little is known regarding patients’ decisions to come to the emergency department (ED) via emergency medical services (EMS) versus privately owned vehicle (POV) and no studies have investigated patients’ trust of the EMS system as it varies by race.&#x0D; Methods: Patients who came to one urban, academic ED were given a mixed methods survey at bedside. Qualitative data identified patient reasoning for utilization of EMS versus POV. Quantitative data included patient demographics, medical and social history, and two validated scales to assess trust and perceived empathy of EMS providers (the Group-Based Medical Mistrust Scale and the Jefferson Scale of Patient Perception of Physician Empathy). Descriptive statistics showed characteristics of patients who came in via EMS versus POV and an unpaired t-test described the difference in EMS trust as it varied by race.&#x0D; Results: Qualitative: Patients who came via EMS reported lack of access to a POV, inability to drive, and the inability to move secondary to the chief presenting medical complaint. Patients who came in via POV based their selection on speed, high cost of EMS transport, the ability to drive themselves safely, or lack of perceived emergency. Quantitative: 9/23 (39.1%) patients utilized EMS transport and 14/23 (60.9%) utilized POV. 56.5% of patients were Black and 39.1% were White. Of those who came in by EMS, only 5/9 (55.5%) felt they had an immediate threat to life, organ or body function. The Group-Based Medical Mistrust Scale indicated that Black patients had less trust in the EMS system than White patients (p=0.04), while the Jefferson Scale of Patient Perception of Physician Empathy demonstrated no significant difference (p=0.60).&#x0D; Conclusion and Potential Impact: Hopefully, this data will inform policy makers attempting to make the emergency care system accessible to all patients and provide appropriate non-emergent options for optimal medical care.

Utilization of pre-hospital emergency medical services: Secondary data analysis of health insurance data from Saxony-Anhalt

Utilization of emergency care is subject to demographic changes. In Germany, there was an increase of 4% to 6% annually between the years 2000 and 2017. Studies revealed that age and regional structures were related to utilization. The aim of this cross-sectional study was to analyze utilization of pre-hospital emergency medical services in Saxony-Anhalt and to identify associated factors. Based on data from the AOK Saxony-Anhalt for 2019, transportation with ground ambulances of insured persons living in Saxony-Anhalt were identified and recorded. Insured time of all AOK insured persons living in Saxony-Anhalt was used to determine incidence rates. For the multivariate analysis of associated factors, a Poisson regression model was adapted. 112,575 transportations of patients were identified; an average of 1.53 events per person or 149.6 per 1,000 person years. Inpatient hospital treatment was provided for 53.2% of emergency patients and outpatient hospital treatment for 37.1%. Frequent users represented 14.6% of the events. The incidence rate was highest for older persons and those with care dependency. In addition, the risk of using emergency services was higher among men and in suburban and urban regions (compared with rural regions), even after adjustment. Utilization is higher in the cohort studied compared to that found in other studies. The high proportion where inpatient hospital treatment is not necessary, as well as the clear association with care dependency and age, offer possible angles of approach for interventions to relieve the burden on emergency services.

The Association Between Access to Athletic Trainers and Emergency Medical Services Activations for Sport-Related Injuries.

Having athletic trainers (ATs) employed at secondary schools is associated with improved preparedness for sport-related emergencies. Utilization of emergency medical services (EMS) with different access to athletic training services remains unknown. Compare the incidence of EMS activations for sport-related injuries between zip-codes with varying access to athletic training services. Descriptive epidemiology study. Data were obtained from the National EMS Information System and the Athletic Training Location and Services Project. Zip-codes where 9-1-1 EMS activations for sport-related injuries among individuals 13-18 years old occurred. Incidence of EMS activations, athletic training service level (NONE, PART, FULL), athletic training employment model (independent contractor, IC; medical or university facility, MUF; school district, SD; mixed employment models, MIX) for each zip-code. There were 2.8±3.5 EMS activations per zip-code (range 1-81, n=4,923). Among zip-codes where at least 1 AT was employed (n=2,228), 3.73% (n=83) were IC, 30.83% (n=687) were MIX, 27.24% (n=607) were SD, and 38.20% (n=851) were MUF. Compared to SD, MUF had a 10.8% lower incidence of EMS activations (95%CI: 0.817, 0.974, p=0.010). IC (IRR: 0.920, 95%CI: 0.758, 1.118, p=0.403) and MIX (IRR: 0.996, 95% CI: 0.909, 1.091, p=0.932) were not significantly different from SD. Service level was calculated for 3,834 zip-codes, with 19.5% (n=746) NONE, 46.2% (n=1,771) PART, and 34.4% (n=1,317) FULL. Compared to NONE, FULL (IRR: 1.416, 95%CI: 1.308, 1.532, p<0.001) and PART (IRR: 1.368, 95%CI: 1.268, 1.476, p<0.001) had higher incidences of EMS activations. Local access to athletic training services is associated with an increased utilization of EMS for sport-related injuries among secondary school aged individuals, potentially indicative of improved identification and triage of sport-related emergencies the area. The difference in EMS utilization between employment models may represent the presence of different policies and procedures for sport-related emergencies.

Emergency medical service utilization among acute ischemic stroke patients in Beijing: An observational study.

ObjectiveTo investigate emergency medical service (EMS) utilization and its associated factors in patients with acute ischemic stroke (AIS), and further explore the urban-rural differences.MethodsMedical records for AIS in all emergency departments in Beijing were obtained from the Beijing Emergency Care Database from January 2018 to December 2021. EMS utilization was described and factors associated with EMS use were examined by multivariable logistic regression models with the generalized estimating equations. Results were compared between urban and rural districts.ResultsA total of 24,296 AIS patients were included in the analysis, and 11,190 (46.1%) were transported to hospitals by EMS. The percentage of EMS usage in urban areas was significantly higher than that in rural areas (53.6 vs. 34.4%, P < 0.001). From 2018 to 2021, EMS utilization was on the increase (P-value for trend <0.001) with a higher average annual growth rate in rural areas (12.6%) than in urban (6.4%). Factors associated with EMS utilization were age (OR: 1.20 per 10-year increase, 95% CI: 1.17–1.23), NIHSS scores, off-hour arrival (OR: 1.32, 95% CI: 1.23–1.37), treatment in tertiary hospitals (OR: 1.75, 95% CI: 1.60–1.92), and possessing comorbidities such as coronary artery disease (OR: 1.15, 95% CI: 1.17–1.24), atrial fibrillation (OR: 1.56, 95% CI: 1.41–1.73), prior stroke (OR: 0.84, 95% CI: 0.78-0.90) or dyslipidemia (OR: 0.78, 95% CI: 0.71–0.85).ConclusionThis study demonstrated an inadequate use of EMS among AIS patients in Beijing, especially in rural areas, and revealed several associated factors. Enhanced education programs and EMS accessibility are necessary particularly for high-risk individuals and regions.

Emergency Medical Services (EMS) Utilization in Zimbabwe: Retrospective Review of Harare Ambulance System Reports

Background:Emergency medical services (EMS) are a critical but often overlooked component of essential public health care delivery in low- and middle-income countries (LMICs). Few countries in Africa have established EMS and there is scant literature to provide guidance for EMS growth.Objective:This study aimed to characterize EMS utilization in Harare, Zimbabwe in order to guide system strengthening efforts.Methods:We performed a retrospective chart review of patient care reports (PCR) generated by the City of Harare ambulance system for patients transported and/or treated in the prehospital setting over a 14-month period (February 2018 – March 2019).Findings:A total of 875 PCRs were reviewed representing approximately 8% of the calls to EMS. The majority of patients were age 15 to 49 (76%) and 61% were female patients. In general, trauma and pregnancy were the most common chief complaints, comprising 56% of all transports. More than half (51%) of transports were for inter-facility transfers (IFTs) and 52% of these IFTs were maternity-related. Transports for trauma were mostly for male patients (63%), and 75% of the trauma patients were age 15–49. EMTs assessed and documented pulse and blood pressure for 72% of patients.Conclusion:In this study, EMS cared primarily for obstetric and trauma emergencies, which mirrors the leading causes of premature death in LMICs. The predominance of requests for maternity-related IFTs emphasizes the role for EMS as an integral player in peripartum maternal health care. Targeted public health efforts and chief complaint-specific training for EMTs in these priority areas could improve quality of care and patient outcomes. Moreover, a focus on strengthening prehospital data collection and research is critical to advancing EMS development in Zimbabwe and the region through quality improvement and epidemiologic surveillance.

Lack of Health Insurance Coverage and Emergency Medical Service Transport for Pediatric Trauma Patients.

Pediatric trauma patients who lack insurance coverage may have less access to transport other than emergency medical services (EMS) or face financial barriers that prevent utilization of these services. We analyzed the association between health insurance coverage and EMS transport while controlling for injury and patient characteristics. De-identified Trauma Quality Programs registry data were queried for pediatric trauma patients age <18y. The primary outcome was arrival by EMS (excluding interfacility transfer) versus private transport or walk-in, and the primary exposure was insurance coverage (any versus none). After exact matching on injury and facility characteristics, propensity matching was used to balance demographic covariates and comorbidities between insured and uninsured patients. Of the 130,246 patients analyzed, 9501 (7%) did not have insurance coverage. After matching 9494 uninsured cases to 9494 insured controls, fixed-effects logistic regression found that uninsured patients had 18% greater odds of using EMS transport, compared to insured patients (odds ratio: 1.18; 95% confidence interval: 1.11, 1.26; P<0.001). Results were similar when comparing uninsured patients to privately insured or publicly insured patients only. Uninsured pediatric trauma patients have a higher likelihood of using EMS transport compared to insured patients with similar demographic and clinical characteristics, including the exact same score of injury severity. Lack of access to private transport may drive higher EMS utilization in uninsured patients with minor injuries and contribute to higher costs of pediatric trauma care borne by institutions and families.