Abstract
Objective
Delays in care for patients with acute cardiac complaints are associated with increased
morbidity and mortality. The objective of this study was to quantify rural and urban
differences in prehospital time intervals for patients with cardiac complaints.
Methods
The ESO Data Collaborative dataset consisting of records from 1332 EMS agencies was
queried for 9–1-1 encounters with acute cardiac problems among adults (age ≥ 18) from
1/1/2013–6/1/2018. Location was classified as rural or urban using the 2010 United
States Census. The primary outcome was total prehospital time. Generalized estimating
equations evaluated differences in the average times between rural and urban encounters
while controlling for age, sex, race, transport mode, loaded mileage, and patient
stability.
Results
Among 428,054 encounters, the median age was 62 (IQR 50–75) years with 50.7% female,
75.3% white, and 10.3% rural. The median total prehospital, response, scene, and transport
times were 37.0 (IQR 29.0–48.0), 6.0 (IQR 4.0–9.0), 16.0 (IQR 12.0–21.0), and 13.0
(IQR 8.0–21.0) minutes. Rural patients had an average total prehospital time that
was 16.76 min (95%CI 15.15–18.38) longer than urban patients. After adjusting for
covariates, average total time was 5.08 (95%CI 4.37–5.78) minutes longer for rural
patients. Average response and transport time were 4.36 (95%CI 3.83–4.89) and 0.62
(95%CI 0.33–0.90) minutes longer for rural patients. Scene time was similar in rural
and urban patients (0.09 min, 95%CI -0.15-0.33).
Conclusion
Rural patients with acute cardiac complaints experienced longer prehospital time than
urban patients, even after accounting for other key variables, such as loaded mileage.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D; use, select 'Corporate R&D; Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Why and when citizens call for emergency help: an observational study of 211,193 medical emergency calls.Scand J Trauma Resusc Emerg Med. 2015; 23: 88https://doi.org/10.1186/s13049-015-0169-0
- Trends of pre-hospital emergency medical services activity over 10 years: a population-based registry analysis.BMC Health Serv Res. 2014; 14: 380https://doi.org/10.1186/1472-6963-14-380
- Emergency department care in the United States: a profile of national data sources.Ann Emerg Med. 2010; 56: 150-165https://doi.org/10.1016/j.annemergmed.2009.11.022
- Heart disease and stroke statistics-2019 update: A report from the American Heart Association.Circulation. 2019; 139: e56-e528https://doi.org/10.1161/CIR.0000000000000659
- Predictors of ambulance use in patients with acute myocardial infarction in Australia.Emerg Med J. 2006; 23: 948-952https://doi.org/10.1136/emj.2006.038414
- Driving times and distances to hospitals with percutaneous coronary intervention in the United States.Circulation. 2006; 113: 1189-1195https://doi.org/10.1161/CIRCULATIONAHA.105.596346
- Nationwide analysis of patients with ST-segment-elevation myocardial infarction transferred for primary percutaneous intervention: findings from the American Heart Association Mission: Lifeline Program.Circ Cardiovasc Interv. 2015; 8https://doi.org/10.1161/CIRCINTERVENTIONS.114.002450
- Regional systems of care demonstration project: American Heart Association Mission: lifeline STEMI systems accelerator.Circulation. 2016; 134: 365-374https://doi.org/10.1161/CIRCULATIONAHA.115.019474
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies | The EQUATOR Network.
- 2010 census urban and rural classification and urban area criteria.(Published online)
- Point-of-care troponin testing during ambulance transport to detect acute myocardial infarction.Prehosp Emerg Care. 2020; 24: 751-759https://doi.org/10.1080/10903127.2020.1721740
- Summarizing the goodness of fit of generalized linear models for longitudinal data.Stat Med. 2000; 19 (doi:10.1002/(sici)1097-0258(20000530)19:10<1265::aid-sim486>3.0.co;2-u): 1265-1275
- Akaike’s information criterion in generalized estimating equations.Biometrics. 2001; 57: 120-125https://doi.org/10.1111/j.0006-341x.2001.00120.x
- Defining urban and rural areas in U.S. epidemiologic studies.J Urban Health. 2006; 83: 162-175https://doi.org/10.1007/s11524-005-9016-3
- American College of Emergency Physicians.(Accessed February 17)
- 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes.Circulation. 2014; 130: e344-e426https://doi.org/10.1161/CIR.0000000000000134
- American Heart Association.(Accessed April 21)
- Improvement in care and outcomes for emergency medical service-transported patients with ST-elevation Myocardial Infarction (STEMI) with and without prehospital cardiac arrest: a mission: lifeline STEMI accelerator study.J Am Heart Assoc. 2017; 6https://doi.org/10.1161/JAHA.117.005717
- Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction.Circulation. 2004; 109: 1223-1225https://doi.org/10.1161/01.CIR.0000121424.76486.20
- 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions.Catheter Cardiovasc Interv. 2013; 82: E1-27https://doi.org/10.1002/ccd.24776
- Association between prehospital time intervals and ST-elevation myocardial infarction system performance.Circulation. 2010; 122: 1464-1469https://doi.org/10.1161/CIRCULATIONAHA.109.931154
- The rural hospital problem.JAMA. 2019; 321: 2271-2272https://doi.org/10.1001/jama.2019.7377
- The rising rate of rural hospital closures.J Rural Health. 2016; 32: 35-43https://doi.org/10.1111/jrh.12128
- Sex differences in diagnoses, treatment, and outcomes for emergency department patients with chest pain and elevated cardiac troponin.Acad Emerg Med. 2018; 25: 413-424https://doi.org/10.1111/acem.13371
- Physician variability in management of emergency department patients with chest pain.West J Emerg Med. 2017; 18: 592-600https://doi.org/10.5811/westjem.2017.2.32747
- Sex disparities in the assessment and outcomes of chest pain presentations in emergency departments.Heart. 2020; 106: 111-118https://doi.org/10.1136/heartjnl-2019-315,667
- The disutility of stress testing in low-risk HEART Pathway patients.Am J Emerg Med. 2020; (Published online August 15)https://doi.org/10.1016/j.ajem.2020.08.032
- Utilization of warning lights and siren based on hospital time-critical interventions.Prehosp Disaster Med. 2010; 25: 335-339https://doi.org/10.1017/s1049023x0000830x
- Is ambulance transport time with lights and siren faster than that without?.Ann Emerg Med. 1995; 25: 507-511https://doi.org/10.1016/s0196-0644(95)70267-9
- Predicting ambulance time of arrival to the emergency department using global positioning system and Google maps.Prehosp Emerg Care. 2013; 17: 458-465https://doi.org/10.3109/10903127.2013.811562
- The effectiveness of lights and siren use during ambulance transport by paramedics.Prehosp Emerg Care. 1999; 3: 127-130https://doi.org/10.1080/10903129908958920
- Emergency medical services intervals and survival in trauma: assessment of the “golden hour” in a North American prospective cohort.Ann Emerg Med. 2010; 55 (e4): 235-246
- Lights and siren use by Emergency Medical Services (EMS): above all do no harm.US Department of Transportation, National Highway Traffic Safety Administration, Office of Emergency Medical Services, 2017
Article Info
Publication History
Published online: December 03, 2021
Accepted:
November 24,
2021
Received in revised form:
October 29,
2021
Received:
June 11,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
