Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908-0699, USA.
Am J Prev Med. 2009 Nov;37(5):428-32. doi: 10.1016/j.amepre.2009.06.016.
Minimizing emergency medical service (EMS) response time is a central objective of prehospital care, yet the potential influence of built environment features such as urban sprawl on EMS system performance is often not considered.
This study measures the association between urban sprawl and EMS response time to test the hypothesis that features of sprawling development increase the probability of delayed ambulance arrival.
In 2008, EMS response times for 43,424 motor-vehicle crashes were obtained from the Fatal Analysis Reporting System, a national census of crashes involving > or =1 fatality. Sprawl at each crash location was measured using a continuous county-level index previously developed by Ewing et al. The association between sprawl and the probability of a delayed ambulance arrival (> or =8 minutes) was then measured using generalized linear mixed modeling to account for correlation among crashes from the same county.
Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival (p=0.03). This probability increases quadratically as the severity of sprawl increases while controlling for nighttime crash occurrence, road conditions, and presence of construction. For example, in sprawling counties (e.g., Fayette County GA), the probability of a delayed ambulance arrival for daytime crashes in dry conditions without construction was 69% (95% CI=66%, 72%) compared with 31% (95% CI=28%, 35%) in counties with prominent smart-growth characteristics (e.g., Delaware County PA).
Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival following motor-vehicle crashes in the U.S. The results of this study suggest that promotion of community design and development that follows smart-growth principles and regulates urban sprawl may improve EMS performance and reliability.
最大限度地缩短紧急医疗服务（EMS）响应时间是院前护理的核心目标，但城市扩张等建筑环境特征对 EMS 系统性能的潜在影响往往未被考虑。
本研究旨在衡量城市扩张与 EMS 响应时间之间的关联，以检验这样一个假设，即扩张发展的特征增加了救护车延误到达的可能性。
2008 年，从 Fatal Analysis Reporting System（一个涉及 > =1 例死亡的全国性车祸普查）中获得了 43424 起机动车事故的 EMS 响应时间。使用 Ewing 等人先前开发的连续县级指数来衡量每个事故地点的扩张程度。使用广义线性混合模型来衡量扩张与救护车延误到达（> =8 分钟）的概率之间的关联，以解释来自同一县的事故之间的相关性。
城市扩张与 EMS 响应时间延长和救护车延误到达的概率增加显著相关（p = 0.03）。在控制夜间事故发生、道路状况和施工情况的情况下，随着扩张程度的加剧，这种概率呈二次方增加。例如，在扩张型县（例如佐治亚州费耶特县），晴天无施工条件下白天车祸的救护车延误到达概率为 69%（95%CI=66%，69%），而在具有明显精明增长特征的县（例如宾夕法尼亚州特拉华县），这一概率为 31%（95%CI=28%，35%）。
在美国，城市扩张与 EMS 响应时间延长和救护车延误到达的概率增加显著相关。本研究结果表明，推广遵循精明增长原则和规范城市扩张的社区设计和发展，可能会提高 EMS 的性能和可靠性。
