Mueller Landon R, Donnelly John P, Jacobson Karen E, Carlson Jestin N, Mann N Clay, Wang Henry E
Prehosp Emerg Care. 2016;20(2):191-9. doi: 10.3109/10903127.2015.1086846. Epub 2016 Jan 25.
Although much is known about EMS care in urban, suburban, and rural settings, only limited national data describe EMS care in isolated and sparsely populated frontier regions. We sought to describe the national characteristics and outcomes of EMS care provided in frontier and remote (FAR) areas in the continental United States (US). We performed a cross-sectional analysis of the 2012 National Emergency Medical Services Information System (NEMSIS) data set, encompassing EMS response data from 40 States. We linked the NEMSIS dataset with Economic Research Service-identified FAR areas, defined as a ZIP Code >60 minutes driving time to an urban center with >50,000 persons. We excluded EMS responses resulting in intercepts, standbys, inter-facility transports, and medical transports. Using odds ratios, t-tests and the Wilcoxon rank-sum test, we compared patient demographics, response characteristics (location type, level of care), clinical impressions, and on-scene death between EMS responses in FAR and non-FAR areas. There were 15,005,588 EMS responses, including 983,286 (7.0%) in FAR and 14,025,302 (93.0%) in non-FAR areas. FAR and non-FAR EMS events exhibited similar median response 5 [IQR 3-10] vs. 5 [3-8] min), scene (14 [10-20] vs. 14 [10-20] min), and transport times (11 [5.,24] vs. 12 [7,19] min). Air medical (1.51% vs. 0.42%; OR 4.15 [95% CI: 4.03-4.27]) and Advanced Life Support care (62.4% vs. 57.9%; OR 1.25 [1.24-1.26]) were more common in FAR responses. FAR responses were more likely to be of American Indian or Alaska Native race (3.99% vs. 0.70%; OR 5.04, 95% CI: 4.97-5.11). Age, ethnicity, location type, and clinical impressions were similar between FAR and non-FAR responses. On-scene death was more likely in FAR than non-FAR responses (12.2 vs. 9.6 deaths/1,000 responses; OR 1.28, 95% CI: 1.25-1.30). Approximately 1 in 15 EMS responses in the continental US occur in FAR areas. FAR EMS responses are more likely to involve air medical or ALS care as well as on-scene death. These data highlight the unique characteristics of FAR EMS responses in the continental US.
尽管人们对城市、郊区和农村地区的急救医疗服务（EMS）了解颇多，但仅有有限的全国性数据描述了偏远和人口稀少的边境地区的EMS服务情况。我们试图描述美国大陆边境和偏远（FAR）地区提供的EMS服务的全国特征及结果。我们对2012年国家紧急医疗服务信息系统（NEMSIS）数据集进行了横断面分析，该数据集涵盖了40个州的EMS响应数据。我们将NEMSIS数据集与经济研究服务局确定的FAR地区相链接，FAR地区定义为距离人口超过5万的城市中心驾车时间超过60分钟的邮政编码区域。我们排除了导致拦截、待命、机构间转运和医疗转运的EMS响应。使用优势比、t检验和威尔科克森秩和检验，我们比较了FAR地区和非FAR地区EMS响应之间的患者人口统计学特征、响应特征（地点类型、护理水平）、临床印象和现场死亡情况。共有15,005,588次EMS响应，其中FAR地区有983,286次（7.0%），非FAR地区有14,025,302次（93.0%）。FAR地区和非FAR地区的EMS事件在中位响应时间（分别为5 [四分位间距3 - 10]分钟和5 [3 - 8]分钟）、现场时间（分别为14 [10 - 20]分钟和14 [10 - 20]分钟）以及转运时间（分别为11 [5,24]分钟和12 [7,19]分钟）方面相似。空中医疗服务（1.51%对0.42%；优势比4.15 [95%置信区间：4.03 - 4.27]）和高级生命支持护理（62.4%对57.9%；优势比1.25 [1.24 - 1.26]）在FAR地区的响应中更为常见。FAR地区的响应更有可能是美洲印第安人或阿拉斯加原住民种族（3.99%对0.70%；优势比5.04，95%置信区间：4.97 - 5.11）。FAR地区和非FAR地区的响应在年龄、种族、地点类型和临床印象方面相似。FAR地区的现场死亡比非FAR地区的响应更有可能发生（每1000次响应中分别为12.2例和9.6例死亡；优势比1.28，95%置信区间：1.25 - 1.30）。在美国大陆，大约每15次EMS响应中就有1次发生在FAR地区。FAR地区的EMS响应更有可能涉及空中医疗或高级生命支持护理以及现场死亡。这些数据突出了美国大陆FAR地区EMS响应的独特特征。
