Prehosp Emerg Care. 2022 Mar-Apr;26(2):233-245. doi: 10.1080/10903127.2020.1868634. Epub 2021 Feb 25.
Background: Prehospital emergency care is a vital component of healthcare access, and emergency medical services (EMS) plays an essential role in healthcare delivery. Understanding the distribution of medical and trauma EMS calls at the neighborhood level would be beneficial to identify at-risk communities and facilitate targeted interventions. : The primary objective was to evaluate and characterize 9-1-1 ambulance contacts for medical and trauma-related events in Denver. The secondary objective was to evaluate the co-existence of medical and trauma-related EMS calls to determine if these emergencies occur in the same neighborhoods. We conducted a secondary analysis of prospectively collected EMS calls in Denver between January 1, 2011, through August 8, 2017. The primary outcome was the incidence of trauma and medical EMS calls in each census tract. EMS events were aggregated to tracts and incidence rates were calculated based on the adult daytime and nighttime population. Three different spatial analysis methods (SaTScan's spatial scan statistic, Gini coefficient, and Local Moran's I) were utilized to identify clusters of medical and trauma EMS events at the tract level. A total of 425,527 EMS calls in 142 census tracts occurred during the study period. The median age of study participants was 48 (IQR 33, 62), 56% were male, and the majority (74%) of EMS calls were for medical events. An emergent EMS return to the hospital occurred in 5% of all calls. We identified several high-risk census tracts with a coexistence of medical and trauma EMS events. When compared to the Denver County population, the tracts with high EMS call rates were diverse, with many tracts exhibiting a higher proportion of black, unemployment, below poverty, and lower median income while other tracts demonstrated a smaller proportion of black, unemployment, below poverty, and a higher median income. Disparities exist in the distribution of medical and trauma EMS calls in varied census tracts in Denver. Identifying neighborhoods in which there is an incidence of higher medical and trauma emergencies is important to guide EMS care delivery and may help facilitate targeted public health interventions for at-risk populations to improve health outcomes.
院前急救是医疗保健可及性的重要组成部分，而紧急医疗服务（EMS）在医疗保健提供中发挥着至关重要的作用。了解邻里层面医疗和创伤 EMS 呼叫的分布情况，有助于识别高风险社区，并便于开展针对性干预。目的：评估和描述丹佛市与医疗和创伤相关的 9-1-1 救护车呼叫情况。次要目的是评估医疗和创伤相关 EMS 呼叫的共存情况，以确定这些紧急情况是否发生在同一社区。方法：我们对 2011 年 1 月 1 日至 2017 年 8 月 8 日期间丹佛市前瞻性收集的 EMS 呼叫进行了二次分析。主要结局是计算每个普查地段的创伤和医疗 EMS 呼叫发生率。将 EMS 事件汇总到地段，并根据成年日间和夜间人口计算发生率。利用三种不同的空间分析方法（SaTScan 的空间扫描统计、基尼系数和局部 Moran's I）来确定地段层面医疗和创伤 EMS 事件的聚类。在研究期间，共有 425527 次 EMS 呼叫发生在 142 个普查地段。研究参与者的中位数年龄为 48 岁（IQR 33 岁，62 岁），56%为男性，大多数（74%）EMS 呼叫是医疗事件。所有呼叫中有 5%出现紧急 EMS 返院。我们确定了几个存在医疗和创伤 EMS 事件共存的高风险普查地段。与丹佛县人口相比，EMS 呼叫率较高的地段分布广泛，许多地段的黑人、失业、贫困线以下和中位数收入比例较高，而其他地段的黑人、失业、贫困线以下和中位数收入比例较低。在丹佛不同普查地段，医疗和创伤 EMS 呼叫的分布存在差异。确定发生较高医疗和创伤紧急情况的社区，对于指导 EMS 护理提供很重要，并且可能有助于为高危人群开展有针对性的公共卫生干预，以改善健康结果。
