新西兰道路交通伤害后院外护理和转运途径的农村和种族差异。

Rural and Ethnic Disparities in Out-of-hospital Care and Transport Pathways After Road Traffic Trauma in New Zealand.

机构信息

University of Otago, Dunedin School of Medicine, Department of Preventive and Social Medicine, Injury Prevention Research Unit, Dunedin, New Zealand.

Auckland University of Technology, Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland, New Zealand.

出版信息

West J Emerg Med. 2024 Jul;25(4):602-613. doi: 10.5811/westjem.18366.

DOI:10.5811/westjem.18366

PMID:39028247

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11254149/

Abstract

INTRODUCTION

The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the first component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health system of Aotearoa-New Zealand (NZ), little is known about inequities in EMS-delivered care and transport pathways to hospital-level care.

METHODS

This population-level cohort study on out-of-hospital care, based on national EMS data, included trauma patients <85 years in age who were injured in a road traffic crash (RTC). In this study we examined the combined relationship between ethnicity and geographical location of injury in EMS out-of-hospital care and transport pathways following RTCs in Aotearoa-NZ. Analyses were stratified by geographical location of injury (rural and urban) and combined ethnicity-geographical location (rural Māori, rural non-Māori, urban Māori, and urban non-Māori).

RESULTS

In a two-year period, there were 746 eligible patients; of these, 692 were transported to hospital. Indigenous Māori comprised 28% (196) of vehicle occupants attended by EMS, while 47% (324) of patients' injuries occurred in a rural location. The EMS transport pathways to hospital for rural patients were slower to reach first hospital (total in slowest tertile of time 44% vs 7%, ≥ 0.001) and longer to reach definitive care (direct transport, 77% vs 87%, = 0.001) compared to urban patients. Māori patients injured in a rural location were comparatively less likely than rural non-Māori to be triaged to priority transport pathways (fastest dispatch triage, 92% vs 97%, respectively, = 0.05); slower to reach first hospital (total in slowest tertile of time, 55% vs 41%, = 0.02); and had less access to specialist trauma care (reached tertiary trauma hospital, 51% vs 73%, = 0.02).

CONCLUSION

Among RTC patients attended and transported by EMS in NZ, there was variability in out-of-hospital EMS transport pathways through to specialist trauma care, strongly patterned by location of incident and ethnicity. These findings, mirroring other health disparities for Māori, provide an equity-focused evidence base to guide clinical and policy decision makers to optimize the delivery of EMS care and reduce disparities associated with out-of-hospital EMS care.

摘要

引言

院外急救医疗服务（EMS）的救治反应和送往医院的途径对创伤后患者的生存至关重要，是运作良好、优化的创伤救治系统的第一个组成部分。尽管在新西兰（NZ）的卫生系统中提供公平医疗服务一直面临挑战，但对于 EMS 提供的救治和送往医院救治途径方面的不平等现象却知之甚少。

方法

这项基于全国 EMS 数据的院外救治的人群队列研究纳入了年龄<85 岁、因道路交通碰撞（RTC）受伤的创伤患者。在这项研究中，我们研究了在新西兰 RTC 后，EMS 院外救治和送往医院救治途径中，种族和受伤地理位置之间的综合关系。分析按受伤地理位置（农村和城市）和种族-地理位置综合情况（农村毛利人、农村非毛利人、城市毛利人和城市非毛利人）进行分层。

结果

在两年期间，有 746 名符合条件的患者；其中 692 人被送往医院。接受 EMS 救治的车辆乘客中，毛利土著人占 28%（196 人），而 47%（324 人）的患者受伤发生在农村地区。农村患者 EMS 送往医院的途径到达第一家医院的速度较慢（最慢的 tertile 时间中 44% vs 7%， ≥ 0.001），到达确定性治疗的时间较长（直接转运，77% vs 87%， = 0.001），与城市患者相比。在农村地区受伤的毛利患者与农村非毛利患者相比，被分诊为优先转运途径的可能性较小（最快的分诊调度，92% vs 97%，分别为， = 0.05）；到达第一家医院的速度较慢（最慢 tertile 时间中 55% vs 41%， = 0.02）；并且获得专科创伤救治的机会较少（到达三级创伤医院，51% vs 73%， = 0.02）。

结论

在新西兰接受 EMS 救治和转运的 RTC 患者中，通过 EMS 转运到专科创伤救治的院外 EMS 转运途径存在差异，强烈受到事件发生地点和种族的影响。这些发现与毛利人其他健康差异相呼应，为临床和政策决策者提供了一个以公平为重点的证据基础，以指导优化 EMS 救治的提供，并减少与 EMS 救治相关的不平等。