救护车服务缺失与紧急医疗服务获取的不平等：受伤患者在院前系统中是否面临延误治疗的风险？

Ambulance deserts and inequities in access to emergency medical services care: Are injured patients at risk for delayed care in the prehospital system?

作者信息

Berry Cherisse, Escobar Natalie, Mann N Clay, DiMaggio Charles, Pfaff Ashley, Duncan Dustin T, Frangos Spiros, Sairamesh Jakka, Ogedegbe Gbenga, Wei Ran

机构信息

From the Department of Surgery, Division of Trauma (C.B.), Rutgers Health, New Jersey Medical School, Newark, New Jersey; Department of Surgery (N.E.), University of California San Francisco School of Medicine, San Francisco, California; National Emergency Medical Services Information System Technical Assistance Center (N.C.M.), University of Utah School of Medicine, Salt Lake City, Utah; Department of Surgery (C.D., A.P., S.F.), New York University Grossman School of Medicine, New York, New York; Columbia University Mailman School of Public Health, New York, New York (D.D.); CapsicoHealth, Inc. (J.S.); Department of Population Health (G.O.), and Department of Medicine (G.O.), Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, New York; and University of California Riverside School of Public Policy, Riverside, California (R.W.).

出版信息

J Trauma Acute Care Surg. 2025 Sep 1;99(3):484-488. doi: 10.1097/TA.0000000000004579. Epub 2025 May 23.

DOI:10.1097/TA.0000000000004579

PMID:40405359

Abstract

INTRODUCTION

Delayed Emergency Medical Services (EMS) response and transport (time from injury occurrence to hospital arrival) are associated with increased injury mortality. Inequities in accessing EMS care for injured patients are not well characterized. We sought to evaluate the association between the area deprivation index (ADI), a measure of geographic socioeconomic disadvantage, and timely access to EMS care within the United States.

METHODS

The Homeland Infrastructure Foundation Level Data open-source database from the National Geospatial Intelligence Agency was used to evaluate the location of EMS stations across the United States using longitude and latitude coordinates. The ADI was obtained from Neighborhood Atlas at the census block group level. An ambulance desert (AD) was defined as populated census block groups with a geographic center outside of a 25-minute ambulance service area. The total population (urban and rural) located within an AD and outside an AD (non-ambulance desert [NAD]) and the ADI index distribution within those areas were calculated with their statistical significance derived from χ 2 testing. Spearman correlations between the number of EMS stations available within 25-minutes service areas and ADI were calculated, and statistical significance was derived after accounting for spatial autocorrelation.

RESULTS

A total of 42,472 ground EMS stations were identified. Of the 333,036,755 people (current US population), 2.6% are located within an AD. When stratified by type of population, 0.3% of people within urban populations and 8.9% of people within rural populations were located within an AD ( p < 0.01). When compared with NADs, ADs were more likely to have a higher ADI (ADI AD , 53.13; ADI NAD , 50.41; p < 0.01). The number of EMS stations available per capita was negatively correlated with ADI ( rs = -0.25, p < 0.01), indicating that people living in more disadvantaged neighborhoods are likely to have fewer EMS stations available.

CONCLUSION

Ambulance deserts are more likely to affect rural versus urban populations and are associated with higher ADIs. The impact of inequities in access to EMS care on outcomes deserves further study.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.

摘要

引言

紧急医疗服务（EMS）响应和转运延迟（从受伤发生到医院到达的时间）与受伤死亡率增加相关。受伤患者获得EMS护理的不平等情况尚未得到充分描述。我们试图评估地区贫困指数（ADI）（一种衡量地理社会经济劣势的指标）与美国境内及时获得EMS护理之间的关联。

方法

使用来自国家地理空间情报局的国土基础设施基础数据开源数据库，通过经度和纬度坐标评估美国各地EMS站点的位置。ADI从人口普查街区组层面的邻里地图集获得。救护车荒漠（AD）定义为地理中心位于25分钟救护车服务区域之外的有人居住的人口普查街区组。计算位于AD内和AD外（非救护车荒漠[NAD]）的总人口（城市和农村）以及这些区域内的ADI指数分布，并通过χ²检验得出其统计学意义。计算25分钟服务区域内可用的EMS站点数量与ADI之间的Spearman相关性，并在考虑空间自相关性后得出统计学意义。

结果

共识别出42472个地面EMS站点。在美国当前的333036755人口中，2.6%位于AD内。按人口类型分层时，城市人口中有0.3%的人以及农村人口中有8.9%的人位于AD内（p<0.01）。与NAD相比，AD更有可能具有较高的ADI（ADI_AD，53.13；ADI_NAD，50.41；p<0.01）。人均可用的EMS站点数量与ADI呈负相关（rs=-0.25，p<0.01），这表明生活在更贫困社区的人可用的EMS站点可能更少。