Rural and Ethnic Disparities in Out-of-Hospital Pathways and Care after Road Traffic-Related Trauma in New Zealand
Authors List
Lilley, R., University of Otago, Dunedin, New Zealand
Davie, G., University of Otago, Dunedin, New Zealand
Dicker, B., Hato Hone St John, Auckland, New Zealand
Reid, P., University of Auckland, Auckland, New Zealand
Civil, I., Te Whatu Ora, Auckland, New Zealand
Ameratunga, S. University of Auckland, Auckland, New Zealand
Kool, B., University of Auckland, Auckland, New Zealand
Introduction
Despite long standing challenges in delivering equitable care to healthcare services in Aotearoa-New Zealand’s healthcare system, little is known about inequities in EMS delivered care and transport pathways to hospital-level care.
Aims
This study examines the inter-relationship between geographical location of injury and ethnicity in Emergency Medical Service (EMS) out-of-hospital processes and pathways following road traffic crashes (RTCs) in Aotearoa-New Zealand (NZ).
Methods
This retrospectively-designed prospective cohort study on out-of-hospital care identified trauma cases injured in a RTC among those aged under 85 years with a status 1 or 2 triage from national EMS data. Analyses of care pathways were stratified by geographical location of injury (rural/urban) and combined ethnicity-geographical location (rural Māori/rural non-Māori and urban Māori/urban non-Māori) with comparison of proportions undertaken.
Results
A total of 746 cases injured following a RTC were attended by out-of-hospital EMS providers. Subsequently, 692 cases were transported to hospital. EMS pathways of transportation to in-hospital care was slower and longer for rurally located cases (47%). 28% of cases were Indigenous Māori, among these rurally located cases were comparatively less likely to be triaged to priority transport pathways (fastest dispatch, 92% vs 97% rural non-Māori, p=0.05); slowest to reach in-hospital care (≥113 minutes to reach first hospital, 55% vs 41%, p=0.02) and had less access to specialist trauma care (never reach L1 trauma hospital, 51% vs 73%, p=0.02).
Conclusion
Among RTC cases attended and transported by EMS, there is variability in out-of-hospital EMS pathways through to specialist trauma care strongly patterned by location and ethnicity. These findings provide a strong equity focused evidence-base to guide clinical and policy decision makers to optimise the delivery of EMS care and to reduce disparities associated with out-of-hospital EMS care.
Lilley, R., University of Otago, Dunedin, New Zealand
Davie, G., University of Otago, Dunedin, New Zealand
Dicker, B., Hato Hone St John, Auckland, New Zealand
Reid, P., University of Auckland, Auckland, New Zealand
Civil, I., Te Whatu Ora, Auckland, New Zealand
Ameratunga, S. University of Auckland, Auckland, New Zealand
Kool, B., University of Auckland, Auckland, New Zealand
Introduction
Despite long standing challenges in delivering equitable care to healthcare services in Aotearoa-New Zealand’s healthcare system, little is known about inequities in EMS delivered care and transport pathways to hospital-level care.
Aims
This study examines the inter-relationship between geographical location of injury and ethnicity in Emergency Medical Service (EMS) out-of-hospital processes and pathways following road traffic crashes (RTCs) in Aotearoa-New Zealand (NZ).
Methods
This retrospectively-designed prospective cohort study on out-of-hospital care identified trauma cases injured in a RTC among those aged under 85 years with a status 1 or 2 triage from national EMS data. Analyses of care pathways were stratified by geographical location of injury (rural/urban) and combined ethnicity-geographical location (rural Māori/rural non-Māori and urban Māori/urban non-Māori) with comparison of proportions undertaken.
Results
A total of 746 cases injured following a RTC were attended by out-of-hospital EMS providers. Subsequently, 692 cases were transported to hospital. EMS pathways of transportation to in-hospital care was slower and longer for rurally located cases (47%). 28% of cases were Indigenous Māori, among these rurally located cases were comparatively less likely to be triaged to priority transport pathways (fastest dispatch, 92% vs 97% rural non-Māori, p=0.05); slowest to reach in-hospital care (≥113 minutes to reach first hospital, 55% vs 41%, p=0.02) and had less access to specialist trauma care (never reach L1 trauma hospital, 51% vs 73%, p=0.02).
Conclusion
Among RTC cases attended and transported by EMS, there is variability in out-of-hospital EMS pathways through to specialist trauma care strongly patterned by location and ethnicity. These findings provide a strong equity focused evidence-base to guide clinical and policy decision makers to optimise the delivery of EMS care and to reduce disparities associated with out-of-hospital EMS care.
