@article{ref1,
title="Rural and ethnic disparities in out-of-hospital care and transport pathways after road traffic trauma in New Zealand",
journal="Western journal of emergency medicine",
year="2024",
author="Lilley, Rebbecca and Davie, Gabrielle and Dicker, Bridget and Reid, Papaarangi and Ameratunga, Shanthi and Branas, Charles and Campbell, Nicola and Civil, Ian and Kool, Bridget",
volume="25",
number="4",
pages="602-613",
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. <br><br>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). <br><br>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%, P ≥ 0.001) and longer to reach definitive care (direct transport, 77% vs 87%, P = 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, P = 0.05); slower to reach first hospital (total in slowest tertile of time, 55% vs 41%, P = 0.02); and had less access to specialist trauma care (reached tertiary trauma hospital, 51% vs 73%, P = 0.02). <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="1936-900X",
doi="10.5811/westjem.18366",
url="http://dx.doi.org/10.5811/westjem.18366"
}