Clinical surgery-American
Does increased emergency medical services prehospital time affect patient mortality in rural motor vehicle crashes? A statewide analysis

Presented at the American Association for the Surgery of Trauma 65th Meeting, September 28–30, 2006, New Orleans, LA.
https://doi.org/10.1016/j.amjsurg.2007.11.018Get rights and content

Abstract

Background

Fatality rates from rural vehicular trauma are almost double those found in urban settings. It has been suggested that increased prehospital time is a factor that adversely affects fatality rates in rural vehicular trauma. By linking and analyzing Alabama's statewide prehospital data, emergency medical services (EMS) prehospital time was assessed for rural and urban vehicular crashes.

Methods

An imputational methodology permitted linkage of data from police motor vehicle crash (MVC) and EMS records. MVCs were defined as rural or urban by crash location using the United States Census Bureau criteria. Areas within Alabama that fell outside the Census Bureau definition of urban were defined as rural. Prehospital data were analyzed to determine EMS response time, scene time, and transport time in rural and urban settings.

Results

Over a 2-year period from January 2001 through December 2002, data were collected from EMS Patient Care Reports and police crash reports for the entire state of Alabama. By using an imputational methodology and join specifications, 45,763 police crash reports were linked to EMS Patient Care Reports. Of these, 34,341 (75%) were injured in rural settings and 11,422 (25%) were injured in urban settings. A total of 714 mortalities were identified, of which 611 (1.78%) occurred in rural settings and 103 (.90%) occurred in urban settings (P < .0001). When mortalities occurred, the mean EMS response time in rural settings was 10.67 minutes and 6.50 minutes in urban settings (P < .0001). When mortalities occurred, the mean EMS scene time in rural settings was 18.87 minutes and 10.83 minutes in urban settings (patients who were dead on scene and extrication patients were excluded from both settings) (P < .0001). When mortalities occurred, the mean EMS transport time in rural settings was 12.45 minutes and 7.43 minutes in urban settings (P < .0001). When mortalities occurred, the overall mean prehospital time in rural settings was 42.0 minutes and 24.8 minutes in urban settings (P < .0001). The mean EMS response time for rural MVCs with survivors was 8.54 minutes versus a mean of 10.67 minutes with mortalities (P < .0001). The mean EMS scene time for rural MVCs with survivors was 14.81 minutes versus 18.87 minutes with mortalities (patients who were dead on scene and extrication patients were excluded) (P = .0014).

Conclusions

Based on this statewide analysis of MVCs, increased EMS prehospital time appears to be associated with higher mortality rates in rural settings.

Section snippets

Materials and Methods

An imputational methodology using a 95% confidence interval and 12 join-specifications were used to link data from Police Accident Reports (PARs) and EMS Patient Care Reports (PCRs). Data were collected retrospectively from EMS PCRs (117,605) and PARs (274,175 PARS and 741,007 occupant records) from the State of Alabama during the 2-year period from January 2001 through December 2002. Linkage of crash data to EMS and/or hospital data was accomplished using Crash Outcome Data Evaluation System

Results

A total of 45,763 PARs were linked to EMS PCRs. Of these, 34,341 (75%) were injured in rural settings and 11,422 (25%) were injured in urban settings. Overall, 714 (1.6%) mortalities from MVCs occurred during the study period. A total of 611 (1.78%) mortalities occurred in rural settings and 103 (.90%) occurred in urban settings (P < .0001). Of all rural trauma patients, .94% were DOS and .46% of all urban patients were DOS (P < .0001). Of the patients who died in rural settings 322 (53%) were

Comments

It has been reported previously that increased EMS prehospital time adversely effects patient mortality from MVCs.2, 3, 7, 8, 9, 10, 11, 12, 13 The purpose of this study was to assess, on a statewide level, whether EMS prehospital time affects the mortality rate from MVCs in the rural state of Alabama.

The overall mortality rate during the 20-month study period caused by rural MVCs was double the urban rate in Alabama. This concurs with prior published data that found mortality rates from MVCs

Acknowledgment

This work was performed under a cooperative agreement with the United States Department of Transportation/National Highway Safety Traffic Administration.

References (13)

  • D.W. Vane et al.

    An analysis of pediatric trauma deaths in Indiana

    J Pediatr Surg

    (1990)
  • S. Feero et al.

    Does out-of-hospital EMS time affect trauma survival?

    Am J Emerg Med

    (1995)
  • S.P. Baker et al.

    The Injury Fact Book

    (1992)
  • R.P. Gonzalez et al.

    Increased mortality in rural vehicular trauma: identifying contributing factors through data linkage

    J Trauma

    (2006)
  • D.C. Grossman et al.

    From roadside to bedside: regionalization of trauma care in a remote rural county

    J Trauma

    (1995)
  • F.B. Rogers et al.

    Rural trauma: the challenge for the next decade

    J Trauma

    (1999)
There are more references available in the full text version of this article.

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This research and article were funded through a cooperative agreement between the University of South Alabama and the Department of Transportation and the National Highway Traffic Safety Administration (NHTSA). The views expressed are those of the authors and do not represent the views of the sponsors or the National Highway Traffic Safety Administration.

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