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

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aut.relation.endpage613
aut.relation.issue4
aut.relation.journalWest J Emerg Med
aut.relation.startpage602
aut.relation.volume25
dc.contributor.authorLilley, Rebbecca
dc.contributor.authorDavie, Gabrielle
dc.contributor.authorDicker, Bridget
dc.contributor.authorReid, Papaarangi
dc.contributor.authorAmeratunga, Shanthi
dc.contributor.authorBranas, Charles
dc.contributor.authorCampbell, Nicola
dc.contributor.authorCivil, Ian
dc.contributor.authorKool, Bridget
dc.date.accessioned2024-07-22T23:19:35Z
dc.date.available2024-07-22T23:19:35Z
dc.date.issued2024-06-04
dc.description.abstractINTRODUCTION: 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%, 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). 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.
dc.identifier.citationWest J Emerg Med, ISSN: 1936-9018 (Online), California Digital Library (CDL), 25(4), 602-613. doi: 10.5811/westjem.18366
dc.identifier.doi10.5811/westjem.18366
dc.identifier.issn1936-9018
dc.identifier.urihttp://hdl.handle.net/10292/17814
dc.languageeng
dc.publisherCalifornia Digital Library (CDL)
dc.relation.urihttps://escholarship.org/uc/item/61t0c674
dc.rightsThe Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health article copyright is held by the authors but distributed in accordance with the Creative Commons Attribution 4.0 International (CC BY 4.0) License for work published in Volume 16; Issue 1 and hence forth. The license allows for copy, redistribution, and adaptation of material published by the author for any purpose, provided due credit is given through proper citation of the author and the original article.
dc.rights.accessrightsOpenAccess
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subject.meshHumans
dc.subject.meshNew Zealand
dc.subject.meshAccidents, Traffic
dc.subject.meshEmergency Medical Services
dc.subject.meshHealthcare Disparities
dc.subject.meshMale
dc.subject.meshFemale
dc.subject.meshAdult
dc.subject.meshMiddle Aged
dc.subject.meshRural Population
dc.subject.meshWounds and Injuries
dc.subject.meshTransportation of Patients
dc.subject.meshAged
dc.subject.meshNative Hawaiian or Other Pacific Islander
dc.subject.meshAdolescent
dc.subject.meshHealth Services Accessibility
dc.subject.meshEthnicity
dc.subject.meshUrban Population
dc.subject.meshCohort Studies
dc.titleRural and Ethnic Disparities in Out-of-Hospital Care and Transport Pathways After Road Traffic Trauma in New Zealand.
dc.typeJournal Article
pubs.elements-id562935
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