Geographical and Population Disparities in Timely Access to Prehospital and Advanced Level Emergency Care in New Zealand: A Cross-sectional Study

Lilley, R
de Graaf, B
Kool, B
Davie, G
Reid, P
Dicker, B
Civil, I
Ameratunga, S
Branas, C
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Objective Rapid access to advanced emergency medical and trauma care has been shown to significantly reduce mortality and disability. This study aims to systematically examine geographical access to prehospital care provided by emergency medical services (EMS) and advanced-level hospital care, for the smallest geographical units used in New Zealand and explores national disparities in geographical access to these services.

Design Observational study involving geospatial analysis estimating population access to EMS and advanced-level hospital care.

Setting Population access to advanced-level hospital care via road and air EMS across New Zealand.

Participants New Zealand population usually resident within geographical census meshblocks.

Primary and secondary outcome measures The proportion of the resident population with calculated EMS access to advanced-level hospital care within 60 min was examined by age, sex, ethnicity, level of deprivation and population density to identify disparities in geographical access.

Results An estimated 16% of the New Zealand population does not have timely EMS access to advanced-level hospital care via road or air. The 700 000 New Zealanders without timely access lived mostly in areas of low-moderate population density. Indigenous Māori, New Zealand European and older New Zealanders were less likely to have timely access.

Conclusions These findings suggest that in New Zealand, geographically marginalised groups which tend to be rural and remote communities with disproportionately more indigenous Māori and older adults have poorer EMS access to advanced-level hospitals. Addressing these inequities in rapid access to medical care may lead to improvements in survival that have been documented for people who experience medical or surgical emergencies.

BMJ Open 2019;9:e026026. doi: 10.1136/bmjopen-2018-026026
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