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

Background There are many long-standing challenges in delivering equitable health care in Aotearoa-New Zealand’s healthcare system. Little is known about inequities in EMS delivered care and transport pathways to hospital-level care, and any overlapping disparities by location of injury incident and ethnicity. Objective 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 comparisons of proportions undertaken. Results A total of 746 major trauma cases injured following a RTC were attended by out-of-hospital EMS providers. Subsequently, 692 were transported to hospital. EMS pathways of transportation to in-hospital care was slower and longer for rurally located cases (47%). Indigenous Māori comprised 28% of cases, with rurally located Māori comparatively less likely to be triaged to priority transport pathways (allocated fastest dispatch, 92% rural-Māori 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 lower levels of 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 intersecting rural and ethnic disparities. 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.

Keywords

4203 Health Services and Systems, 42 Health Sciences, 44 Human Society, Rural Health, Health Disparities, Clinical Research, 3 Good Health and Well Being, 1106 Human Movement and Sports Sciences, 1117 Public Health and Health Services, 1701 Psychology, Public Health, 4202 Epidemiology, 4206 Public health

Source

Lilley R, Davie G, Campbell N, et al266 Rural and ethnic disparities in out-of-hospital pathways and care after road traffic-related trauma in New ZealandInjury Prevention 2024;30:A58.