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

Abstract

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.