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Background:
Road Safety is a major cause of death around the world and South Africa has one of the highest road fatality rates. Many measures, engineering and medical, are investigated. However, analysis of the accessibility of emergency care facilities is often overlooked. This paper aims to fill the gap between pre-crash engineering solutions an...
Contexts in source publication
Context 1
... indicated, engineers mostly analyse pre-crash conditions categorised into six E's and the accessibility to emergency care facilities, especially in rural areas, is often overlooked. Figure 1 gives the events in chronological order. Informa- tion needed for assessing the serviceability of a medical facility, is the time it takes between each of the post- crash events shown (i.e. the arrows). ...
Citations
... Notably, the period of golden hour includes the time taken for the ambulance service to reach the accident scene and, from there, transporting the patient(s) to the facility of trauma management; of course, the transport system -the ambulance service -is assumed to have all the pre-hospital emergency medical services enabled. [15][16][17][18][19] This study aims to determine the response time of ambulance reachability to the accident spot on Indian national highways as well as transporting the patient to the nearest trauma facility; for this, a pan-India survey has been conducted by interacting with the victims or their family members. The results from this survey were analysed and synthesised to understand the prevailing situation of ambulance reachability on Indian National Highways; thereby, the results should be helpful for policymakers while developing the transport infrastructure and recognising the importance of emergency and rescue management on the highways. ...
Background
The transportation system plays a crucial role in the context of socioeconomic development, whereas the highway infrastructure acts as a base for the transportation system. In recent years, a rich impetus has been given to the development of road infrastructure by Indian governance. There is a need to introspect how well the prevailing highway infrastructure is equipped with emergency rescue management during road accidents. Lack of ambulance service and trauma facilities along the highways results in a steady loss of lives and injuries and increases people’s exposure to risks.
Objective
This study aims to determine the response time of ambulance reachability to the accident spot on Indian national highways associated with heavy commercial transportation. Also, determining the time to transport the injured to the nearest trauma facility is another factor included as an objective in this investigation.
Methods
The study adopted survey-based research, whereby the variables in the questionnaire were designed to record and assess the time for an ambulance to reach the accident spot and, from there, to transport the injured to the trauma management facility on Indian highways. Two hundred twenty-five participants who were either victims/relatives of victims or those involved in the rescue of the injured have participated in the survey. The dates of the accident events were 2017 and 2022.
Results
The survey resulted in the identification of two categories of highway accidents. The first category of accidents happened on the highways near city limits/dense settlements, and the second category occurred on the core highways. The percentage of accidents caused on the highways either adjacent to or passing through the city limits/dense settlements was reported to be higher than the accidents on the core highways. Ninety percent of the participants reported successful contact with the ambulance call/service centre, but only ~75% success rate exists for ambulances to reach the accident scene. On the core highways, the time taken for the ambulance to arrive at the accident scene is 25–35 minutes. The results from the survey ascertained that the patients were prioritised for treatment in the nearest hospitals (irrespective of having a trauma facility) at a distance of ~12–20 km, for which the time taken is ~15–25 minutes. Importantly, from the interviews, it is understood that in many cases, these hospitals have further referred to specialty hospitals located in nearby cities or trauma centres with greater facilities. Occasions exist where the injured were taken directly to hospitals 30–40 km from the accident spot, for which the time was more than 40 minutes.
Conclusions
The results provide evidence that in either of the accident cases on the highways that are adjacent to/passing through the city limits or on the core highways, the total time for emergency care accessibility is nearly 60 minutes or greater; this implies that in the majority of cases, there is very meagre time left to provide emergency medical care to the needy and injured on the Indian highways to abide by the concept of golden hour. Plausible reforms backed by technology for enabling highways into ‘emergency rescuable highways’ are highly needed to guarantee a safer and more sustainable transportation system in India.
... However, there is little consensus in the literature regarding how to define the geographic coverage for primary EMS facilities [4,23]. In our study, the service coverage standard for LEMIs is defined based on the street-network-based travel time from a LEMI to demand areas, which is a 30 min street-network-based travel time distance as the threshold for emergency service coverage for a LEMI, which is generally accepted for the geographic scale of the study area in South Korea [43,44]. As a measure of the weighted demand, we utilized the population size at each Dong (~town, total 468 Dongs in the study area), the standard administrative district for our case study. ...
This research employs a spatial optimization approach customized for addressing equitable emergency medical facility location problems through the p-dispersed-median problem (p-DIME). The p-DIME integrates two conflicting classes of spatial optimization problems, dispersion and median problems, aiming to identify the optimal locations for emergency medical facilities to achieve an equitable spatial distribution of emergency medical services (EMS) while effectively serving demand. To demonstrate the utility of the p-DIME model, we selected Gyeongsangbuk-do in South Korea, recognized as one of the most challenging areas for providing EMS to the elderly population (aged 65 and over). This challenge arises from the significant spatial disparity in the distribution of emergency medical facilities. The results of the model assessment gauge the spatial disparity of EMS, provide significantly enhanced solutions for a more equitable EMS distribution in terms of service coverage, and offer policy implications for future EMS location planning. In addition, to address the computational challenges posed by p-DIME’s inherent complexity, involving mixed-integer programming, this study introduces a solution technique through constraint formulations aimed at tightening the lower bounds of the problem’s solution space. The computational results confirm the effectiveness of this approach in ensuring reliable computational performance, with significant reductions in solution times, while still producing optimal solutions.
... 3 Although they travel faster (»150 mph), additional time is necessary to start the aircraft and fly from remote bases to the scene. 4 Helicopter crews can generally perform a larger selection of medical interventions than ground ambulance crews, 5,6 most notably for hemorrhage and airway control, 7 and helicopter crews may have greater experience and a broader scope of practice. 8 In contrast to ground ambulance crews, which typically transport rapidly to the closest hospital after limited interventions ("scoop and run"), 9 the helicopter crews may stay on the scene of injury and deliver interventions to stabilize the patient before initiating transport. ...
Objective: Treating traumatic hemorrhage is time sensitive. Prehospital care and transport modes (eg, helicopter and ground) may influence in-hospital events. We hypothesized that prehospital time (on-scene time [OST] and total prehospital time [TPT]) and transport mode are associated with same-day transfusion and mortality. Furthermore, we sought to identify regions of anatomic injury that modify the relationship between prehospital time and outcomes in strata corresponding to transport types. Methods: We obtained prehospital, in-hospital, and trauma registry data from an 8-center cohort of adult nonburn trauma patients from 2017 to 2022 directly transported from the scene to the hospital and having an Injury Severity Score (ISS) > 9 for the Task Order 1 project of the Linking Investigators in Trauma and Emergency Services research network. We excluded patients missing prehospital times, patients < 18 years of age, patients from interfacility transfers, and recipients of prehospital blood. Our same-day outcomes were in-hospital transfusions within 4 hours and 24-hour mortality. Each outcome was adjusted using multivari-able logistic regression for covariates of prehospital phases (OST and TPT), mode of transport (helicopter and ground), age, sex, ISS, Glasgow Coma Scale motor subscale score < 6, and field hypotension (systolic blood pressure < 90 mm Hg). We evaluated the association of prehospital time on outcomes for scene missions by transport mode across severe injury patterns defined by Abbreviated Injury Scale > 2 body regions. Results: Of 78,198 subjects, 34,504 were eligible for the study with a mean age of 47.6 § 20.3 years, ISS of 18 § 11, OST of 15.9 § 9.5 minutes, and TPT of 48.7 § 20.3 minutes. Adjusted for injury severity and demographic factors, transport type significantly modified the relationship between prehospital time and
... However, there is little consensus in the literature regarding how to define the geographic coverage for primary EMS facilities [4,23]. In our study, the service coverage standard for LEMIs is defined based on the street-network based travel time from a LEMI to the demand areas, which is a 30-minute street network-based travel-time distance as the threshold for emergency service coverage for a LEMI, which is generally accepted for the geographic scale of the study area in South Korea [43,44]. As a measure of the weighted demand, we utilized the population size at each Dong (~town, total 468 Dongs in the study area), the standard administrative district for our case study. ...
This research employs a spatial optimization approach customized for addressing equitable emergency medical facility location problems, through the p-dispersed-median problem (p-DIME). The p-DIME integrates two conflicting classes of spatial optimization problems, dispersion, and median problems, aiming to identify the optimal locations for emergency medical facilities to achieve a balanced spatial distribution of emergency medical services (EMS) while effectively serving demands. To demonstrate the utility of the p-DIME model, we selected Gyeongsangbuk-do in South Korea, recognized as one of the most challenging areas for providing EMS to the elderly population (aged 65 and over). This challenge arises from the significant spatial disparity in the distribution of emergency medical facilities. The results of the model assessment gauge the spatial disparity of EMS, provide significantly enhanced solutions for a more equitable EMS distribution in terms of service coverage, and offer policy implications for future EMS location planning. In addition, to address the computational challenges posed by p-DIME's inherent complexity, involving mixed-integer programming, this study introduces a solution technique through constraint formulations aimed at tightening the lower bounds of the problem's solution space. The computational results confirm the effectiveness of this approach in ensuring reliable computational performance, with significant reductions in solution times, while still producing optimal solutions.
... (The «Golden Hour» refers to the first hour following an incident within which definitive emergency treatment must be provided. The patient must be transported to a medical facility within the hour and receive definitive care at the facility to decrease the risk of death and disability [33]). ...
In the Republic of South Africa (RSA) healthcare quality including Emergency Medical Services (EMS) is impaired by scarce resources and variable governance and management. The National Health Quality Improvement Plan (NHQIP) seeks to transform health care quality through standards setting. In RSA EMS managers monitor and adjust quality to comply with the Regulations Relating to Standards for EMS. EMS management training is deficient, and it is unknown how prepared they are to meet quality standards. Object of research: How can the knowledge, attitude, and practice (KAP) of EMS managers be transformed to comply with the standards regulations for EMS. A mixed methods explanatory sequential design was conducted in two phases. Phase one consisted of a KAP quantitative survey (n = 352). Phase two included the non-participant observations (N-PO) at country-wide management workshops (n = 7 provinces) and interviews (n = 11) with key informants/power brokers. The data was analyzed to develop themes to deepen the understanding of the survey data. Fragmentation of EMS into districts; ineffective workforce management; poor fleet management; poorly trained dispatchers, underutilization of information communication technology and vehicle tracking are factors that compromises the access, safety and contribute to ineffective and inefficient EMS. The World Health Organization (2020) report on EMS in Ukraine identified similar challenges. EMS quality challenges in RSA are not unique, and sharing common challenges, experiences and solutions may benefit EMS organizations in other developing countries such as Ukraine.
... The operational definition of travel time distance constraints (TDC) is used to define the coverage from each trauma center and candidate location based on the time geography concept of potential path area [14]. As the standard time frame in which patients should be transferred to the nearest emergency medical care facility, a 60-minute travel time constraint is applied to the TDC of this research to show the coverage of each facility [15,16]. ...
Accessibility to trauma centers is vital for the patients of severe motor vehicle crashes. Many vehicle crash fatalities failed to reach the proper emergency medical services since the accident location was far away from trauma centers. The spatial discordance between the service coverage area of trauma centers and actual locations of motor vehicle accidents delays the definitive medical care and results in death or disability. Many fatalities would have been prevented if the patients had a chance to get proper treatment in time at Southeastern region of the U.S. Also, the accessibility to trauma centers from the actual locations of motor vehicle accidents is different in the Southeastern region. This research aimed to facilitate the accessibility to trauma centers for severe motor vehicle crash patients in the Southeastern region. The analyses are conducted to assess current trauma center accessibility and suggest the optimal locations of future trauma centers using the Anti-covering location model for trauma centers (TraCt model). This study found that existing trauma centers failed to serve many demands, and the actual coverages of the current locations of trauma centers over potential demands are highly different in each Southeastern state. TraCt model is applied to each Southeastern state, and its solutions provide better coverage for demand locations. However, the TraCt model for each state tends to choose too many facilities, with excessively supplied facilities across the Southeastern region. The excessive service supply issue is addressed by applying the TraCt Model to a broader spatial extent. TraCt model applied to the entire Southeastern region and most of the demand, over 98% covered by the service coverage of optimal facility locations with 15 additional facilities. This research proves that the GIS and TraCt model applied to the broader spatial extent works well with increasing trauma medical service beneficiaries while providing a minimum number of additional facilities.
... This study explained geographical context, health management context, and community knowledge related to emergency care accessibility for road traffic victims. 4 articles described geographical accessibility of emergency care from crash scene, 19,22,26,27 10 articles explained the health management setting for emergency care, [17][18][19][20]22,[22][23][24][25]28 and community knowledge was defined by 2 studies. 18,20 ...
... 14 Emergency care including prehospital care and ambulance service is available in certain areas, but having barriers such as the absence of ambulance at night 17 , lack of physicians at certain areas, 18,24 and out of golden hour zone location. 25,27 Contrastingly, some areas only had limited access to prehospital care or no access at all such as in Malawi and Uganda, 19,23 making patients seek services from other facilities before coming to emergency care. 19 This also happened in Hanoi where victims of road crashes occurred in north-south main roads could not easily access trauma care. ...
Road traffic accident has become a public health concern. More than 80% injury-related deaths occurred in low-middle income countries (LMICs). Despite its importance, emergency care accessibility for road crash victims is still questionable. This study aims to review emergency care accessibility from approachability, acceptability, availability, affordability, and appropriateness dimensions for crash victims. This is a scoping review with literatures extracted from ScienceDirect, ProQuest, and Scopus. Articles analyzed using PCC (Problem/Population, Concept, Context) of scoping review. 1544 articles identified from databases of which 81 are relevant for full-text screening. The final 12 articles were eligible to be reviewed. Although emergency care is available in most areas, its existence was not well-known. Victims and helpers are treated unfairly in emergency care. Emergency care system also lacks clear coordination and it does not give appropriate treatment in timely manner. There was little evidence of how accessible emergency care to crash victims. Most studies only examined the availability of emergency care without comparing its actual utilization and other determinants impacting its accessibility. Future study should aim to assess approachability, acceptability, affordability, and appropriateness of emergency care. Strengthening emergency care from all dimensions is important to ensure its accessibility.
... Physical distance to a transfusing health facility is one of the major reasons for the delay in receiving transfusion. Optimal travel times to health facilities vary depending on conditions, for example in maternal and neonatal care this is often defined as travel time within 2 h [8,9], while for emergency and trauma related interventions this has been defined as within 1 h [10,11]. Advances in availability of geographical data and spatial analysis techniques have improved how physical accessibility is defined, moving away from simplistic estimates of Euclidean distance. ...
Background
Estimating accessibility gaps to essential health interventions helps to allocate and prioritize health resources. Access to blood transfusion represents an important emergency health requirement. Here, we develop geo-spatial models of accessibility and competition to blood transfusion services in Bungoma County, Western Kenya.
Methods
Hospitals providing blood transfusion services in Bungoma were identified from an up-dated geo-coded facility database. AccessMod was used to define care-seeker’s travel times to the nearest blood transfusion service. A spatial accessibility index for each enumeration area (EA) was defined using modelled travel time, population demand, and supply available at the hospital, assuming a uniform risk of emergency occurrence in the county. To identify populations marginalized from transfusion services, the number of people outside 1-h travel time and those residing in EAs with low accessibility indexes were computed at the sub-county level. Competition between the transfusing hospitals was estimated using a spatial competition index which provided a measure of the level of attractiveness of each hospital. To understand whether highly competitive facilities had better capacity for blood transfusion services, a correlation test between the computed competition metric and the blood units received and transfused at the hospital was done.
Results
15 hospitals in Bungoma county provide transfusion services, however these are unevenly distributed across the sub-counties. Average travel time to a blood transfusion centre in the county was 33 min and 5% of the population resided outside 1-h travel time. Based on the accessibility index, 38% of the EAs were classified to have low accessibility, representing 34% of the population, with one sub-county having the highest marginalized population. The computed competition index showed that hospitals in the urban areas had a spatial competitive advantage over those in rural areas.
Conclusion
The modelled spatial accessibility has provided an improved understanding of health care gaps essential for health planning. Hospital competition has been illustrated to have some degree of influence in provision of health services hence should be considered as a significant external factor impacting the delivery, and re-design of available services.
... But current accessibility studies did not consider ambulance type and class (32). Finally, most studies have focused only on descriptive analysis of the spatial distribution of EMS accessibility (6,29,32,37) and lacked a more comprehensive factor analysis of the socio-economic, geographic and population factors affecting EMS accessibility. ...
Background
Timely access to emergency medical services (EMS) can significantly reduce mortality. In China, the evidence of the accessibility of complete EMS which considers two related trips and involves large rural areas is insufficient. This study aimed to explore the accessibility of ambulance services and complete EMS in Chongqing and its regional differences, and to provide a reference for improving spatial accessibility of EMS in Chongqing and optimizing allocation of EMS resources.
Methods
The nearest neighbor method was used to measure spatial accessibility of ambulance services and complete EMS. Spatial aggregation patterns and influencing factors of spatial accessibility of complete EMS were analyzed using Moran's I index, Pearson correlation and multiple linear regression.
Results
The medians of shortest travel time for ambulance, monitoring ambulance, primary EMS and advanced EMS in Chongqing were 7.0, 18.6, 36.2, and 47.8 min. The shortest travel time for complete EMS showed significant spatial aggregation characteristics. The Low-Low types that referred to cluster of short EMS travel time mainly distributed in city proper. The High-High types that referred to cluster of long EMS travel time mainly distributed in northeast and southeast of Chongqing. Urbanization rate was a negative influencing factor on shortest travel time for primary EMS, while average elevation and the number of settlements were positive influencing factors. GDP per capita and urbanization rate were negative influencing factors on shortest travel time for advanced EMS, while the number of settlements was a positive influencing factor.
Conclusion
This study evaluated the accessibility of EMS which considers two related trips in Chongqing. Although the accessibility of ambulances in Chongqing was relatively high, the accessibility of monitoring ambulance was relatively low. Regional and urban-rural differences in the accessibility of complete EMS integrating two related trips were obvious. It was recommended to increase financial investment in economic backward areas, increase high-quality EMS resources, enhance EMS capacity of central township health centers, strengthen road construction in mountainous areas, and provide reasonable planning of rural settlements for improving the spatial accessibility of EMS, narrowing the urban-rural gap and improving equity in getting EMS for all the people.
... These imputations, although based on reasonable definitions, is plausible that a slightly lower proportion of patients experienced PCC; however, other administrative and research reports from the Western Cape support our timeframes. 35,36 Next, there were relatively few EMSs critical interventions performed in this pilot data set, which limits the strength of those conclusions-future analyses of EpiC data will be based on larger EMSs samples to yield stronger evidence. In addition, almost one third of patient injuries were due to stab wounds, which are less representative of modern combat casualties. ...
Background:
Civilian and military populations alike are increasingly faced with undesirable situations in which prehospital and definitive care times will be delayed. The Western Cape of South Africa has some similarities in capabilities, injury profiles, resource-limitations, and system configuration to U.S. military prolonged casualty care (PCC) settings. This study provides an initial description of civilians in the Western Cape who experience PCC and compares the PCC and non-PCC populations.
Methods:
We conducted a 6 month analysis of an on-going, prospective, large-scale epidemiologic study of prolonged trauma care in the Western Cape ('EpiC'). We define PCC as ≥10 hours from injury to arrival at definitive care. We describe patient characteristics, critical interventions, key times, and outcomes as they may relate to military PCC and compare these using chi-squared and Wilcoxon tests. We estimated the associations between PCC status and the primary and secondary outcomes using logistic regression models.
Results:
146 of 995 patients experienced PCC. The PCC group, compared to non-PCC, were more critically injured (66% vs 51%), received more critical interventions (36% vs 29%), had a greater proportionate mortality (5% vs 3%), longer hospital stays (3 vs 1 day), and higher SOFA scores (5 vs 3). The odds of 7-day mortality and a SOFA score ≥ 5 were 1.6 (OR: 1.59; 0.68, 3.74) and 3.6 (OR: 3.69; 2.11, 6.42) times higher, respectively, in PCC versus non-PCC patients.
Conclusions:
EpiC enrolled critically injured patients with PCC who received resuscitative interventions. PCC patients had worse outcomes than non-PCC. EpiC will be a useful platform to provide on-going data for PCC relevant analyses, for future PCC-focused interventional studies, and to develop PCC protocols and algorithms. Findings will be relevant to the Western Cape, South Africa, other LMICs, and military populations experiencing prolonged care.
Level of evidence:
III; prospective comparative study.
