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Do neighbourhood income levels influence emergency response times?

Cardiac arrest requires immediate emergency response. How quickly patients receive emergency medical services may depend on the average income of their area.

When health emergencies occur, most North Americans turn to emergency medical services. Bystanders dial 9-1-1 almost immediately. It is expected that critical care will be provided in a timely manner. Across the United States, emergency response time benchmarks are set between four to 15 minutes. These timings are a vital factor of this public service; depending on the type of emergency, even seconds can determine life or death.

Public access to emergency medical services depends on many factors, including social status. Vulnerable communities have unequal access to health care. This directly ties into health care disparities and furthers the gap with high-income groups. Yet, this link is vague and has been poorly researched. Earlier this year, academics from the University of California, San Francisco investigated this. The connection between socioeconomic status and the availability of emergency medical services was studied with past data. Their findings were published in JAMA Network Open.

In June 2017, the research team collected data from the National Emergency Medical Services Information System (NEMSIS) 2014 logs. This data spanned 46 states and 63,600 patient who faced cardiac arrests, did not die on the scene, and were transported to a hospital. Cardiac arrests were useful to gauge emergency response times because of the high mortality rate and need for immediate medical attention. The NEMSIS reports had data on patient demographics, emergency medical service dispatch times, and transport. Thus, patients were not contacted for this study.

The research team broke down each cardiac arrest incident into four sections. Response time from the point of the initial call to the arrival of the ambulance onsite, on-scene time, transport time between the incident site and a hospital, and total time were assessed. This was measured as the average length in time in minutes. It was compared against income of the areas in which the ambulance call was placed.

Of the 63,600 incidences, patients who made ambulance calls within high-income areas were more likely to be Caucasian and male. Such areas also had a greater proportion of privately insured and uninsured patients. Low-income areas, conversely, had a greater proportion of patients insured by Medicaid.

Emergency response times were faster in high-income areas

The total emergency response time was about four minutes faster for high-income areas. In fact, it took slightly longer in each subcategory of the response encounter for low-income emergency calls. There is also a notable difference in driving distance between high- and low-income areas for ambulances. It takes slightly longer to drive to the latter area.

It was uncommon for emergency medical services to arrive at the incident scene within the four-minute benchmark for any income level. However, meeting the eight and fifteen-minute marks was more likely for high-income distress calls.

Cannot apply the findings to all other time-sensitive and life-threatening calls

These findings cannot be applied to all other time-sensitive life-threatening calls. There may be variables beyond the scope of this study that affected the time disparity. Most importantly, the registry used for this study was not organized by the patient. Instead, it was based on each incident. That means that multiple reports could have been analyzed for one patient. Hence, repeated demographic data may have been used.

Despite this, the study shows that total emergency response time for cardiac arrest incidents is shorter and more likely to meet national response time goals in high-income areas than low ones. No doubt, longer response times mean a higher death rate. Quicker overall response time can reduce this and the health care disparity between income classes.

Written by Amrita Jaiprakash, MSc

Reference: Hsia et al. A US National Study of the Association Between Income and Ambulance Response Time in Cardiac Arrest. JAMA Network Open. 2018. doi: 10.1001/jamanetworkopen.2018.5202



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