Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb:52:64-68.
doi: 10.1016/j.ajem.2021.11.038. Epub 2021 Nov 30.

Prehospital time for patients with acute cardiac complaints: A rural health disparity

Nicklaus P Ashburn  1 , Anna C Snavely  2 , Ryan M Angi  3 , James F Scheidler  4 , Remle P Crowe  5 , Henderson D McGinnis  3 , Brian C Hiestand  3 , Chadwick D Miller  3 , Simon A Mahler  3 , Jason P Stopyra  3
Affiliations

Prehospital time for patients with acute cardiac complaints: A rural health disparity

Nicklaus P Ashburn et al. Am J Emerg Med. 2022 Feb.

Abstract

Objective: Delays in care for patients with acute cardiac complaints are associated with increased morbidity and mortality. The objective of this study was to quantify rural and urban differences in prehospital time intervals for patients with cardiac complaints.

Methods: The ESO Data Collaborative dataset consisting of records from 1332 EMS agencies was queried for 9-1-1 encounters with acute cardiac problems among adults (age ≥ 18) from 1/1/2013-6/1/2018. Location was classified as rural or urban using the 2010 United States Census. The primary outcome was total prehospital time. Generalized estimating equations evaluated differences in the average times between rural and urban encounters while controlling for age, sex, race, transport mode, loaded mileage, and patient stability.

Results: Among 428,054 encounters, the median age was 62 (IQR 50-75) years with 50.7% female, 75.3% white, and 10.3% rural. The median total prehospital, response, scene, and transport times were 37.0 (IQR 29.0-48.0), 6.0 (IQR 4.0-9.0), 16.0 (IQR 12.0-21.0), and 13.0 (IQR 8.0-21.0) minutes. Rural patients had an average total prehospital time that was 16.76 min (95%CI 15.15-18.38) longer than urban patients. After adjusting for covariates, average total time was 5.08 (95%CI 4.37-5.78) minutes longer for rural patients. Average response and transport time were 4.36 (95%CI 3.83-4.89) and 0.62 (95%CI 0.33-0.90) minutes longer for rural patients. Scene time was similar in rural and urban patients (0.09 min, 95%CI -0.15-0.33).

Conclusion: Rural patients with acute cardiac complaints experienced longer prehospital time than urban patients, even after accounting for other key variables, such as loaded mileage.

Keywords: Acute coronary syndrome; Chest pain; Disparity; Emergency medical services (EMS); Prehospital; Rural; Urban.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Case-selection flow diagram.
Fig. 2.
Fig. 2.
The prehospital time intervals of interest presented with median rural and urban times.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Møller TP, Ersbøll AK, Tolstrup JS, et al. Why and when citizens call for emergency help: an observational study of 211,193 medical emergency calls. Scand J Trauma Resusc Emerg Med. 2015;23:88. 10.1186/s13049-015-0169-0. - DOI - PMC - PubMed
    1. Pittet V, Burnand B, Yersin B, Carron PN. Trends of pre-hospital emergency medical services activity over 10 years: a population-based registry analysis. BMC Health Serv Res. 2014;14:380. 10.1186/1472-6963-14-380. - DOI - PMC - PubMed
    1. Owens PL, Barrett ML, Gibson TB, Andrews RM, Weinick RM, Mutter RL. Emergency department care in the United States: a profile of national data sources. Ann Emerg Med. 2010;56(2):150–65. 10.1016/j.annemergmed.2009.11.022. - DOI - PubMed
    1. Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics-2019 update: A report from the American Heart Association. Circulation. 2019;139(10): e56–528. 10.1161/CIR.0000000000000659. - DOI - PubMed
    1. Kerr D, Holden D, Smith J, Kelly A-M, Bunker S. Predictors of ambulance use in patients with acute myocardial infarction in Australia. Emerg Med J 2006;23(12): 948–52. 10.1136/emj.2006.038414. - DOI - PMC - PubMed

MeSH terms