Using geographic rescue time contours, point-of-care strategies, and spatial care paths to prepare island communities for global warming, rising oceans, and weather disasters

Abstract

Objectives: To perform geographic contour analysis of sea and land ambulance rescue times in an archipelago subject to super typhoons; to design point-of-care testing strategies for medical emergencies and weather disasters made more intense by global warming and rising oceans; and to assess needs for prehospital testing on spatial care paths that accelerate decision making, increase efficiency, improve outcomes, and enhance standards of care in island nations.

Methods: We performed needs assessments, inspected healthcare facilities, and collected ambulance rescue times from professionals in the Bantayan Archipelago, Philippines. We mapped sea/land ambulance rescue routes and time contours. To reveal gaps, we statistically compared the fastest and slowest patient rescue times from islands/islets and barangays to the District Hospital on Bantayan Island. We developed spatial care paths (the fastest routes to care) for acute myocardial infarction, community care, and infectious diseases. We generated a compendium of prehospital diagnostic testing and integrated outcomes evidence, diagnostic needs, and public health goals to recommend point-of-care strategies that build geographic health resilience.

Results: We observed limited access to COVID-19 assays, absence of blood gas/pH testing for critical care support, and spatial gaps in land and airborne rescues that worsened during inclement weather and sea swells. Mean paired differences (slowest-fastest) in ambulance rescue times to the District Hospital for both islands and barangays were significant (P < 0.0001). Spatial care path analysis showed where point-of-care cardiac troponin testing should be implemented for expedited care of acute myocardial infarction. Geospatial strengths comprised distributed primary care that can be facilitated by point-of-care testing, logical interisland transfers for which decision making and triage could be accelerated with onboard diagnostics, and healthcare networks amenable to medical advances in prehospital testing that accelerate treatment.

Conclusions: Point-of-care testing should be positioned upstream close to homes and island populations that have prolonged rescue time contours. Geospatially optimized point-of-need diagnostics and distributed prehospital testing have high potential to improve outcomes. These improvements will potentially decrease disparities in mortality among archipelago versus urban dwellers, help improve island public health, and enhance resilience for increasingly adverse and frequent climate change weather disasters that impact vulnerable coastal areas. [350 words].

Keywords: Climate change; Geographic rescue time contours; Global warming; Island communities; Medical emergencies; Point-of-care strategies; Rising oceans; Spatial care paths; Spatial injustice; Weather disasters.

Fig. 1

Cebu Province Ambulance Transport Times. The contours show ambulance rescue times to Vicente Sotto Memorial Medical Center in Cebu City. The Bantayan Archipelago is situated within the Northern Primary Care Network to the north of Cebu City

Fig. 2

Healthcare Resources in the Bantayan Archipelago. This figure shows the distribution of healthcare resources in the small-world network of the Bantayan Archipelago. The District Hospital, a basic resource, is the main referral site on Bantayan Island

Fig. 3

Bantayan Archipelago Minimum Transport Times. Rescue times become progressively longer radiating out from the District Hospital. Time intervals were determined from raw data provided by sea and land ambulance operators

Fig. 4

Bantayan Archipelago Maximum Transport Times. During low tides, the port of call changes to a sandbar southwest from Bantayan Island. Patients must be hand-ported from the sea ambulance to the land ambulance waiting onshore

Fig. 5

Spatial Care Paths for Acute Myocardial Infarction. A patient with acute myocardial infarction must endure a total transit time of 95 min (purple). If transported directly to the District Hospital via the spline (green) from the port (3 min), the total transit time would be < 30 min

Fig. 6

Helicopter Transport. Helicopters and helipads are not currently available in the Bantayan Archipelago. However, direct helicopter transport could decrease the rescue time from islands/islets to Heart Centers in Cebu City to 35 min. This figure shows two recommended sites for island helipads

Fig. 7

Global Warming, Rising Oceans, and Population Migration. Climate change, rising oceans, and population migration demand changes in the way emergency healthcare services are delivered

Fig. 8

Proposed Sites and Recommended POCT in the Bantayan Archipelago. The POC test clusters shown in the margins draw on outcomes evidence documented in the Compendium and include prehospital tests recommended in Table 3, as well as a third POCT-equipped sea ambulance to be stationed at the Bantayan Port. AED automated external defibrillator, AbT antibody test, CBC complete blood count, CXR chest x-ray, ECG electrocardiogram, Flu A/B influenza A/B, HbA1c hemoglobin A1c, HIV human immunodeficiency virus, hs-cTn T/I cardiac biomarkers troponin T or I, RAgT, rapid antigen test, RT-PCR reverse transcriptase polymerase chain reaction, TB tuberculosis, UTZ ultrasound; and WBA, whole-blood analyzer