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Comparing Prehospital Time Among Pediatric Poisoning Patients in Rural and Urban Settings
Aaron T Phillips1, Michael Denning1, Em Long-Mills2
1Brody School of Medicine, Department of Medical Education, Greenville, North Carolina.
Insights
Pediatric poisoning patients in rural areas face longer emergency medical services (EMS) response times. Rural EMS response was 6.6 minutes slower, highlighting the need for better rural healthcare resource allocation.
Area of Science:
- Emergency Medicine
- Pediatric Toxicology
- Public Health
Background:
- Healthcare access in rural areas presents challenges for timely pediatric poisoning treatment.
- Emergency Medical Services (EMS) play a critical role in prehospital care for poisoned children.
Purpose of the Study:
- To compare EMS response times and delays for pediatric poisoning incidents between rural and urban settings.
- To identify disparities in prehospital care based on geographic location.
Main Methods:
- Utilized data from the 2021 National Emergency Medical Services Information System (NEMSIS).
- Included 11,911 pediatric patients (<18 years) with a primary impression of poisoning.
- Employed rank-sum, chi-square, quantile regression, and logistic regression for analysis.
Main Results:
- Median total prehospital time was 40 minutes; scene delay was the most common (6%).
- Rural EMS patients experienced significantly longer prehospital times (6.6 minutes longer, P<0.001).
- No significant differences were found in dispatch, response, scene, or transportation delays between rural and urban EMS.
Conclusions:
- Findings underscore the need for equitable resource allocation and enhanced training for rural EMS responders.
- The extended prehospital time in rural areas poses greater physiological risks to pediatric patients.
- Targeted interventions are crucial to improve rural pediatric emergency care and achieve geographic equity.
Objectives:
Barriers to healthcare in rural areas can delay treatment in pediatric patients who have experienced poisoning. We compared emergency medical services (EMS) response times and EMS-reported delays in responding to pediatric poisoning incidents between rural and urban settings using the 2021 National Emergency Medical Services Information System (NEMSIS).
Methods:
The NEMESIS defines rural areas as locations with a population of <50,000, not part of metropolitan areas, while all other locations are classified as urban (metropolitan) areas. In this study we included 11,911 patients (12% rural) <18 years of age who were transported by EMS with a first-responder primary impression of poisoning. We compared study variables using rank-sum tests and chi-square tests. Multivariable analysis of outcomes included quantile regression and logistic regression for continuous data and categorical data, respectively.
Results:
The median total prehospital time by EMS was 40 minutes (interquartile range 29-57), and the most common type of delay was scene delay (6%). On multivariable quantile regression, patients transported by rural EMS agencies experienced 6.6 minutes (95% confidence interval 5-8, P<0.001) longer prehospital time than those transported by urban agencies. There were no differences between rural and urban EMS agencies in the occurrence of dispatch, response, scene, and transportation delays.
Conclusion:
These results elucidate the need for equitable allocation of resources and training to enhance rural EMS responders. The additional nearly seven minutes translates into greater risk for the human body to remain physiologically unstable and not be optimally treated. Therefore, by integrating targeted interventions to rural pediatric populations, better care can be achieved across all geographic regions. Further research must be conducted to ascertain the specific factors, aside from delays, that result in the disparity between rural and urban prehospital response time.
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