Disparities in Emergency Medical Services Intra-Arrest Transport by Neighborhood Socioeconomic Vulnerability

Out-of-hospital cardiac arrest (OHCA) survival is lower in neighborhoods with low (vs high) socioeconomic status. While emergency medical services (EMS) practices of intra-arrest transport (IAT) vary, it is unknown whether neighborhood-level factors are associated with these transport patterns.

To determine the association between greater neighborhood socioeconomic vulnerability and odds of IAT among adults with OHCA.

This cohort study used a large national database of deidentified EMS electronic health record data. The cohort comprised US adults (aged ≥18 years) with attempted EMS resuscitations for nontraumatic OHCA between January 1, 2022, and December 31, 2022. Data were analyzed between December 2023 and December 2024.

The exposure was the Social Vulnerability Index (SVI) of the EMS encounter within a US Census tract. Neighborhoods were stratified into quartiles based on SVI percentile. Higher SVI percentiles indicated greater socioeconomic vulnerability.

The primary outcome was the odds of IAT. The association between SVI quartile and EMS transport pattern was assessed using marginal logistic regression modeling.

A total of 61 524 patient encounters were included. Patients had a median (IQR) age of 65 (52-76) years and included 38 546 males (62.6%). Bystander resuscitation was administered in 23 124 encounters (37.6%), while 23 492 patients (38.2%) received IAT and 38 032 patients (61.8%) received continued on-scene resuscitation. Adults in neighborhoods in the highest SVI quartile had a higher occurrence of IAT than those in the lowest SVI quartile (7052 [41.1%] vs 4000 [32.8%]; P < .001). After adjustment, patients in the highest SVI quartile had greater odds of receiving IAT than those in the lowest SVI quartile (adjusted odds ratio, 1.35; 95% CI, 1.15-1.57).

In this cohort study of EMS resuscitations of adults for nontraumatic OHCA, greater neighborhood socioeconomic vulnerability was associated with increased odds of IAT. This association may contribute to socioeconomic disparities in OHCA outcomes and warrant further investigations into factors in EMS transport decisions for OHCA, particularly in marginalized communities.