Study: Longer Ambulance Drives as Hospitals Close in Rural Communities

(Photo/A.J. Heightman)

People in rural areas of the United States wait, on average, nearly twice as long for ambulances as those in urban areas. New research from the UNC Gillings School of Global Public Health has found that hospital closures in rural areas increase those EMS transport times.

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Many rural hospitals struggle to remain financially viable, and hospital closures are becoming more and more common in these areas. This puts a population that already experiences longer wait times for acute medical care even more at risk for poor health outcomes, not only because the distance between the patient and the nearest hospital increases, but also because hospital closures often mean the hospital-based EMS agency may also close. This requires the 911 dispatcher to notify an EMS agency that may be farther away from the patient.

The study was recently published in Health Services Research. Because timely and appropriate response is important, EMS records include thorough data about EMS behavior through the lifecycle of a 911 call, beginning from the time a call for help arrives at 911 dispatch until the EMS team returns to service after the completion of an encounter with the patient. This data is tracked through the National Emergency Medical Services Information System (NEMSIS).

Through a retrospective cohort study that examined EMS transport times, response times and total activation times, the team compared pre- and post-hospital closure EMS times in areas designated by NEMSIS as rural or wilderness ZIP codes. They compared these times to patient encounters in rural or wilderness ZIP codes that did not experience a hospital closure after controlling for baseline differences between those that had a closure and those that did not.

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The study found that in the year a hospital closed in a rural area, the average EMS transport and activation times increase. The closure did not affect average EMS response times. EMS transport times increased by an average of 2.6 minutes, and EMS activation times increased by an average of 7.2 minutes. In the subsequent year post-closure, the study found that transportation times increased by 4.7 minutes, and total activation time increased by 9.5 minutes as compared to the year prior to closure.

While these increases may seem small at first, evidence in previous studies has shown that even one-minute increases in EMS times could raise the chances of patient mortality.

While the results of this study emphasize the need for timely EMS response in rural areas, they are also important because this data could help policymakers design solutions that better support hospitals in rural areas. Ensuring that patients have access to these critical services may factor into policy decisions regarding financial investments, both for rural hospitals and their local EMS agencies.

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