Spatial Distribution and Influence Factors of Cross-District Transports among Major Trauma in Emergency Medical Services System
Date Issued
2008
Date
2008
Author(s)
Ko, Chow-In
Abstract
Objective:“The right patient, to the right place, at the right time.” is the most important principle for regionalization of EMSS (Emergency Medical Services System). EMSS regionalization could effectively improve the mortality and morbidity of major trauma patients. Evaluating the cross-district EMS transports of major trauma patients would promptly represent the exact demand of cross-district access to emergency healthcare, and would reflect the performance of regionalization. With character of spatial data, spatial analysis should be utilized in evaluations of cross-district EMS transport. In consideration of the lack of data in Taiwan for EMS regionalization and cross-district EMS transport, this study is to analyze the impacts of spatial, time, and human factors on cross-district EMS transport of major trauma patients in northern Taiwan. ethod: From the electronic data of Taiwan Emergency Medical Services Registry provided by Department of Health, Taiwan, we analyzed the data of January 2007 among the five districts in northern Taiwan including Taipei City, Taipei County, Taoyuan County, Keelung City, and Eland County. Three subjects were studied: (1) the amount of cross- district EMS transports for major trauma patients, and its proportion among district- wide EMS transports, by descriptive analysis of each district respectively; (2) the spatial distribution and characters of cross-district EMS transports for major trauma patients, by positioning the EMS scene exactly through GIS (Geographic Information System) utilization; (3) the correlation between time or human factor and cross-district EMS transport, by regression analysis for the difference of transport time correlating with cross-district transports, and categorical data analysis for the man-made impacts on cross-district transports, inclusive of patient or family’s insistence or EMS providers’ decision on the receiving hospital. esult: There are three major results in this study: (1) a total of 6,235 EMS transports of major trauma patients occurred in January 2007 among the five districts, inclusive of 389 cross-district ones. Taipei County possesses the most 326 cross-district EMS transports out of the 389 ones, which accounts for 12.8% (95% CI: 11.6~14.2%) of its county-wide EMS transports, significantly higher than the proportions of the other four districts (95%CI: 0~3.1%). (2) Among the 6,235 EMS transports, EMS scenes were successfully positioned by GIS in 75.5% of cases. The cross-district EMS transports were clustered in Sanchong, Lujou, northern Banchiau, Yungho, Junghe, and southern Linkou. The regions with higher proportion of cross-district EMS transport distributed in southern Linkou, Taishan, western Hsichih, Shenkeng, Shrding, Pingshi, Pinglin, western Rueifang, Bali, and Wanli. (3) The difference of transport time is not an influence factor on deciding cross-district transport. Categorical data analyses reveal both human factors- family’s insistence and EMS providers’ decision on the receiving hospital are significantly (p<0.05) correlated with cross-district transports, especially in regions with longer cross-district transport time compared with non-cross-district ones.onclusions: Our data indicate that (1) Taiwan EMSS demands cross-district transports for major trauma patients, and the proportion of demands significantly varied across the island. Current EMS regionalization should be enhanced or revised. (2)Utilizing GIS may comprehensively illustrate the spatial characters for these cross-district transports. Spatial analysis may target the exact regions of concern, providing the spatial priority for reconstruction of EMS regionalization. (3) Human factor, instead of time factor, impacts on the decision of cross-district EMS transport, especially among the regions where cross-district transports are significantly time-consuming than the non-cross- district. For obstacles to restrict human factors, EMSS should improve the efficiency of cross-district transports, or to redefine the geographic jurisdiction of regionalization. The impact on patient outcome by cross-district EMS transports may need further in depth studies.
Subjects
Emergency Medical Services Regionalization
Cross-district Transport
Major Trauma
Geographic Information System
Spatial Analysis
SDGs
Type
thesis
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