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Effect of socioeconomic status on out-of-hospital transport delays of patients with chest pain

ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 481-490页

作者： Govindarajan, A Schull, M Sunnybrook & Womens Coll Hlth Sci Ctr Clin Epidemiol Unit Toronto ON M4N 3M5 Canada Univ Toronto Fac Med Toronto ON Canada

Study objective: The effect of socioeconomic status on out-of-hospital care has not been widely examined. We determine whether socioeconomic status was associated with out-of-hospital transport delays for patients with chest pain. Methods: A retrospective study of patients with chest pain transported by means of ambulance in Toronto, Ontario, Canada, in 1999 was conducted. The primary outcome measure was the 90th percentile system response interval, with secondary outcomes being the 90th percentile on-scene interval, transport interval, and total out-of-hospital interval. Socioeconomic status was the primary independent variable. Covariates were age, sex, case severity, dispatch and return priority, time and day of transport, paramedic training, and percentage of high-rise apartments in the region. Results: Four thousand three hundred fifty-six patients met the inclusion criteria. The 90th percentile system response interval and total out-of-hospital interval were 11 minutes and 49 minutes, respectively. In multivariate analyses, the highest socioeconomic status neighborhoods were significantly associated with decreased system response interval (34.0 seconds;95% confidence interval [Cl] 6.2 to 70.9 seconds) and transport interval (132.3 seconds;95% Cl 24.1 to 229.6 seconds). In addition, age (+45.3 seconds per 10 years;95% Cl 13.3 to 75.1 seconds), female sex (+205.0 seconds;95% C1 78.1 to 287.7 seconds), and advanced care paramedic crews (+371.6 seconds;95% Cl 263.3 to 490.1 seconds) were associated with delays in total out-of-hospital interval. Lastly, calls originating from the highest socioeconomic status neighborhoods were dispatched the highest proportion of advanced care paramedic crews, despite similar dispatch priorities and case severities. Conclusion: High socioeconomic status neighborhoods were associated with shorter out-of-hospital transport intervals for patients with chest pain. In addition, out-of-hospital delays were associated with age, sex, and a

关键词：急救医疗服务/经济学急救医疗服务/统计学和数值数据卫生服务研究收入/统计学和数值数据安大略贫困区试验预期值回归分析居住特征/统计学和数值数据回顾性研究疾病严重程度指数性别因素社会阶级时间因素病人转送/经济学病人转送/统计学和数值数据女(雌)性人类男(雄)性中年人

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Rural Emergency Medical Services: Patients, Destinations, Times, and Services

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The Journal of Rural Health 1995年第4期11卷 286-294页

作者： Morrisey, Michael A. Johnson, Victoria Treat, Richard Lister Hill Center for Health Policy University of Alabama at Birmingham Birmingham Alabama 35294‐2010 1825 University Blvd. United States

Abstract: This study sought to describe the volume of use, mix of patients, origin and destination of runs, times and distances to care, and the volume of clinical services provided in a rural emergency medical services region. This study summarizes all 6,080 rural emergency ambulance trip reports filed from April through September 1991 from the 12 rural counties surrounding Augusta, GA. Rural ambulances are regularly used and are used extensively by elderly populations. The pattern of services provided suggests that while advanced care may or may not have been indicated, it was rarely provided and that rural emergency medical service programs should consider a greater reliance on basic life support teams. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：救护车/统计学和数值数据卫生服务范围地理学佐治亚卫生服务易得程度/组织和管理卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据病人/分类病人/统计学和数值数据乡村卫生服务/组织和管理乡村卫生服务/标准乡村卫生服务/统计学和数值数据乡村卫生服务/利用时间因素病人转送/统计学和数值数据青少年成年人老年人儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性中年人

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The Relationship of Farm Residency Status to Demographic and Service Characteristics of Agricultural Injury Victims in Central Wisconsin

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The Journal of Rural Health 1995年第2期11卷 98-105页

作者： Stueland, Dean Cleveland, David A. Rothfusz, Ron R. Zoch, Tom Jr., Peter Stamas Department of Emergency Medicine Marshfield Clinic Marshfield Wisconsin 54449‐5777 1000 N. Oak Ave. United States

Abstract: This study performed a surveillance of a defined population in central Wisconsin during a two‐year period that included six months of follow‐up. The study included those who worked and lived on farms and those who only worked on farms. The injury rate for farm residents was 3.15 injuries per 100 persons per year. However, 195 of the 510 injuries (38.2%) involved persons who were not farm residents. For nonfarm residents, 88.7 percent of the victims were male, whereas for farm residents 79 percent of the victims were male. More than one half of the farm residents who were injured were the owners and an additional 21 percent were juvenile children. Of those aged 18 to 29 years, 51.3 percent were nonfarm resident victims and 15.2 percent were farm resident victims. Of nonfarm residents, 41.1 percent were married;of farm residents, 65.3 percent were married. More than one half of all injured nonfarm residents were seen within two hours of injury while one quarter of the injured farm residents were seen more than 24 hours after the injury. Only 4 percent of the injured farm residents were self‐insured, but 15 percent of the nonfarm residents were self‐insured. However, the time of injury, actual injuries, diagnoses rendered, and services received were similar for injured farm residents and injured nonfarm residents. Effective attempts to intervene on agricultural injuries will need to consider different risk factors for injuries for nonfarm residents as compared to farm residents. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：事故职业/预防和控制事故职业/统计学和数值数据农业/统计学和数值数据卫生服务范围/统计学和数值数据卡方分布社区卫生服务/组织和管理综合保健/组织和管理数据收集人口统计学保险健康/统计学和数值数据居住特征/统计学和数值数据农村卫生病人转送/方法病人转送/统计学和数值数据威斯康星/流行病学创伤和损伤/流行病学成年人老年人儿童人类中年人

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