Int J Health Geogr - A validation of ground ambulance pre-hospital times modeled using geographic information systems.

Tópicos

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Resumo

CKGROUND: Evaluating geographic access to health services often requires determining the patient travel time to a specified service. For urgent care, many research studies have modeled patient pre-hospital time by ground emergency medical services (EMS) using geographic information systems (GIS). The purpose of this study was to determine if the modeling assumptions proposed through prior United States (US) studies are valid in a non-US context, and to use the resulting information to provide revised recommendations for modeling travel time using GIS in the absence of actual EMS trip data.METHODS: The study sample contained all emergency adult patient trips within the Calgary area for 2006. Each record included four components of pre-hospital time (activation, response, on-scene and transport interval). The actual activation and on-scene intervals were compared with those used in published models. The transport interval was calculated within GIS using the Network Analyst extension of Esri ArcGIS 10.0 and the response interval was derived using previously established methods. These GIS derived transport and response intervals were compared with the actual times using descriptive methods. We used the information acquired through the analysis of the EMS trip data to create an updated model that could be used to estimate travel time in the absence of actual EMS trip records.RESULTS: There were 29,765 complete EMS records for scene locations inside the city and 529 outside. The actual median on-scene intervals were longer than the average previously reported by 7-8 minutes. Actual EMS pre-hospital times across our study area were significantly higher than the estimated times modeled using GIS and the original travel time assumptions. Our updated model, although still underestimating the total pre-hospital time, more accurately represents the true pre-hospital time in our study area.CONCLUSIONS: The widespread use of generalized EMS pre-hospital time assumptions based on US data may not be appropriate in a non-US context. The preference for researchers should be to use actual EMS trip records from the proposed research study area. In the absence of EMS trip data researchers should determine which modeling assumptions more accurately reflect the EMS protocols across their study area.

Resumo Limpo

ckground evalu geograph access health servic often requir determin patient travel time specifi servic urgent care mani research studi model patient prehospit time ground emerg medic servic em use geograph inform system gis purpos studi determin model assumpt propos prior unit state us studi valid nonus context use result inform provid revis recommend model travel time use gis absenc actual em trip datamethod studi sampl contain emerg adult patient trip within calgari area record includ four compon prehospit time activ respons onscen transport interv actual activ onscen interv compar use publish model transport interv calcul within gis use network analyst extens esri arcgi respons interv deriv use previous establish method gis deriv transport respons interv compar actual time use descript method use inform acquir analysi em trip data creat updat model use estim travel time absenc actual em trip recordsresult complet em record scene locat insid citi outsid actual median onscen interv longer averag previous report minut actual em prehospit time across studi area signific higher estim time model use gis origin travel time assumpt updat model although still underestim total prehospit time accur repres true prehospit time studi areaconclus widespread use general em prehospit time assumpt base us data may appropri nonus context prefer research use actual em trip record propos research studi area absenc em trip data research determin model assumpt accur reflect em protocol across studi area

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