The association of crash response times and deaths at the crash scene: A cross‐sectional analysis using the 2019 National Emergency Medical Service Information System

Abstract

Background Deaths at the crash scene (DAS) are crash deaths that occur within minutes after a crash. Rapid crash responses may reduce the occurrence of DAS. Objectives This study aims to assess the association of crash response time and DAS during the rush and nonrush hour periods by rurality/urbanicity. Method This single‐year cross‐sectional study used the 2019 National Emergency Medical Services (EMS) Information System. The outcome variable was DAS. The predictor variables were crash response measures: EMS Chute Initiation Time (ECIT) and EMS Travel Time (ETT). Age, gender, substance use, region of the body injured, and the revised trauma score were used as potential confounders. Logistic regression was used to assess the unadjusted and adjusted odds of DAS. Results A total of 654,675 persons were involved in EMS‐activated road crash events, with 49.6% of the population exposed to crash events during the rush hour period. A total of 2,051 persons died at the crash scene. Compared to the baseline of less than 1 minute, ECIT ranging from 1 to 5 minutes was significantly associated with 58% (95% CI: 1.45‐1.73) increased odds of DAS. Also, when compared to the baseline of less than 9 minutes, ETT ranging between 9 and 18 minutes was associated with 34% (95% CI: 1.22‐1.47) increased odds of DAS. These patterns were consistent during the rush and nonrush hour periods and across rural and urban regions. Conclusion Reducing crash response times may reduce the occurrence of DAS.

Substance Use and Pre-Hospital Crash Injury Severity Among U.S. Older Adults: A Five-Year National Cross-sectional Study

“…Additionally, suburban and rural areas had higher fatal injury probabilities compared to urban areas. The observed rural-urban stepwise increase in the predicted probabilities of critical and emergent crash injuries among older adults is similar to earlier studies that have reported similar stepwise increases in crash injury patterns across all age groups, 26 at the county level, 27 in EMS response times, 27,28 in the pattern of deaths at the scene of the crash, 28 and among substance use-related non-fatal crash injuries across all age groups. 13…”

“…The significant association in suburban and urban areas persisted after controlling for patient and injury characteristics. Despite this observed finding, earlier studies have reported that rural areas have significantly prolonged response times, 26,28 increased deaths at the crash scene, 28 and increased proportions of crash fatalities. [50][51][52] These metrics would affect all injured rural patients and may blur the difference between the injury severity categories of crash victims in rural areas.…”

“…We selected these patient and injury characteristics a priori from the literature. 13,26,28 Road user type was measured in four categories using the ICD-10 codes: car occupants (V40 – V49), pedestrians (V00 – V09), two/three-wheel vehicle occupants (V10 – V39), and occupants of trucks, buses, industrial vehicles (V50 – V89). We defined the injured anatomic region in five categories: injury to the head and neck, abdomen and genitals, chest and back, upper and lower limbs (extremities), and general body injuries.…”

“…13,24,25 Furthermore, the crash response times in rural areas are longer, 26,27 and the proportions of deaths at the crash scenes in rural areas are higher. 28 The rural-urban disparity in crash characteristics, and the presence of background co-morbid illnesses may predispose older adults in rural areas to experience worse crash injury severity and increased mortality risk.…”

Substance use and pre-hospital crash injury severity among U.S. older adults: A five-year national cross-sectional study

“…Although crash injuries are preventable, rapid provision of care can improve injury outcomes among older adults. The rural-urban disparity in Emergency Medical Service (EMS) response [ 24 , 25 ], may disproportionately predispose older adults with crash injuries to worse injury severity compared to older adults with similar injuries in urban areas [ 26 ]. Earlier studies have reported that, while fatal injuries occur more in rural areas, minor and serious injuries occur more in urban areas [ 14 , 27 , 28 ].…”