Road traffic accidents cause several thousand deaths each year in Engl
and and Wales. One approach to reducing this toll is to ensure that se
rvices are planned to achieve early response of ambulances to accident
victims and their rapid conveyance to a hospital with good accident a
nd emergency facilities. In order to undertake medical care of the hig
hest quality, there has been a policy of concentrating such facilities
in large units. Unfortunately, this has the disadvantage that distanc
es and travel times from some accident sites to these centres can be c
onsiderable, particularly in rural areas. The county of Norfolk is a g
enerally rural area which has a high death rate from road traffic acci
dents, and it has been suggested that access to accident and emergency
facilities may be a factor. Data on serious and fatal road accidents
from police accident records were;analysed for the period 1987 to 1991
. The time taken for an ambulance to reach each accident and to convey
the victim to the nearest hospital accident and emergency department
was estimated using a geographical information system. Regression anal
ysis was used to analyse the factors affecting the odds of death versu
s serious injury for each individual. An elevated probability of death
was found among the old, pedestrians, casualties involved in multiple
accidents, and casualties on roads with higher speed limits. However,
no relationship was found between outcome and the estimated time take
n to reach victims and to convey them to hospital, either before or af
ter adjustment for other factors. This negative finding suggests that
previous reports of a link between emergency response times and outcom
e may have been subject to confounding owing to the effects of more se
vere accidents on fast rural roads in more inaccessible areas. Another
possibility is that any influence of access on outcomes may be limite
d to more rural settings where distances are greater than in Norfolk.
However, for the area studied there is no evidence that survival is re
lated to ambulance journey times.