URBAN-RURAL DIFFERENCES IN PREHOSPITAL CARE OF MAJOR TRAUMA

Objectives: To compare differences in response times, scene times, and transport times by advanced life support-trained paramedics to trauma incidents in urban and rural locations, Methods: This report was a pr ospective cohort study of professional emergency medical services cond ucted in a five-county area in the state of Washington, Ninety-eight p ercent of trauma transports are provided by professional paramedics tr ained in advanced life support, Subjects were included in this study i f they qualified as a major trauma victim and were transported or foun d dead at the scene by one of the region's advanced life support trans port agencies between August 1, 1991, and January 31, 1992, The severi ty of injury was rated using the Prehospital Index, Incident locations were defined as ''rural'' if they occurred in a US Census division (a geographic area) in which more than 50% of the residents resided in a rural location, Results: During the 6-month data collection period, a dvanced life support agencies responded to a total of 459 major trauma victims in the region, A geographic location was determined for 452 o f these subjects, Of these, 42% of subjects were injured in urban area s and the remainder in rural areas, The severity of injuries, as deter mined both by the triage classification (p = 0.17) and the distributio n of Prehospital Index scores (p = 0.92), was similar for urban and ru ral major trauma patients, Twenty-six (5.7%) subjects died at the scen e, About one quarter of both groups had a severe injury, as indicated by Prehospital Index score of more than 3, The mean response time for urban locations was 7.0 minutes (median = 6 minutes) compared with 13. 6 minutes (median = 12 minutes) for rural locations (p < 0.0001), The mean scene time in rural areas was slightly longer than in urban areas (21.7 vs, 18.7 minutes, p = 0.015), Mean transport times from the sce ne to the hospital were also significantly longer for rural incidents (17.2 minutes vs, 8.2 minutes, p < 0.0001), Rural victims were over se ven times more likely to die before arrival (relative risk = 7.4, 95% confidence interval 2.4-22.8) if the emergency medical services' respo nse time was more than 30 minutes, Conclusions: Response and transport times among professional, advanced life-support-trained paramedics re sponding to major trauma incidents are longer in rural areas, compared with urban areas.