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A Spatial Analysis of Incident Location and Prehospital Mortality for Two United Kingdom Helicopter Emergency Medical Services (HEMS)

A Spatial Analysis of Incident Location and Prehospital Mortality for Two United Kingdom... Most trauma and out of hospital cardiac arrest (OHCA) deaths occur prior to arrival at hospital, with increased risk for rural compared to urban patients. Essex and Hertfordshire Air Ambulance Trust (EHAAT) and Kent Surrey Sussex Air Ambulance Trust (KSS) provide a physician-paramedic Helicopter Emergency Medical Service (HEMS) in two regions of the United Kingdom. We investigated whether an association exists between prehospital mortality and distance from care in HEMS patients. We performed a retrospective study using spatial statistics to investigate the geographic distribution of scene outcome (alive versus deceased). We also performed multiple logistic regression of outcome against quartiles of distance from base to scene and a relative risk (RR) estimation over the operational areas. Organisations were analysed separately to assess consistency of spatial relationships. 2680 EHAAT and 4213 KSS patients met the inclusion criteria. Ripley’s K and Cross K functions indicated that outcomes (death and leaving the scene alive) cluster together. For KSS distance was not associated with outcome, for EHAAT distance was a significant predictor of mortality at furthest distance (41 to 95 km; OR 5.82, 95%CI 1.63 to 37.18, p = 0.019). Only one area of KSS and no areas of EHAAT had an increased RR of mortality. In contrast to previous research of pre-hospital patients, we found little evidence of geographic difference in scene outcome for trauma patients attended by the two HEMS services. Increased mortality risk for OHCA at the furthest distance from helicopter base was found in one organisation; a single area of increased RR of mortality was found for the other organisation. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Applied Spatial Analysis and Policy Springer Journals

A Spatial Analysis of Incident Location and Prehospital Mortality for Two United Kingdom Helicopter Emergency Medical Services (HEMS)

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Publisher
Springer Journals
Copyright
Copyright © Springer Nature B.V. 2019
Subject
Social Sciences; Human Geography; Landscape/Regional and Urban Planning; Regional/Spatial Science
ISSN
1874-463X
eISSN
1874-4621
DOI
10.1007/s12061-019-09318-2
Publisher site
See Article on Publisher Site

Abstract

Most trauma and out of hospital cardiac arrest (OHCA) deaths occur prior to arrival at hospital, with increased risk for rural compared to urban patients. Essex and Hertfordshire Air Ambulance Trust (EHAAT) and Kent Surrey Sussex Air Ambulance Trust (KSS) provide a physician-paramedic Helicopter Emergency Medical Service (HEMS) in two regions of the United Kingdom. We investigated whether an association exists between prehospital mortality and distance from care in HEMS patients. We performed a retrospective study using spatial statistics to investigate the geographic distribution of scene outcome (alive versus deceased). We also performed multiple logistic regression of outcome against quartiles of distance from base to scene and a relative risk (RR) estimation over the operational areas. Organisations were analysed separately to assess consistency of spatial relationships. 2680 EHAAT and 4213 KSS patients met the inclusion criteria. Ripley’s K and Cross K functions indicated that outcomes (death and leaving the scene alive) cluster together. For KSS distance was not associated with outcome, for EHAAT distance was a significant predictor of mortality at furthest distance (41 to 95 km; OR 5.82, 95%CI 1.63 to 37.18, p = 0.019). Only one area of KSS and no areas of EHAAT had an increased RR of mortality. In contrast to previous research of pre-hospital patients, we found little evidence of geographic difference in scene outcome for trauma patients attended by the two HEMS services. Increased mortality risk for OHCA at the furthest distance from helicopter base was found in one organisation; a single area of increased RR of mortality was found for the other organisation.

Journal

Applied Spatial Analysis and PolicySpringer Journals

Published: Sep 19, 2020

References