Highlights
- •Empirical work on the impact of emergency medical service response time on patient outcomes has provided mixed results.
- •This article displays the endogenous characteristics of response time when estimating its impact on patient outcomes and provides a novel solution to the estimation of this relationship by using “road” time.
- •This article will help healthcare decision makers better understand the relationship between response time and patient outcomes. The results can contribute to more reliable evaluation of policies aimed at optimizing emergency medical service response time.
Abstract
Objectives
This article builds on the literature regarding the association between emergency
medical service (EMS) response times and patient outcomes (death and severe injury).
Three issues are addressed in this article with respect to the empirical estimation
of this relationship: the endogeneity of response time (systematically quicker response
for higher degrees of urgency), the nonlinearity of this relationship, and the variation
between such estimations for different patient outcomes.
Methods
Binomial and multinomial logistic regression models are used to estimate the impact
of response time on the probabilities of death and severe injury using data from French
Fire and Rescue Services. These models are developed with response time as an explanatory
variable and then with road time (dispatch to arrival) hypothesized as representing
the exogenous variation within response time. Both models are also applied to data
subsets based on response time intervals.
Results
The results show that road time yields a higher estimate for the impact of response
time on patient outcomes than (total) response time. The impact of road time on patient
outcomes is also shown to be nonlinear. These results are of both statistical significance
(model coefficients are significant at the 95% confidence level) and economical significance
(when taking into account the number of annual interventions performed).
Conclusions
When using heterogeneous data on EMS interventions where endogeneity is a clear issue,
road time is a more reliable indicator to estimate the impact of EMS response time
on patient outcomes than (total) response time.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
PDF Download and 24 Hours Online AccessSubscribe:
Subscribe to Value in HealthAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mortality risk valuation in environment, health and transport policies. OECD.https://www.oecd.org/environment/mortalityriskvaluationinenvironmenthealthandtransportpolicies.htmDate accessed: October 22, 2021
- Evaluating the handling of medical emergencies - Ambulance services and critical care. French National Authority for Health.https://www.has-sante.fr/upload/docs/application/pdf/2020-11/fiche_pedagogique_urgences_samu_smur.pdfDate accessed: October 22, 2021
- Fire and Rescue Service Statistics (2018 edition). Department for Civil Protection and Emergency Preparedness.https://mobile.interieur.gouv.fr/Publications/Statistiques/Securite-civile/2017Date accessed: August 20, 2021
- NHS ambulance services. National Audit Office.https://www.nao.org.uk/wp-content/uploads/2017/01/NHS-Ambulance-Services.pdfDate accessed: August 20, 2021
- NFPA fire experience survey. National Fire Protection Agency.https://www.nfpa.org/News-and-Research/Data-research-and-tools/Emergency-Responders/Fire-department-callsDate accessed: August 20, 2021
- Fire and Rescue Service Statistics: 2015-2018. Department for Civil Protection and Emergency Preparedness.https://mobile.interieur.gouv.fr/Publications/Statistiques/Securite-civileDate accessed: August 20, 2021
- Les Statistiques Des Services d’Incendie et de Secours (edition 2020). Direction Générale de la Sécurité Civile et de la gestion des Crises (DGSCGC).https://www.interieur.gouv.fr/fr/Publications/Statistiques/Securite-civile/2019Date accessed: August 20, 2021
- Statistical note: Ambulance quality indicators (AQI). National Health Services.https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2021/05/20210513-Stats-Note-AQI.pdfDate accessed: August 20, 2021
- Emergency medical services response times in rural, suburban, and urban areas.JAMA Surg. 2017; 152: 983-984
- Response time in the emergency services.Acta Cir Bras. 2018; 33: 1110-1121
- Operations research models for the deployment of emergency services vehicles.EMS Manag J. 2004; 1: 20-39
- Dynamic ambulance reallocation for the reduction of ambulance response times using system status management.Am J Emerg Med. 2015; 33: 159-166
- Response time as a sole performance indicator in EMS: pitfalls and solutions.Open Access Emerg Med. 2010; : 1-6
- The ambulance service: understanding the new standards. NHS Providers.https://nhsproviders.org/the-ambulance-service-understanding-the-new-standardsDate accessed: August 13, 2021
- Economic value of out-of-hospital emergency care: a structured literature review.Ann Emerg Med. 2006; 47: 515-524
- Association between ambulance response time and neurologic outcome in patients with cardiac arrest.Am J Emerg Med. 2019; 37: 1999-2003
- The effect of ambulance response time on survival following out-of-hospital cardiac arrest-an analysis from the German resuscitation registry.Dtsch Arztebl Int. 2018; 115: 541-548
- Effects of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological recovery in paediatric patients with out-of-hospital cardiac arrest based on the pre-hospital emergency medical service response time interval.Resuscitation. 2018; 130: 49-56
- Emergency medical system response time does not affect incidence of return of spontaneous circulation after prehospital resuscitation in one million central European agglomeration residents.Kardiol Pol. 2017; 75: 240-246
- Association of bystander cardiopulmonary resuscitation and survival according to ambulance response times after out-of-hospital cardiac arrest.Circulation. 2016; 134: 2095-2104
- Role of ambulance response times in the survival of patients with out-of-hospital cardiac arrest.Emerg Med J. 2011; 28: 703-706
- Survival from prehospital cardiac arrest is critically dependent upon response time.Resuscitation. 2006; 69: 229-234
- Using simulation to estimate the cost effectiveness of improving ambulance and thrombolysis response times after myocardial infarction.Emerg Med J. 2006; 23: 67-72
- The relationship between time to arrival of emergency medical services (EMS) and survival from out-of-hospital ventricular fibrillation cardiac arrest.Resuscitation. 2010; 81: 622-625
- Every minute counts: the impact of pre-hospital response time and scene time on mortality of penetrating trauma patients.Am J Surg. 2019; 220: 240-244
- The influence of prehospital time on trauma patients outcome: a systematic review.Injury. 2015; 46: 602-609
- Association between emergency medical service response time and motor vehicle crash mortality in the United States.JAMA Surg. 2019; 154: 286-293
- Emergency response time and pre-hospital trauma survival rate of the national ambulance service, Greater Accra (January-December 2014).BMC Emerg Med. 2018; 18: 33
- Influence of prehospital response times in the survival of trauma patients in Navarre.An Sist Sanit Navar. 2015; 38: 269-278
- Response time effectiveness: comparison of response time and survival in an urban emergency medical services system.Acad Emerg Med. 2002; 9: 288-295
- Lack of association between prehospital response times and patient outcomes.Prehosp Emerg Care. 2009; 13: 444-450
- Emergency medical services response time and mortality in an urban setting.Prehosp Emerg Care. 2012; 16: 142-151
- Does ambulance response time influence patient condition among patients with specific medical and trauma emergencies?.South Med J. 2013; 106: 230-235
- Eight minutes or less: does the ambulance response time guideline impact trauma patient outcome?.J Emerg Med. 2002; 23: 43-48
- Paramedic response time: does it affect patient survival?.Acad Emerg Med. 2005; 12: 594-600
- Do emergency medical system response times matter for health outcomes?.Health. 2008; 1131: 1127-1131
- Time is money, but how much? The monetary value of response time for Thai ambulance emergency services.Value Heal. 2014; 17: 555-560
- Measuring the capabilities of the Swedish fire service to save lives in residential fires.Fire Technol. 2019; 56: 583-603
- Smooth associations between the emergency medical services response time and the risk of death in road traffic crashes.J Transp Heal. 2019; 12: 379-391
- Commissariat Général à la stratégie et à la prospective.https://www.strategie.gouv.fr/sites/strategie.gouv.fr/files/atoms/files/cgsp_evaluation_socioeconomique_29072014.pdfDate accessed: August 20, 2021
- Emergency medical services intervals and survival in trauma: assessment of the “Golden Hour” in a North American prospective cohort.Ann Emerg Med. 2010; 55: 235-246.e4
- Redefining the golden hour for severe head injury in an urban setting: the effect of prehospital arrival times on patient outcomes.Injury. 2013; 44: 606-610
- Guide de l'Evaluation Socio-Economique des Investissements Publics - Tableau des compléments B: Valeurs tutélaires de référence pour valoriser les effets non-marchands.https://www.strategie.gouv.fr/sites/strategie.gouv.fr/files/atoms/files/20181214_complement_b_valeurs_tutelaires.xlsxDate: 2018Date accessed: October 27, 2021
Article Info
Publication History
Published online: November 01, 2021
Accepted:
September 15,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2021 ISPOR-The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc.
