scholarly journals Geographical and population disparities in timely access to prehospital and advanced level emergency care in New Zealand: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e026026 ◽  
Author(s):  
Rebbecca Lilley ◽  
Brandon de Graaf ◽  
Bridget Kool ◽  
Gabrielle Davie ◽  
Papaarangi Reid ◽  
...  
Keyword(s):  
New Zealand ◽  
Population Density ◽  
Hospital Care ◽  
Advanced Level ◽  
Zealand Population ◽  
Rapid Access ◽  
Emergency Medical ◽  
Geographical Access ◽  
Timely Access ◽  
Level Hospital

ObjectiveRapid access to advanced emergency medical and trauma care has been shown to significantly reduce mortality and disability. This study aims to systematically examine geographical access to prehospital care provided by emergency medical services (EMS) and advanced-level hospital care, for the smallest geographical units used in New Zealand and explores national disparities in geographical access to these services.DesignObservational study involving geospatial analysis estimating population access to EMS and advanced-level hospital care.SettingPopulation access to advanced-level hospital care via road and air EMS across New Zealand.ParticipantsNew Zealand population usually resident within geographical census meshblocks.Primary and secondary outcome measuresThe proportion of the resident population with calculated EMS access to advanced-level hospital care within 60 min was examined by age, sex, ethnicity, level of deprivation and population density to identify disparities in geographical access.ResultsAn estimated 16% of the New Zealand population does not have timely EMS access to advanced-level hospital care via road or air. The 700 000 New Zealanders without timely access lived mostly in areas of low-moderate population density. Indigenous Māori, New Zealand European and older New Zealanders were less likely to have timely access.ConclusionsThese findings suggest that in New Zealand, geographically marginalised groups which tend to be rural and remote communities with disproportionately more indigenous Māori and older adults have poorer EMS access to advanced-level hospitals. Addressing these inequities in rapid access to medical care may lead to improvements in survival that have been documented for people who experience medical or surgical emergencies.

Preventable injury deaths: identifying opportunities to improve timeliness and reach of emergency healthcare services in New Zealand

2017 ◽  
Vol 24 (5) ◽  
pp. 384-389 ◽  
Author(s):  
Rebbecca Lilley ◽  
Bridget Kool ◽  
Gabrielle Davie ◽  
Brandon de Graaf ◽  
Shanthi N Ameratunga ◽  
...  
Keyword(s):  
New Zealand ◽  
Hospital Care ◽  
Healthcare Services ◽  
Care Providers ◽  
Cross Sectional ◽  
Advanced Level ◽  
Fatal Injury ◽  
Timely Access ◽  
Serious Injury ◽  
Level Hospital

BackgroundTraumatic injury is a leading cause of premature death and health loss in New Zealand. Outcomes following injury are very time sensitive, and timely access of critically injured patients to advanced hospital trauma care services can improve injury survival.ObjectiveThis cross-sectional study will investigate the epidemiology and geographic location of prehospital fatal injury deaths in relation to access to prehospital emergency services for the first time in New Zealand.Design and study populationElectronic Coronial case files for the period 2008–2012 will be reviewed to identify cases of prehospital fatal injury across New Zealand.MethodsThe project will combine epidemiological and geospatial methods in three research phases: (1) identification, enumeration, description and geocoding of prehospital injury deaths using existing electronic injury data sets; (2) geocoding of advanced hospital-level care providers and emergency land and air ambulance services to determine the current theoretical service coverage in a specified time period and (3) synthesising of information from phases I and II using geospatial methods to determine the number of prehospital injury deaths located in areas without timely access to advanced-level hospital care.DiscussionThe findings of this research will identify opportunities to optimise access to advanced-level hospital care in New Zealand to increase the chances of survival from serious injury. The resulting epidemiological and geospatial analyses will represent an advancement of knowledge for injury prevention and health service quality improvement towards better patient outcomes following serious injury in New Zealand and similar countries.

Potential survivability of prehospital injury deaths in New Zealand: a cross-sectional study

2020 ◽  
pp. injuryprev-2019-043408
Author(s):  
Bridget Kool ◽  
Rebbecca Lilley ◽  
Gabrielle Davie ◽  
Brandon de Graaf ◽  
Pararangi Reid ◽  
...  
Keyword(s):  
New Zealand ◽  
Hospital Care ◽  
Cross Sectional Study ◽  
Insufficient Information ◽  
Injury Death ◽  
Cross Sectional ◽  
Advanced Level ◽  
Physical Injuries ◽  
Level Hospital ◽  
Do So

IntroductionAcknowledging a notable gap in available evidence, this study aimed to assess the survivability of prehospital injury deaths in New Zealand.MethodsA cross-sectional review of prehospital injury death postmortems (PM) undertaken during 2009–2012. Deaths without physical injuries (eg, drownings, suffocations, poisonings), where there was an incomplete body, or insufficient information in the PM, were excluded. Documented injuries were scored using the AIS and an ISS derived. Cases were classified as survivable (ISS <25), potentially survivable (ISS 25–49) and non-survivable (ISS >49).ResultsOf the 1796 cases able to be ISS scored, 11% (n=193) had injuries classified as survivable, 28% (n=501) potentially survivable and 61% (n=1102) non-survivable. There were significant differences in survivability by age (p=0.017) and intent (p<0.0001). No difference in survivability was observed by sex, ethnicity, day of week, seasonality or distance to advanced-level hospital care. ‘Non-survivable’ injuries occurred more commonly among those with multiple injuries, transport-related injuries and aged 15–29 year. The majority of ‘survivable’ cases were deceased when found. Among those alive when found, around half had received either emergency medical services (EMS) or bystander care. One in five survivable cases were classified as having delays in receiving care.DiscussionIn New Zealand, the majority of injured people who die before reaching hospital do so from non-survivable injuries. More than one third have either survivable or potentially survivable injuries, suggesting an increased need for appropriate bystander first aid, timeliness of EMS care and access to advanced-level hospital care.

Access to advanced-level hospital care: differences in prehospital times calculated using incident locations compared with patients’ usual residence

2021 ◽  
pp. injuryprev-2021-044351
Author(s):  
Gabrielle Davie ◽  
Rebbecca Lilley ◽  
Brandon de Graaf ◽  
Bridget Dicker ◽  
Charles Branas ◽  
...  
Keyword(s):  
Hospital Care ◽  
Injury Incidence ◽  
Industrial Construction ◽  
Advanced Level ◽  
Home Location ◽  
Home Address ◽  
Usual Residence ◽  
Timely Access ◽  
The Usa ◽  
Level Hospital

Studies estimate that 84% of the USA and New Zealand’s (NZ) resident populations have timely access (within 60 min) to advanced-level hospital care. Our aim was to assess whether usual residence (ie, home address) is a suitable proxy for location of injury incidence. In this observational study, injury fatalities registered in NZ’s Mortality Collection during 2008–2012 were linked to Coronial files. Estimated access times via emergency medical services were calculated using locations of incident and home. Using incident locations, 73% (n=4445/6104) had timely access to care compared with 77% when using home location. Access calculations using patients’ home locations overestimated timely access, especially for those injured in industrial/construction areas (18%; 95% CI 6% to 29%) and from drowning (14%; 95% CI 7% to 22%). When considering timely access to definitive care, using the location of the injury as the origin provides important information for health system planning.

scholarly journals Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e043791
Author(s):  
Jan Bauer ◽  
Dieter Moormann ◽  
Reinhard Strametz ◽  
David A Groneberg
Keyword(s):  
Cost Effectiveness ◽  
Emergency Medical Services ◽  
Rural Areas ◽  
Medical Services ◽  
Secondary Outcome ◽  
Annual Average ◽  
Emergency Medical ◽  
Life Years ◽  
Timely Access ◽  
The Cost

ObjectivesThis study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response times of emergency medical services (EMS) early lay defibrillation could lead to a significant higher survival in OHCA.Participants3296 emergency medical stations in Germany.SettingRural areas in Germany.Primary and secondary outcome measuresThree UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS (ie, time-to-defibrillation: >10 min) were developed using a location allocation analysis. For each UAV network, primary outcome was the cost-effectiveness using the incremental cost-effectiveness ratio (ICER) calculated by the ratio of financial costs to additional life years gained compared with current EMS.ResultsCurrent EMS with 3926 emergency stations was able to gain 1224 life years on annual average in the study area. The UAV network providing 100% coverage consisted of 1933 UAV with average annual costs of €43.5 million and 1845 additional life years gained on annual average (ICER: €23 568). The UAV network providing 90% coverage consisted of 1074 UAV with average annual costs of €24.2 million and 1661 additional life years gained on annual average (ICER: €14 548). The UAV network providing 80% coverage consisted of 798 UAV with average annual costs of €18.0 million and 1477 additional life years gained on annual average (ICER: €12 158).ConclusionThese results reveal the relevant life-saving potential of all modelled UAV networks. Furthermore, all analysed UAV networks could be deemed cost-effective. However, real-life applications are needed to validate the findings.

Senecio lautus complex in Australia. I. Taxonomic considerations and discussion of some of the related taxa from New Zealand

1964 ◽  
Vol 12 (2) ◽  
pp. 282 ◽  
Author(s):  
SI Ali
Keyword(s):  
New Zealand ◽  
Zealand Population ◽  
The Status ◽  
First Time

Reasons for the retention of the name Senecio lautus Forst. f. ex Willd. for both New Zealand and Australian forms are advanced. It is concluded that the New Zealand population should be given the status of a subspecies. Synonymy of S. lautus subsp. lautus and typification of various names involved are discussed. S. glaucophyllus subsp. discoideus (T. Kirk) Ornd. is reported for the first time from Tasmania.

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