THE USE OF GEOGRAPHIC INFORMATION SYSTEMS AND SPATIAL ANALYSIS IN DESCRIBING PATTERNS OF PREHOSPITAL RESPONSE TO HIGH-ACUITY TRAUMA IN HOWARD COUNTY, MARYLAND
Embargo until
2024-12-01
Date
2021-08-24
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Johns Hopkins University
Abstract
Background: For many patients, prehospital care is the first contact with the healthcare system in a medical emergency. When traumatic injuries are involved, timely response is particularly important as increased time to definitive care is associated with worsened health outcomes. This dissertation focuses on the prehospital response to high-acuity trauma patients in Howard County, Maryland, and describes the spatial distribution of the ambulance calls with a particular examination of the timeliness of response and socioeconomic factors of the location of the traumas.
Methods: Data was obtained in collaboration with the Howard County Department of Fire and Rescue Services and encompassed all ambulance calls to high-acuity trauma cases from May 2013 – May 2020. For spatial information on census tracts and data on socioeconomic indicators, information was obtained from the United States Census Bureau. Calls were categorized into “delayed” or “non-delayed” responses based on national published guidelines, and the location of the calls were geocoded. We performed spatial analyses to explore the spatial distribution of both delayed and non-delayed calls and to identify any statistically significant clustering. Calls were also cross tabulated with socioeconomic data on census tracts to identify any association between delayed prehospital responses and the general household income of a tract.
Results: The overwhelming majority of responses to high-acuity traumas in Howard County were delayed during the time period. More traumas occurred in the eastern, more urbanized area of the county. There was clustering of all high-acuity traumas, whether they were delayed or non-delayed. The eastern part of the county also had more census tracts with lower socioeconomic indicators, although the county as a whole is relatively affluent compared to the rest of the United States. There was not a higher proportion of delayed calls in lower income tracts compared to higher income tracts.
Conclusions: Trauma calls in a high-income county tended to have delayed responses and spatially cluster together. Delayed calls did not occur more commonly in lower income areas in Howard County than in higher income areas. The dissertation also used spatial analytical techniques that have not been previously employed in prehospital care research.
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Keywords
GIS, spatial analysis, prehospital care, emergency medical services, healthcare disparities,