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Rural-urban differences in emergency medical services bypass routing of stroke in North Carolina.

Rural-urban differences in emergency medical services bypass routing of stroke in North Carolina.

Authors :
Patel MD
Chari SV
Cui ER
Fernandez AR
Planey AM
Jauch EC
Winslow JE
Source :
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association [J Rural Health] 2025 Jan; Vol. 41 (1), pp. e12868. Date of Electronic Publication: 2024 Jul 25.
Publication Year :
2025

Abstract

Purpose: Acute stroke is a serious, time-sensitive condition requiring immediate medical attention. Emergency medical services (EMS) routing and direct transport of acute stroke patients to stroke centers improves timely access to care. This study aimed to describe EMS stroke routing and transports by rurality in North Carolina (NC).<br />Methods: We conducted a retrospective study using existing data on EMS transports of suspected stroke patients in NC in 2019. The primary study outcome was EMS bypass of the nearest hospital for transport to a nonnearest hospital, determined by geographic information systems (GIS) analysis. Incident addresses were geocoded to census tracts and classified as urban, suburban, or rural by Rural-Urban Commuting Area codes. We compared the frequency of bypass and estimated additional transport times by urban, suburban, and rural incident locations.<br />Findings: Of 3666 patients, 1884 (51%) EMS transports bypassed the nearest hospital. Bypass occurred less often for rural EMS incidents (39%) compared to those in urban (57%) and suburban (63%) tracts. The estimated additional transport time for rural bypasses of nonendovascular-capable stroke centers for endovascular-capable stroke centers was a median of 25 min (interquartile range 13-33).<br />Conclusions: Using GIS analysis, we found nearly half of EMS transports of suspected stroke patients in NC bypassed the nearest hospital, including noncertified hospitals and stroke centers. Bypasses occurred less often in rural areas, though incurred significantly longer transport times, compared to urban areas. These findings are important for regional stroke system planning, especially for improving rural access to acute stroke care.<br /> (© 2024 National Rural Health Association.)

Details

Language :
English
ISSN :
1748-0361
Volume :
41
Issue :
1
Database :
MEDLINE
Journal :
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
Publication Type :
Academic Journal
Accession number :
39054674
Full Text :
https://doi.org/10.1111/jrh.12868