Geographical Distribution of Emergency Services Times in Traffic Accidents in Extremadura

Objective: To analyze the response time and transport time taken by the emergency medical services (EMS), considering their urban or rural location, to attend traffic accident casualties that occurred in the different geographical areas of Extremadura (Spain) from 2012 to 2015. Methods: This was a cross-sectional study of the data recorded by the Emergency Response Coordination Center 112 (ERCC-112) from traffic accidents attended by EMS. Response time was defined as the time elapsed from the request-for-care receipt until arrival of the EMS at the accident scene, and transport time as that from leaving the scene until arrival to the referral hospital. Rural EMS were those based in locations where there is no hospital, and urban EMS those located in towns or cities with a hospital. Results: During the 4-year period studied, 5,572 traffic accidents requested assistance through the ERCC-112. From the 2,875 accidents (51.9%) in which EMS were mobilized, 55.4% occurred in urban roads and the remaining in interurban ones. A total of 113 people (mean age 48.4 ± 19.0 years, range 15–84 years) died at the accident scene or before arrival to the hospital, 88.5% of them in interurban accidents. The average response time of urban and rural EMS was 10.7 ± 7.3 and 18.0 ± 12.6 min (p < 0.001), respectively, and the average transport time was 13.2 ± 11.7 and 45.2 ± 25.0 min (p = 0.009). Response time was longer than the 30-min optimum only in the most peripheral areas of Extremadura, while transport time exceeded the optimum of 90 min in the eastern regions of two health areas (Cáceres and Don Benito-Villanueva). 19.1% of the victims attended by rural EMS were classified as having a serious prognosis or as having died, as compared with 11.2% (p = 0.048) of those attended by urban EMS. Conclusions: The geographical location of EMS in Extremadura (Spain) guarantees adequate response times in traffic accidents, both in rural and urban areas. However, recommended transport times were occasionally exceeded in the most peripheral areas, due to hospital location.