The 130th Annual Meeting of APHA

Abstract #49253

Tracy Young, MS¹, James Torner, MS, PhD¹, Kristen C. Sihler, MD², Alfred R. Hansen, MD, PhD³, Corinne Peek-Asa, PhD¹, and Craig Zwerling, MD, PhD, MPH¹. (1) Injury Prevention Research Center, University of Iowa, 100 Oakdale Campus, #124 IREH, Iowa City, IA 52242, (319)335-4222, tracy-young@uiowa.edu, (2) Departments of Epidemiology and Surgery, University of Iowa, 1900 Steindler Building, Iowa City, IA 52242, (3) Department of Emergency Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242

Purpose: This study identifies factors associated with mode of transport to rural hospitals.

Methods: We evaluated 11,541 emergency department (ED) injury visits that arrived by ground ambulance or private vehicle to one of six northwest Iowa rural hospitals. We performed univariate analyses and logistic regression analyses to identify factors associated with mode of transport for each severity level (major/fatal and minor).

Results: For major/fatal injuries, we found that those aged 65 and over were 3.6 (95% CI=2.7 – 4.9) times more likely to use ambulances than those less than 15. Motor vehicle/traffic injuries and hip fractures were also associated with ambulance usage, while arm fractures and farm-related injuries were not.

Conclusions: We conclude that for major/fatal injuries, older persons, those injured from high velocity causes, and those with hip fractures are more likely to use an ambulance. EMS may improve the community’s decision-making scheme by providing public education (e.g., proper use of 911 and injury severity recognition), and by collaborating with dispatch, the local community, and health care providers. Further study of the decision-making factors determining mode of transportation is needed.

Learning Objectives:

• 1. Recognize some of the challenges traumatic injury poses in the rural setting.
• 2. Identify factors associated with mode of transport to rural hospitals for both major and minor trauma.
• 3. Recognize the need for further research with comprehensive databases in rural settings to better understand the decision-making process used for determining prehospital mode of transportation.
• 4. Recognize that further research with larger databases will aid in monitoring the proportion of severely injured patients transported by private vehicle and in determining intervention strategies to reduce the proportion of EMS under-utilization.
• 5. Recognize the role local Emergency Medical Services (EMS) can play in improving the community’s decision-making scheme by providing public education, and by collaborating with dispatch, the local community, and health care providers.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.