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Ambulance response times are significantly longer in low-income areas

A new study from the University of California San Francisco (UCSF) has revealed that ambulance response times are not as fast for low-income people. Based on more than 63,000 cases of cardiac arrest, the researchers found that ambulances took an average of four minutes longer to respond to calls from low-income areas compared to high-income communities.

Study lead author Dr. Renee Y. Hsia is a professor of Emergency Medicine at UCSF and an emergency physician at Zuckerberg San Francisco General Hospital and Trauma Center.

“When it comes to a cardiac arrest, every minute counts,” said Dr. Hsia. “We found that emergency medical services response times were 10 percent longer in the poorest neighborhoods.”

“That stacks the odds against survival for low-income patients. As a society, we might hope that public services, such as ambulances, would be equally accessible, but our results show that this is not the case, even for deadly conditions like cardiac arrest.”

While unequal access to medical care has been established as one of the biggest contributors to the health care disparities found in poorer communities, hospital and ER shutdowns across the country and the closures of privately-owned ambulance companies are making the issue even worse.

“The repercussions of the loss of these services may be particularly detrimental in low-income communities, which rely more heavily on prehospital care and have a higher increased incidence of severe, life-threatening illnesses,” wrote the study authors.

The investigation was focused on cardiac arrest cases from the 2014 National Emergency Medical Services Information Systems, which included data from 46 states. The team examined the length of time from ambulance dispatch to arrival at the patient’s location, from arrival to departure from the scene, from departure at the scene to arrival at the hospital, and also the total emergency medical services time.

Overall, the experts analyzed 63,600 cardiac arrest cases, which involved patients who had an average age of 60. The authors reported that high-income areas had a greater proportion of white, male patients with private insurance, while low-income areas had a greater proportion of Medicaid-insured patients.

The study revealed that the average emergency response time was 43 minutes in the lowest income zip code, compared to 37.5 minutes in the highest income zip code. The analysis also showed that EMS responses were more likely to meet the 8-minute and 15-minute national benchmarks in high-income communities.

Even after the team controlled for differences such as the time of day, the average emergency response times were 10 percent longer in low-income communities.

“Each minute of delay increases the odds that a patient will not survive a heart attack,” said Dr. Hsia. “Our findings are particularly concerning given the time-sensitivity of conditions like cardiac arrest, in which the heart has ceased functioning and immediate medical care is required to restore function and circulation.”

“Our findings show that health care disparities exist at the system-level, including ambulance transport times. As hospital closures and the cost of health care continue to rise, we must examine how to ensure access to care for our most vulnerable.”

The study is published in the journal JAMA Network Open.

By Chrissy Sexton, Staff Writer

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