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Longer ambulance journeys to hospital can reduce a patient's chance of survival, a British study has shown.
Researchers looked at 10315 cases in four English ambulance services where patients with potentially life threatening conditions other than cardiac arrest were transported to hospital. The trusts covered were Royal Berkshire, Derbyshire, Essex, and West Midlands.
The results, published in the Emergency Medicine Journal, were adjusted for age, sex, clinical category, and seriousness of condition (2007;24:665-8 doi: 10.1136/emj.2007.047654). The ambulance journeys varied in straight line distance between 0 and 58 km, with a median of 5 km.
In all, 644 patients died, either before reaching hospital or after arriving. Chances of survival before discharge fell as the distance increased. Between 0 and 10 km patients had a 94.2% survival rate; between 11 and 20 km it was 92.3%; but at 21 km or more it was 91.2%.
“Our data suggest that each additional kilometre is associated with a 2% relative increase in mortality,” say the authors, from the University of Sheffield. “This equates to an approximate 1% absolute increase in mortality associated with each 10 km increased in straight line distance.”
The results also showed a sharp increase in mortality in patients with respiratory problems, but less change was seen in patients with chest pain.
The authors warn that their statistics did not apply to patients who did not have potentially life threatening conditions, and that the figures refer to cases between 1997 and 2001.
“Changes in performance in recent years or new policies that have changed to both increase distances and either improve care at the more distant facilities or improve the effectiveness of prehospital care could attenuate the potential effect of increased journey distance upon mortality,” they say.
The authors accept that patients who need specialist care for burns or head injuries will benefit from additional journey time if it means that they are taken to a more appropriate hospital. But for patients with conditions that could be cared for in any hospital, such as after an asthma attack or a drowning incident, longer journey times could affect the chances of survival.
Any changes in the local configuration of services that affect journey times for ambulances may lead to an increased risk of death for a small number of patients with life threatening emergencies, the authors conclude.