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Although geographic differences in prehospital time (PHT) are recognized, contemporary national estimates and their implications for resuscitation readiness are not well defined. This study aimed to characterize geographic variation in PHT among trauma patients at risk of hemorrhagic shock to inform strategies for earlier intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design and Methods<\/jats:title>\n                    <jats:p>We analyzed 2020\u20132023 data from the National Emergency Medical Services (EMS) Information System (NEMSIS) and included trauma patients aged \u226516\u2009years at risk of hemorrhagic shock, defined as shock index (heart rate\/systolic blood pressure) \u22651 at the scene. PHT was defined as the interval from dispatch to hospital arrival and compared across urbanicity (urban, suburban, rural, wilderness) and transport mode (ground or air).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 939,335 eligible encounters, the median prehospital time (PHT) differed significantly across urbanicity categories, increasing progressively from urban to wilderness regions (urban 39\u2009min [IQR 30\u201351], suburban 45 [32\u201363], rural 50 [34\u201371], wilderness 56 [37\u201378];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001). All three components of PHT\u2014system response, scene, and transport time\u2014were longer in rural and wilderness. Total PHTs remained stable, with only minor year\u2010to\u2010year variation. Air PHT was consistently longer than ground PHT (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001) and showed no temporal improvement across 2020\u20132023.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>National EMS data show persistently prolonged prehospital times for trauma patients at risk of hemorrhagic shock, especially in rural and wilderness areas. Bringing transfusion capability closer to patients through prehospital blood programs may be critical to reducing time\u2010dependent mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/trf.70086","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T13:17:21Z","timestamp":1769174241000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Unequal access to timely care: Geographic variation in prehospital time among injured patients at risk of hemorrhagic shock"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1731-3196","authenticated-orcid":false,"given":"Pawan","family":"Acharya","sequence":"first","affiliation":[{"name":"Division of Trauma and Acute Care Surgery, Department of Surgery University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"Center for Injury Science University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5614-183X","authenticated-orcid":false,"given":"Timothy","family":"Hurson","sequence":"additional","affiliation":[{"name":"Division of Trauma and Acute Care Surgery, Department of Surgery University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"Center for Injury Science University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandler","family":"Annesi","sequence":"additional","affiliation":[{"name":"Division of Trauma and Acute Care Surgery, Department of Surgery University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"Center for Injury Science University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7426-8200","authenticated-orcid":false,"given":"Christine","family":"Carico","sequence":"additional","affiliation":[{"name":"Division of Trauma and Acute Care Surgery, Department of Surgery University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"Center for Injury Science University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"School of Medicine University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9489-3633","authenticated-orcid":false,"given":"Daniel","family":"Lammers","sequence":"additional","affiliation":[{"name":"Division of Trauma and Acute Care Surgery, Department of Surgery University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"Center for Injury Science University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"Department of Surgery University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. 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