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Prehospital critical care response time predictions were generated from service-supplied operational parameters and calibrated against observed data with rural-urban adjustment. High-risk neighbourhoods were defined by above-median OHCA incidence and below-median bystander CPR. Pre-EMS predicted survival was estimated using a published model. Deprivation was measured with Index of Multiple Deprivation. Weighted regression models with service-by-response time interaction terms examined each neighbourhood metric per 5-minute response time increase. A secondary analysis examined a HEMS-only configuration by removing the unique urban, NHS car asset in service B.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 52.9% of the resident population and 51.3% of OHCAs were within 15\u00a0min of a prehospital critical care response. In two services, increasing response time was associated with higher odds of a neighbourhood being high-risk and with greater deprivation. For pre-EMS predicted survival, poor alignment was found in one service, favourable alignment in another, and no significant association in the third. Service B showed favourable alignment across all three metrics. Removing the urban car asset (HEMS-only configuration) reversed this favourable pattern, producing gradients consistent with the other two services. Sensitivity analysis using observed response times and distances produced consistent but attenuated associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Prehospital critical care provision, particularly HEMS, is generally poorly aligned with neighbourhood OHCA risk, pre-EMS predicted survival, and deprivation. The only region demonstrating favourable cardiac arrest alignment was attributable to its urban NHS car asset. Expanding car-based prehospital critical care in deprived urban areas may warrant consideration as a strategy to reach more OHCA patients and improve equity of access.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13049-026-01655-9","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T04:25:22Z","timestamp":1784089522000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Geographical alignment of prehospital critical care services with population need for out-of-hospital cardiac arrest patients"],"prefix":"10.1186","volume":"34","author":[{"given":"Adam J.","family":"Boulton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Lang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Adam","family":"Whitley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Zorab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"de Paeztron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Leech","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paramjit","family":"Gill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin D.","family":"Perkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Porto","family":"de Albuquerque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry P.","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Yeung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"1655_CR1","doi-asserted-by":"publisher","first-page":"100803","DOI":"10.1016\/j.resplu.2024.100803","volume":"21","author":"AJ Boulton","year":"2025","unstructured":"Boulton AJ, Edwards R, Gadie A, Clayton D, Leech C, Smyth MA, et al. 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