{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:43:18Z","timestamp":1790253798495,"version":"4.1.0"},"reference-count":0,"publisher":"California Digital Library (CDL)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Western Journal of Emergency Medicine"],"abstract":"<p>Introduction: The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the \ufb01rst component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health system of Aotearoa-New Zealand (NZ), little is known about inequities in EMS-delivered care and transport pathways to hospital-level care. Methods: This population-level cohort study on out-of-hospital care, based on national EMS data, included trauma patients &amp;lt;85 years in age who were injured in a road traf\ufb01c crash (RTC). In this study we examined the combined relationship between ethnicity and geographical location of injury in EMS out-of-hospital care and transport pathways following RTCs in Aotearoa-NZ. Analyses were strati\ufb01ed by geographical location of injury (rural and urban) and combined ethnicity-geographical location (rural M\u0101ori, rural non-M\u0101ori, urban M\u0101ori, and urban non-M\u0101ori). Results: In a two-year period, there were 746 eligible patients; of these, 692 were transported to hospital. Indigenous M\u0101ori comprised 28% (196) of vehicle occupants attended by EMS, while 47% (324) of patients\u2019 injuries occurred in a rural location. The EMS transport pathways to hospital for rural patientswere slower to reach \ufb01rst hospital (total in slowest tertile of time 44% vs 7%, P \u2265 0.001) and longer to reach de\ufb01nitive care (direct transport, 77% vs 87%, P = 0.001) compared to urban patients. M\u0101ori patients injured in a rural location were comparatively less likely than rural non-M\u0101ori to be triaged to priority transport pathways (fastest dispatch triage, 92% vs 97%, respectively, P = 0.05); slower to reach \ufb01rst hospital (total in slowest tertile of time, 55% vs 41%, P = 0.02); and had less access to specialist trauma care (reached tertiary trauma hospital, 51% vs 73%, P = 0.02). Conclusion: Among RTC patients attended and transported by EMS in NZ, there was variability in out-of-hospital EMS transport pathways through to specialist trauma care, strongly patterned by location of incident and ethnicity. These \ufb01ndings, mirroring other health disparities for M\u0101ori, provide an equity-focused evidence base to guide clinical and policy decision makers to optimize the delivery of EMS care and reduce disparities associated with out-of-hospital EMS care.<\/p>","DOI":"10.5811\/westjem.18366","type":"journal-article","created":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T19:07:38Z","timestamp":1721070458000},"source":"Crossref","is-referenced-by-count":1,"title":["Rural and Ethnic Disparities in Out-of-hospital Care and Transport Pathways After Road Traffic Trauma in New Zealand"],"prefix":"10.5811","volume":"25","author":[{"given":"Rebbecca","family":"Lilley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Davie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridget","family":"Dicker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Papaarangi","family":"Reid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanthi","family":"Ameratunga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Branas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Civil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridget","family":"Kool","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"29705","published-online":{"date-parts":[[2024,6,4]]},"container-title":["Western Journal of Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T19:08:16Z","timestamp":1721070496000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/61t0c674"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,4]]},"references-count":0,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,7,9]]}},"URL":"https:\/\/doi.org\/10.5811\/westjem.18366","relation":{},"ISSN":["1936-9018"],"issn-type":[{"value":"1936-9018","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,4]]}}}