Emergency Medical Services (EMS) and the California EMS Information System (CEMSIS) Working Paper

This study examines data from the California EMS Information System (CEMSIS) to identify factors that influence prehospital time for EMS events related to motor vehicle collisions (MVCs). While only 19 percent of the United States population resides in rural areas, over half of all traffic fatalities involve rural motor vehicle collisions. Rural and urban MVCs result in similar injury severities, however relative inaccessibility of trauma centers and prehospital EMS time (activation, response, and transport time) likely contribute to the generally higher mortality rate in rural areas. For the present study, 24 CEMSIS data variables were requested, many of which involved missing data, which severely restricted the potential analysis of the impact of EMS response times. However, the findings did show that average overall EMS time (including response, scene and transport time) were approximately twice as long for collisions in rural zip codes compared with urban zip codes. Several limitations influence the interpretation of these results. Data on prehospital EMS times is missing for much of the state—even for zip codes with records of EMS events, data is likely incomplete. In addition, zip code level location data is insufficient for adequate study of the effects of the built environment and road network on prehospital time. Furthermore, according to the National EMS Information System (NEMSIS) User Manual, the national dataset suffers from selection and information bias, which are likely also present in the CEMSIS data. Although the present study cannot analyze the effect of longer prehospital times on patient outcome, other research has found that longer prehospital times may negatively impact patient health. Recommendations for reducing time from injury to appropriate medical care in rural areas include improving cell phone coverage, compliance of rural 911 center with FCC wireless, use of GPS technology, and integration of automatic vehicle location and computer aided navigation technologies into all computer-aided dispatch systems. In addition, CEMSIS should improve the coverage of their dataset and ensure that all EMS activities are recorded. To expand the type of analyses that can be conducted using CEMSIS data, EMS records must include fields that allow them to be linked to hospital and police datasets. When such data becomes available, research must be conducted to determine whether prehospital time is significantly related to patient outcome following motor vehicle collisions.