Location, Location, Location

At Navigator last week, I had the opportunity to attend two fascinating meetings about dispatch research. One was the research council meeting, where we discussed the ongoing research projects being done by the Academies, the creation of the Annals, and future directions for research. The other was a meeting of several researchers working, in various ways, on the question of how to apply spatial or geographical data to dispatch studies. This work is so varied and interesting that I thought I would share it with all of you.

The first issue discussed was a topic of special interest to Linda Edelman, Ph.D., a professor of nursing at the University of Utah. Her work focuses on the elderly, especially on how elderly patients are assessed for traumatic injuries and why they tend to be under-triaged. Recently, she has been working to understand the differences in treatment options, time-to-treatment, and treatment choices between urban and rural seniors with traumatic injuries.

She’s found that elderly rural patients, in addition to being at higher risk for traumatic injury and farther from a Trauma 1 or Trauma 2 hospital, also often choose to stay near their homes. Difficulties getting transportation for their families to visit them in a far-away urban hospital, a desire to keep seeing their own doctors, and the unfamiliarity of travel often contribute to this desire.

Meanwhile, Phoebe McNeally, Ph.D., who was unfortunately unable to attend the meeting, has been working with the Academy to add a spatial element to our research studies. For example, she has been plotting addresses from a recent diabetes study to identify where the majority of cases occur and where the worst cases occur. This could help more appropriately allocate resources—both emergency resources and educational and clinical resources.

Eventually, it could be possible to create interactive maps of all kinds of emergencies, allowing researchers to look at where, for example, strokes are occurring, or what areas have the worst outcomes for cardiac arrest. Weather researchers have been tracking storms, and public health workers tracking epidemics, for years; why should we not map the need for our services and the outcomes we’re getting?

Storms are mapped; why not other kinds of emergencies?

Storms are mapped; why not other kinds of emergencies?

That is precisely what Comilla Sasson, MD, has been doing. She has used what are called census tracts—the smallest areas for which population data are generally known—to look at outcomes and access to service in much more detail compared to research about whole counties, cities, states, or regions. She has looked particularly at cardiac arrest outcomes by socioeconomic status, finding that in at least one major metropolitan area, those from lower socioeconomic-status areas tend to have significantly worse overall access to emergency services and outcomes from cardiac arrest.

Interestingly, these are issues apply not only to major metropolitan areas in the U.S. and Europe, but also to areas in which emergency services are just developing. The issues raised at this meeting—urban-rural differences, problems with access to care, discrepancies in outcomes by location or socioeconomic status, and the necessity of pinpointing and mapping where certain events and outcomes are occurring—are certainly going to continue to be key issues in dispatch research in the near future.

What about your center or your research? How do you use spatial or geographic data to learn more about your system or improve your services? What kind of location-based improvements or research projects would you do if you had the time and resources? Join the conversation by commenting below!

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One Response to Location, Location, Location

  1. Dr Chris Olola says:

    The dispatch research enthusiasm witnessed at the just concluded Navigator conference in Salt Lake City, Utah, USA, was just overwhelming — to state the least! I have never been reinvigorated more!

    Each year, it is cogently evident how much dispatch research has matured and continues to evolve. Dispatch research continues to propel imminent divorce from the approach of expert-based experience to evidence-based dispatch practice. At least all of the research meeting attendees unanimously agreed that proposals for change (aka PFCs) should and must continue to be evidence-based. This way, outcomes from various constituted committees, charged with the responsibility of reviewing, and approving the PFCs, would easily translated into dispatch practice.

    The deliberations also dwelt on the major obstacles facing dispatch research. Sticking out was the impediments towards easy access to hospital outcome data. Even where hospital data is available and accessible, linking dispatch/EMS and hospital databases remains a mammoth task — never trivial by all means! Apparently, there is no master patient/caller index (ID) to easily link the two data sources — information is in silos. There is an imperative need to bring hospital healthcare providers and dispatch/EMS family to a discussion table to (1) review how best continuity of care can be enhanced by implementing appropriate linkage data elements (caller/patient identifiers) between their data sources, and to support research as well, and (2) advocate for the promotion of collaborative research between dispatch and hospitals. This approach would add an unparalleled dimension to dispatch research — and enhanced continuity of care at the ED/hospitals.

    Dispatch research has a bright future — especially in a collaborative model. Dispatch research capacity building (in terms of e.g., skilled staff, funding stec) should be embraced and given adequate attention.

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