Miller et al.: Effect of Rural Hospital Closures on EMS Response Time

In The Effect of Rural Hospital Closures on Emergency Medical Service Response and Transport Times, authors Katherine E. M. Miller (Health Policy and Management, University of North Carolina), Hailey J. James (Population Health Sciences, Duke University), George Mark Holmes (Health Services Research, Duke University), and Courtney H. Van Houtven (Health Policy, Duke University) examine the effect of rural hospital closures on emergency medical service (EMS) response time, transport time, and total activation time. From 2013 to 2017, rural hospital closures doubled from the previous five years. Because EMS response times in rural areas already doubled that of urban areas, the authors asked whether this increase in rural hospital closure would deepen impact on patients receiving care from rural EMS crews.

To determine the impact hospital closures had on rural areas, the authors compared rural areas experiencing closures and rural areas without closures. After matching study areas for comparison, the authors looked at three different time measures: response time, transport time, and total activation time (all defined in the study). The authors retrieved the data from the National Emergency Medical Services Information System (NEMSIS) database, where states voluntarily send data on their EMS response times. The study evaluated the period two years before the hospital closure to two years after the hospital had closed.

The study found that, overall, there was no change in the response times of the EMS crews in closure areas when compared to non-closure areas, but transport times increased by 2.6 minutes in rural areas that had hospital closures and total activation time in these areas increased by 7.2 minutes. These findings, however, are subject to caveats: First, the 2.6-minute increase in transport time was not statistically significant and, therefore, cannot be said to be certainly caused by rural hospital closure. Second, the NEMSIS database is a convenience sample, meaning the data is voluntarily given. While it is not likely that the data was incorrect or misrepresented, there is a possibility the data are incomplete. Third, the sample usable in NEMSIS was only for 21 states of the 50, so there may be unrepresented geographic differences.

Nonetheless, the authors reiterate the importance of this study by referencing prior research conducted by E.T. Wilde (Health Policy and Management, Columbia University). Wilde’s work determined that a one-minute increase in response time resulted in a mortality increase from 8 percent to 17 percent. This statistic is based only data from Utah, and a more universally applicable increase in mortality rate in all areas with rural hospital closures is unknown. Yet, some places such as Utah have experienced a near 10 percent increase.

Ultimately, more research is needed to know the closures’ true effect on EMS response and transport times. The authors specifically call for further research into mortality rates and the impact of specific patient complaints on response times.