Spatiotemporal access to emergency medical services in Wuhan, China: accounting for scene and transport time intervals

Optimal allocation of physicians improves accessibility and workload disparities in stroke care

BACKGROUND

Inequalities in access to stroke care and the workload of physicians have been a challenge in recent times. This may be resolved by allocating physicians suitable for the expected demand. Therefore, this study analyzes whether reallocation using an optimization model reduces disparities in spatial access to healthcare and excessive workload.

METHODS

This study targeted neuroendovascular specialists and primary stroke centers in Japan and employed an optimization model for reallocating neuroendovascular specialists to reduce the disparity in spatial accessibility to stroke treatment and workload for neuroendovascular specialists in Japan. A two-step floating catchment area method and an inverted two-step floating catchment area method were used to estimate the spatial accessibility and workload of neuroendovascular specialists as a potential crowdedness index. Quadratic programming has been proposed for the reallocation of neuroendovascular specialists.

RESULTS

The reallocation of neuroendovascular specialists reduced the disparity in spatial accessibility and the potential crowdedness index. The standard deviation (SD) of the demand-weighted spatial accessibility index improved from 125.625 to 97.625. Simultaneously, the weighted median spatial accessibility index increased from 2.811 to 3.929. Additionally, the SD of the potential crowdedness index for estimating workload disparity decreased from 10,040.36 to 5934.275 after optimization. The sensitivity analysis also showed a similar trend of reducing disparities.

CONCLUSIONS

The reallocation of neuroendovascular specialists reduced regional disparities in spatial accessibility to healthcare, potential crowdedness index, and disparities between facilities. Our findings contribute to planning health policies to realize equity throughout the healthcare system.

Changes in the epidemiological characteristics of prehospital emergency services before and during the COVID-19 pandemic, Chengdu, 2016-2021

The coronavirus disease 2019 (COVID-19) brought a healthy crisis all around the world. It's not only affected healthcare utilization, but also some disease's incidence. We collected pre-hospital emergency data in Chengdu from January 2016 to December 2021, and studied the demand for emergency medical services (EMSs), emergency response times (ERTs), and the disease spectrum in the city proper of Chengdu as a whole. A total of 1,122,294 prehospital emergency medical service (EMS) instances met the inclusion criteria. Under the influence of COVID-19, notably in 2020, the epidemiological characteristics of prehospital emergency services in Chengdu were considerably altered. However, as the pandemic was brought under control, they returned to normal or even earlier in 2021.The COVID-19 pandemic had an effect on people's medical care-seeking behavior and the performance of prehospital emergency services. Although the indicators associated with prehospital emergency services eventually recovered as the epidemic was brought under control, they remained marginally different from before the outbreak.

Spatial Accessibility Evaluation and Location Optimization of Primary Healthcare in China: A Case Study of Shenzhen

The unbalanced allocation of healthcare resources is a major challenge that hinders access to healthcare. Taking Shenzhen as an example, this study aimed to enhance equity in obtaining healthcare services, through measuring and visualizing the spatial accessibility of community healthcare centers (CHC), and optimizing CHC geospatial allocation. We used the number of health technicians per 10,000 to represent the CHC's service capacity, combined with resident points and census data to calculate the population the CHC needs to carry, and then analyzed the accessibility based on the Gaussian two-step floating catchment area method. In 2020, five regions in Shenzhen had better spatial accessibility scores: Nanshan (0.250), Luohu (0.246), Futian (0.244), Dapeng (0.226), and Yantian (0.196). The spatial accessibility of CHCs shows a gradual decrease from the city center to the edge, which is affected by economic and topographic factors. With the support of the maximal covering location problem model, we selected up to 567 candidate locations for the new CHC, which could improve Shenzhen's accessibility score from 0.189 to 0.361 and increase the coverage population by 63.46% within a 15-min impedance. By introducing spatial techniques and maps, this study provides (a) new evidence for promoting equitable access to primary healthcare services in Shenzhen and (b) a foundation for improving the accessibility of public service facilities in other areas.

Are the epidemic prevention facilities effective? How cities should choose epidemic prevention facilities: Taking Wuhan as an example

The COVID-19 pandemic highlighted the limitations of urban public health emergency response capabilities. Taking Wuhan as an example, this study used breakpoint regression, kernel density analysis, overlay analysis, and accessibility analysis from Stata and ArcGIS, and divided epidemic prevention facilities into the basic epidemic prevention facilities (hospitals), and the emergency epidemic prevention facilities (mobile cabin hospitals) for further analysis. The results showed that over 70% of the basic epidemic prevention facilities in Wuhan were located in high density population areas. On the contrary, most of the emergency epidemic prevention facilities were located in low density population areas. The local treatment effect of the implementation of the emergency epidemic prevention facility policy is about 1, indicating that there was a significant impact of emergency epidemic prevention facilities on outbreak control, which passed the bandwidth test. What’s more, the analysis of the accessibility of residential points revealed that more than 67.3% of people from the residential points could arrive at the epidemic prevention facilities within 15 min, and only 0.1% of them took more than 20 min to arrive. Therefore, the epidemic prevention facilities can effectively curb the spread of the epidemic, and people from residential areas can quickly get there. This study summarized the spatial characteristics of epidemic prevention facilities in Wuhan and analyzed the importance of them, thus providing a new perspective for future research on upgrading the city’s comprehensive disaster prevention system.

Spatial accessibility of emergency medical services in Chongqing, Southwest China

Background

Timely access to emergency medical services (EMS) can significantly reduce mortality. In China, the evidence of the accessibility of complete EMS which considers two related trips and involves large rural areas is insufficient. This study aimed to explore the accessibility of ambulance services and complete EMS in Chongqing and its regional differences, and to provide a reference for improving spatial accessibility of EMS in Chongqing and optimizing allocation of EMS resources.

Methods

The nearest neighbor method was used to measure spatial accessibility of ambulance services and complete EMS. Spatial aggregation patterns and influencing factors of spatial accessibility of complete EMS were analyzed using Moran's I index, Pearson correlation and multiple linear regression.

Results

The medians of shortest travel time for ambulance, monitoring ambulance, primary EMS and advanced EMS in Chongqing were 7.0, 18.6, 36.2, and 47.8 min. The shortest travel time for complete EMS showed significant spatial aggregation characteristics. The Low-Low types that referred to cluster of short EMS travel time mainly distributed in city proper. The High-High types that referred to cluster of long EMS travel time mainly distributed in northeast and southeast of Chongqing. Urbanization rate was a negative influencing factor on shortest travel time for primary EMS, while average elevation and the number of settlements were positive influencing factors. GDP per capita and urbanization rate were negative influencing factors on shortest travel time for advanced EMS, while the number of settlements was a positive influencing factor.

Conclusion

This study evaluated the accessibility of EMS which considers two related trips in Chongqing. Although the accessibility of ambulances in Chongqing was relatively high, the accessibility of monitoring ambulance was relatively low. Regional and urban-rural differences in the accessibility of complete EMS integrating two related trips were obvious. It was recommended to increase financial investment in economic backward areas, increase high-quality EMS resources, enhance EMS capacity of central township health centers, strengthen road construction in mountainous areas, and provide reasonable planning of rural settlements for improving the spatial accessibility of EMS, narrowing the urban-rural gap and improving equity in getting EMS for all the people.

Establishment of hospital resilience framework in urban China: insight from Wuhan City

Since the Corona Virus Disease 2019 (COVID-19) swept the world, many countries face a problem that is a shortage of medical resources. The role of emergency medical facilities in response to the epidemic is beginning to arouse public attention, and the construction of the urban resilient emergency response framework has become the critical way to resist the epidemic. Today, China has controlled the domestically transmitted COVID-19 cases through multiple emergency medical facilities and inclusive patient admission criteria. Most of the existing literature focuses on case studies or characterizations of individual facilities. This paper constructs an evaluation system to measure urban hospital resilience from the spatial perspective and deciphered the layout patterns and regularities of emergency medical facilities in Wuhan, the city most affected by the epidemic in China. Findings indicate that the pattern of one center and two circles are a more compelling layout structure for urban emergency medical facilities in terms of accessibility and service coverage for residents. Meanwhile, the Fangcang shelter hospital has an extraordinary performance in terms of emergency response time, and it is a sustainable facility utilization approach in the post-epidemic era. This study bolsters areas of the research on the urban resilient emergency response framework. Moreover, the paper summarizes new medical facilities’ planning and location characteristics and hopes to provide policy-makers and urban planners with valuable empirical evidence.

Healthy Community-Life Circle Planning Combining Objective Measurement and Subjective Evaluation: Theoretical and Empirical Research

BACKGROUND

The world faces vast health challenges, and urban residents living in high-density areas have even greater demand for healthy lifestyles.

METHODS

Based on the data of points of interest, a field survey, and an interview, we explored the healthy community-life circle in the downtown area of Chengdu, China from two perspectives: objective measurement and subjective perception of residents. We evaluated the coverage rate and convenience in accessing eight types of health service facilities within a 15-min walk using linear and logistics regression models to explore the degree of resident satisfaction with facilities and influencing factors.

RESULTS

Results showed significant differences in coverage rates between different districts. The overall convenience in accessing health service facilities decreased gradually from the city center to the outskirts. The social environment, the layout of health service facilities, and residents' travel habits were related to health service facility satisfaction. Results also showed significant differences in various facilities' accessibility satisfaction between objective measurement and residents' perception measurement. Compared with subjective measurement, the objective measurements of accessibility for sports venues (objectively measured average minus perceived average: -1.310), sports zones (-0.740), and specialized hospitals (-1.081) were lower; those for community hospitals (0.095), clinics (1.025), and pharmacies (0.765) were higher; and facility accessibility measured by subjective perception had a more significant impact on health facility satisfaction. Pharmacies (OR: 1.932) and community hospitals (OR: 1.751) had the largest impact among the eight types of facilities.

CONCLUSION

This study proposed to construct a healthy community-life circle with a category and hierarchy system.

Variation in on-scene time of emergency medical services and the extent of the difference of on-scene time between genders: a retrospective population-based registry study in Riyadh Province, Saudi Arabia

OBJECTIVES

To identify the intergender variation of on-scene time (OST) for highly urgent emergency cases conveyed by emergency medical services (EMS) in Saudi Arabia and to assess other predictors of OST and hypothesise for possible factors delaying OST.

DESIGN

A retrospective population-based registry study.

SETTING

Riyadh Province is the largest province in terms of population and the second in terms of geographical area.

PARTICIPANTS

All highly urgent transported patients from the scene to emergency departments, be they medical emergencies or trauma emergencies during 2018.

OUTCOME MEASURE

OST difference between men and women transported by EMS.

RESULTS

In total, 21 878 patients were included for analysis: 33.9% women and 66.1% men. The median OST for women was 22 min (IQR 15-30) and 18 min (IQR 11-26) for men (p<0.001); for medical cases, median OST was 23 min (IQR 16-31) for women compared with 20 min (IQR 13 - 29) for men (p<0.001); for trauma cases, the median OST of both sexes was equal. We found the following additional predictors of OST: factors of emergency type, sex, age category, geographical areas, type of ambulance vehicle and hospital type were all significantly associated with OST in the crude or adjusted analyses. Factors of emergency type, sex, age category, geographical areas, type of ambulance vehicle and hospital type were also significantly associated with the odds of OST of more than 15 min in the crude and adjusted regression analyses.

CONCLUSIONS

The median OST was longer than 15 min for more than half of transported cases. For medical cases, women had a longer median OST than men. Additional predictors associated with prolonged OST were the patient's age, area (ie, urban vs rural), type of ambulance vehicle and season. These findings are hypothesis generating and require further studies.

Will multi-industry supply chains' resilience under the impact of COVID-19 pandemic be different? A perspective from China's highway freight transport

The pandemic caused by coronavirus disease 2019(COVID-19) continues to disrupt the global supply chain system, bringing new risks and challenges. The uncertainty created by COVID-19 makes it is difficult for various industries to deal with the pandemic. Since the pandemic, the supply chain's resilience has been discussed and examined in some studies. However, most existing works start from a single industry perspective or pay more attention to the disturbance caused by changes in the production side. Supply chain networks of different industries, mainly transport networks, are relatively limited under the epidemic's impact. In this paper, from the perspective of highway freight transport, a comprehensive competitiveness evaluation framework was proposed to reveal and the disruption and resilience of the supply chain under the outbreak based on nine indexes with five dimensions, including efficiency, capacity, activity, connectivity, and negotiability. Based on the availability of the data(Large-scale truck trajectory), we sorted out seven categories of Chinese industries(related to highway transport) and divided them into four categories respectively: (a) Slight disruption and worse resilience; (b) Slight disruption and remarkable resilience; (c) Serious disruption and worse resilience; (d) Serious disruption and remarkable resilience. The measurement results of supply chain network performance show that the industries (cold-chain, general products, and other industries) dominated by "Efficiency - Negotiability - Connectivity" are slightly disrupted (about 33%), forming a spatial diffusion with Wuhan(the city where the pandemic first broke out) as the disrupted center, spreading outward in a circle structure. Simultaneously, five urban agglomerations surrounding it have been impacted. By contrast, due to the strict isolation measures, the industries (building materials, construction, engineering, and high-value products industry) more vulnerable to be disrupted seriously (about 82%) tend to be the pattern of "Capacity - Activity". However, a large-scale centralized disruption was observed in the Triangle of Central China urban agglomeration was presented, resulting in almost stagnation of industry development. Meanwhile, as the future of the pandemic remains uncertain, the supply chain represented by the engineering industry, construction industry, etc are deserved to be paid more attention in line with they are prone to large-scale centralized damage due to the disruption of a single city node.

Assessing Trauma Center Accessibility for Healthcare Equity Using an Anti-Covering Approach

Motor vehicle accidents are one of the most prevalent causes of traumatic injury in patients needing transport to a trauma center. Arrival at a trauma center within an hour of the accident increases a patient's chances of survival and recovery. However, not all vehicle accidents in Tennessee are accessible to a trauma center within an hour by ground transportation. This study uses the anti-covering location problem (ACLP) to assess the current placement of trauma centers and explore optimal placements based on the population distribution and spatial pattern of motor vehicle accidents in 2015 through 2019 in Tennessee. The ACLP models seek to offer a method of exploring feasible scenarios for locating trauma centers that intend to provide accessibility to patients in underserved areas who suffer trauma as a result of vehicle accidents. The proposed ACLP approach also seeks to adjust the locations of trauma centers to reduce areas with excessive service coverage while improving coverage for less accessible areas of demand. In this study, three models are prescribed for finding optimal locations for trauma centers: (a) TraCt: ACLP model with a geometric approach and weighted models of population, fatalities, and spatial fatality clusters of vehicle accidents; (b) TraCt-ESC: an extended ACLP model mitigating excessive service supply among trauma center candidates, while expanding services to less served areas for more beneficiaries using fewer facilities; and (c) TraCt-ESCr: another extended ACLP model exploring the optimal location of additional trauma centers.