Nearly one in four Americans live more than an hour away from the type of hospital that’s most prepared to save their life during an emergency, according to researchers from the University of Pennsylvania School of Medicine. What’s more, since it isn’t always clear which hospitals are best able to handle critical events like strokes, heart attacks, and serious infections, many more could be in danger because no system exists to transport them to the right hospital at the right time, says the study published in the journal Annals of Emergency Medicine.

 

“Whether you are bleeding to death from an injury, having a heart attack, or having a stroke, the common denominator is time,” says lead author Brendan Carr, an assistant professor of Emergency Medicine and Epidemiology and senior fellow in Penn’s Leonard Davis Institute of Health Economics. “In those life-threatening emergencies, we must blindly rely upon the system to rapidly deliver us to the care that we need. If we knew what services were provided where, we could design a system that would do that for patients everywhere in the country.”

 

Some patients are better off than others. Conducted with collaborators from the Emergency Medicine Network at Massachusetts General Hospital, the study finds that 71 percent of Americans have access to an emergency department within 30 minutes. And a full 98 percent can reach one within an hour. But on a state-by-state basis, the study says many of those nearby facilities may not be able to provide care for the most serious conditions.

 

According to the researchers, hospitals that treat a higher volume of patients tend to have more resources such as staffing, specialized imaging equipment, and care protocols. As a result, they tend to have better patient outcomes, the study finds. Meantime, rural area dwellers appear to be much less likely to have access to those types of facilities, according to the new study. The study cites Montana, for instance, where just 8 percent of the population lives within 60 minutes of an emergency department that sees three or more patients per hour. When it comes to teaching hospitals, less than half of Americans have access within an hour’s drive to these facilities, which tend to offer more sophisticated treatments and be staffed by subspecialists round-the-clock, the study says.

 

How to fix the problem? Carr suggests broadening the nation’s regionalized trauma care system, which allows for emergency medical service providers to bypass the closest hospital and bring severely injured patients to accredited facilities which meet specific care benchmarks. The model could be followed for other time-sensitive conditions like heart attack and stroke, he says.

 

But there’s another issue. It is challenging for emergency medical services planners to deliver acutely ill patients to the place that is best prepared to care for them without any centralized inventory of emergency department capabilities or resources available at all times of day and night within individual hospitals, the study says. Time matters immensely in critical situations: Following a stroke, patients must receive clot-busting drugs within three hours for the best chance at avoiding long-term cognitive or physical impairments, the study says.

 

To boost care quality in rural or other underserved areas, possibilities include subsidizing rural hospitals or offering incentives for physicians to practice at those facilities, the authors say. Officials can also improve inter-hospital referral networks and identify hospitals that can specialize in treatment of certain emergent illnesses. “A truly comprehensive emergency care system, however, needs to be built from a population health perspective, with groups of EMS providers and hospitals thinking collaboratively about how to provide the best emergency care to their region,” says Carr.