21 August 2007
Longer ambulance journeys mean more patient deaths
Government plans to close local Accident and Emergency (A&E) departments may lead to more deaths in some groups of patients, according to research carried out by the University of Sheffield. The study, published today in the Emergency Medicine Journal, found that the further seriously ill patients have to travel by ambulance to reach emergency care, the more likely they are to die.
The findings are based on a review of life-threatening (category A) calls to four ambulance services in England, representing urban, rural, mixed, and remote areas, between 1997 and 2001.
The researchers studied ambulance journey distances ranging from 0 to 58 km. Overall, 644 patients (just over six per cent) died, but the further patients had to travel by ambulance to hospital, the more likely they were to die. The findings show overall patients´ risk of death rose by one per cent for every 10 kilometres (six miles) they had to travel.
Patients most likely to be affected by distance travelled were those with severe breathing problems. Their chances of dying were 13% if the distance to hospital was between 10 and 20 km, and 20% if this was 20 or more kilometres.
The researchers suggest that the findings have implications for the UK government´s proposals to close local A&E departments in favour of fewer, more specialised centres, in a bid to save lives.
Plans suggested by the Institute for Public Policy Research, and put forward by the Government, will focus emergency care on local urgent care treatment centres staffed by GPs and nurses, treating non-life-threatening problems. Large specialist centres will focus on treating critical emergencies such as heart attacks and multiple serious injuries. However, the Sheffield research highlights the fact that there is an important group of emergency patients whose conditions are life-threatening but who do not need specialist care.
Professor Jon Nicholl, Director of the Medical Care Research Unit at the University of Sheffield, who led the study, said: "Decisions regarding reconfiguration of acute services are complex and require consideration of many conflicting factors. Our data suggests that any changes that increase journey distances to hospital for all emergency patients may lead to an increase in mortality for some."
He added: "Patients who are in anaphylactic shock, choking, drowning, or having an acute asthma attack need urgent care that would be the same wherever it is provided. It is likely that these patients would survive by travelling a short distance to a local A&E department rather than travelling a long distance to a specialist hospital."
Notes for Editors: `The relationship between distance to hospital and patient mortality in emergencies: an observational study´ has been published in the Emergency Medicine Journal.
The findings held true even after taking account of age, sex, and illness severity.
As part of the study life-threatening ambulance calls were sampled annually from 1997 to 2001 at Berkshire Ambulance Service, Derbyshire Ambulance Service, Essex Ambulance Service, and West Midlands Ambulance Service. The services were representative of the types of environment typically encountered in England, including urban, mixed urban, rural and very rural areas.
For further information please contact: Jenny Wilson, Media Relations Officer on 0114 2225339 or email j.c.wilson@sheffield.ac.uk
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