Analysis of risks and restrictions in hospitalization of urgent patients by ground transport

Relevance. Mortality from accidents, poisoning, acute diseases and injuries in Russia and the world remains high. For a number of urgent conditions, fast medical evacuation to a medical facility and prompt specialized care are critical. In a metropolis, there are a number of features that limit the work of ambulance ground teams (AGT).
Intention. To analyze medical evacuation of patients to a hospital in a metropolis (the city of Moscow as an example) using ground transportation, with its shortcomings and limitations.
Methodology. Patterns prehospital and early hospital mortality of patients in need of emergency medical care were analyzed, main reasons for the fastest possible transportation to a specialized hospital were determined. The statistics of road traffic accidents involving ambulances in Moscow for 2019-2020 were analyzed. Average traffic loads in Moscow for the period of 2017-2019 were estimated. Cases of rendering emergency medical care to Muscovites outside the city and in places without a road transport system were analyzed.
Results and Discussion. The main causes of death before arrival of ambulance teams are blood loss of various origins (28 %), burn shock (6 %), poisoning with various substances (31 %), traumatic brain injury and stroke (12 %), acute coronary syndrome (7 %) and a number of other conditions. If resuscitation measures are required, risks of death increase by 10.7 % for every 10 minutes of waiting for an ambulance. One-day outcomes were influenced by time to hospital admission for cardiovascular diseases (26.9-30.1 % mortality rate ); diseases and injuries of the central nervous system, i.e. stroke, head injury (25.2-25.5 % mortality rate); internal bleeding (12.6-15.2 % mortality rate). In Moscow in 2019, an average of 2.8 ambulance vehicles got into road accidents daily. This probability amounted to 2.78 x10^-3 and was 2.5 times higher than for other vehicles (1.11 x10^-3). The main restrictions for ground transportation in a metropolis are as follows: unpredictable traffic conditions increase time to hospital admission, difficulty transporting patients from remote areas, including off-road locations.
Conclusion. When urgent patients are admitted to a specialized hospital by road in a metropolis, there are a number of restrictions that must be taken into account when organizing emergency medical care. The main potential risks of increased time to hospital admission in Moscow is unpredictable road traffic.

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