A Cross-Sectional Analysis of ALS/ BLS Care in Low Acuity 9-1-1 Response by Geography and Insurance Status Utilizing the 2019 NEMSIS Dataset
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Abstract
Purpose. The objective of this study was to examine the relationship between patient acuity and level of EMS care adjusting for rurality and insurance.
Methods. Data were obtained from the National Emergency Services Information System (NEMSIS) database for 2019. EMS responses (n = 4,375,568) were analyzed comparing patient acuity and CMS Service level, Advanced Life Support (ALS) vs Basic Life Support (BLS), to assess for associations in acuity and CMS Service level using logistic regression.
Results. Overall, there was a decreased odds of advanced life service use at low acuity EMS responses (OR=0.443, 95% CI=0.440-0.445). Sub analysis exploring the interaction between CMS Service Level, Rurality demonstrates an overall trend of decreasing odds of low acuity EMS responses among rural areas and BLS care (OR=0.492, 95% CI=0.486,0.498) and ALS care (OR=0.198, 95% CI=0.197,0.200). When analyzing trends among public vs all other insurance and rural vs urban settings, there were decreases in low acuity ALS care in the rural setting; ALS and Pub Insurance (OR 0.447, 0.444-0.450, p<0.001), ALS and Rural (OR 0.198, CI 0.197-0.914, p<0.001) among low acuity responses. The results indicate that acuity and service level vary according to insurance and rurality. In the low acuity call type, we see decreased odds of ALS use compared BLS use in those with public insurances compared to other insurance. There is also a geographic component to these results where the use of Advance Life Support services declined with decreases in urbanicity.
Discussion. These results potentially highlight that rural areas utilize less emergency medical response resources in low acuity responses. As such, EMS programs like community paramedicine, could be potentially effective interventions to close gaps in access to care for rural residents.
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