Jukka Pappinen

Nurse

Finland

Doctorate Title: Analysing accessibility to emergency medical services using spatial analysis methods.

Doctorate Description: Variation in access to healthcare services is one of the key indicators of equity and equality in public healthcare services. Comparing access to care reliability between areas with similar characteristics is essential to evaluate spatial equity. Therefore, we present methods for utilising geographic data for such purposes.

In Finland, organising emergency medical services (EMS) is the responsibility of hospital districts (HD). Each HD is mandated to make a service-level decision that sets, for example, response time targets for different area types. In this study, the service-level decision concept’s ability is evaluated to ensure equity of access to EMS. Also, an updated version of area type classification based on geographic area classifications published by the Finnish Environmental Institute is presented. This standardises the area classification methods used by public agencies and authorities. The area categorisation and grid-based data collection are feasible methods to evaluate and compare EMS demand and response times within and between HDs and other administrative areas.

In certain patient groups, the total time from symptom onset or accident to definitive care in a hospital defines the outcome more than the initial ambulance response time. Furthermore, in this study, a method to simulate a patient’s logistics chain from scene to hospital using different transportation methods is explored. The method was tested with a dataset containing ca. 20 000 EMS missions with stroke symptoms as a dispatch reason. In addition, ground ambulance and helicopter transportation strategies were compared to find mission locations where helicopter transportation might offer a reasonable benefit for the patient.

Should the patient need university hospital care in optimum conditions, almost every third stroke patient would have benefitted more than 30 minutes using helicopter transportation. Not surprisingly, rural and remote patients would benefit most, which would increase spatial equity in access to care. The cost effects of different transportation strategies were not considered in this study.

Open datasets, such as digital maps, were utilised in this study. Open datasets are frequently used in healthcare research and development, but the feasibility of open data grows when the selection of health-and population-related datasets increases.

A probable contradiction was identified between the fastest-reached and administratively correct university hospitals in one of every six missions. In these areas, special attention should be paid to ensure patient interest-based selection of hospitals in time-critical conditions.