Factors associated with mode of transport to acute care hospitals in rural communities

This study identifies factors associated with mode of transport to rural hospitals. We evaluated 11,541 trauma patient visits that came by ground ambulance or private vehicle to the Emergency Department of one of six northwest Iowa rural hospitals. We performed univariate analyses and logistic regression analyses to identify factors associated with mode of transport for each severity level (fatal, major and minor). For major/fatal injuries, we found that those aged 65 years and over were 3.6 (95% CI = 2.7-4.9) times more likely to use ambulances than those under 15. Motor vehicle traffic injuries and hip fractures were also associated with ambulance usage, while arm fractures and farm-related injuries were not. We conclude that for major/fatal injuries, older persons, those injured from high velocity causes, and those with hip fractures are more likely to use an ambulance. Emergency Medical Services may improve the community's ambulance utilization by providing public education (e.g., proper use of 911 and injury severity recognition), and by collaborating with dispatch, the local community and health care providers. Further study of the community's and individuals' decision-making factors determining mode of transportation is needed.