Rurality as a factor in ambulance use in health emergencies

Introduction: Ambulance use in rural and remote parts of Australia has been reported anecdotally to be lower than urban areas. Experiences of paramedics in rural locations gave rise to questions of whether this phenomenon was occurring and to what degree. 

Methods: Data from emergency department (ED) records was obtained from the Hunter New England Area Health Service from 1 July 2008 to 30 June 2009. In total, 354,909 records were obtained. These records were de-identified and analysed to determine the method of arrival to ED, specifically in high acuity patients. 

Results: People from inner regional areas are 41.5% less likely overall and 27.7% less likely in serious health emergencies to attend EDs by ambulance compared to people in major cities. People from outer regional and remote areas are 55.1% less likely overall and 27.9% less likely in serious health emergencies to attend EDs by ambulance compared to people living in major cities. Logistic regression modelling indicated rurality was a significant factor in ambulance use in adults in areas outside major cities and in children in inner regional areas. Age was a significant predictor of ambulance demand with older people using ambulances more. 

Discussion: This study indicates disparity between rates of ambulance use in urban and non-urban areas. The concept of unmet need should be considered as a more complex phenomenon than simply a utilisation gap and exploration of unmet need is warranted. 

Conclusion: A clearer understanding of how rurality affects ambulance use has a number of implications for ambulance services.