EMERGENCY RESPONSE SERVICES: Mortality – The Case of Cardiac Arrest 3

It is also worth noting the large differences between patients in No 911 counties and other counties in the level of technology possessed by the hospital which receives the patients. None of the No 911 patients receive treatment in a certified trauma center, and only a quarter go to hospitals with cardiac catheterization laboratories. Likewise, the emergency room volume and size of hospitals is much lower in No 911 counties. There are also significant differences between Basic and Enhanced 911 counties in the provision of hospital care, but these differences are not as dramatic once the four largest counties are excluded.

Now consider the effects of 911 technology on the various components of response time, beginning with the time elapsed between the dispatch of a 911 call and the arrival at the emergency (TIME_TO_SCENE) (Table 6). There are four specifications, which include a number of patient-level as well as county-level covariates (the results in Tables 6-8 about the effects of patient-level characteristics are generally robust to specifications which include county fixed effects instead of county-level covariates). The base regression includes 911 dummies, patient-level variables, county-level demographics and hospital infrastructure variables, as well as characteristics of the receiving hospital. Since the hospital allocation is conditioned on patient severity, it is difficult to interpret the coefficients for characteristics of the receiving hospitals. One interpretation is that they are simply controls for the patient’s county and severity. further

DEPENDENT VARIABLE = L TIME_TO_SCENE
BASE TIME EXCLUDING ONLY COUNTIES
REGRESSION CONTROLS 4 LARGEST WITH 911 LEVEL
(OLS) (OLS) COUNTIES CHANGES
(OLS) (FIXED EFFECTS)
TIME CONTROLS
LTTME_AT_SCENE -0.13163 *0.15461 -0.19951
(0.00654) (0.00763) (0.02159)
LTTME_TO__HOSP 0.32575 0.3462 0.36371
(0.00507) (0.00607) (0.02057)
911 LEVEL
N0 911 0.09383 0.01831 0.05215 0.08953
(0.01698) (0.01557) (0.01656) (0.07063)
BASIC 911 0.07538 0.0222 0.00226 0.13546
(0.01341) (0.01228) (0.01261) (0.04305)
PATIENT CHARACTERISTICS
MALE 0.03631 0.01558 0.01846 0.04848
(0.0083) (0.00759) (0.00924) (0.02857)
AGE 0.00745 0.00398 0.00197 0.01683
(0.00205) (0.00188) (0.00252) (0.0076)
AGE.SQUARED -0.00006 -0.00002 -0.00001 -0.00011
(0.00002) (0.00001) (0.00002) (0.00006)
CARDIAC ARREST -0.12503 -0.06098 0.05545 0.15153
(0.01787) (0.01635) (0.03558) (0.11695)
DEFIBRILLATE 0.03474 0.02764 0.02735 0.02532
(0.00846) (0.00773) (0.0095) (0.03216)
GLASGOW TRAUMA SCORE (15=Least Severe; 3=Most Severe; 0=Unknown)
GLASGOW 0 1.60486 1.33791 0.41029 -0.05927
(0.20163) (0.18496) (0.22467) (0.18582)
GLASGOW 3 1.63347 1.41933 0.41626 -0.10982
(0.20315) (0.18649) (0.22637) (0.18081)
GLASGOW 4-9 1.6558 1.4468 0.47398
(0.20322) (0.18644) (0.22688)
GLASGOW 10-12 1.70663 1.43213 0.49918 -0.17747
(0.20283) (0.18607) (0.22608) (0.18852)
GLASGOW 13*14 1.6681 1.39132 0.45937 0.0092
(0.20118) (0.18456) (0.22433) (0.15863)
GLASGOW 15 1.6887 1.38023 0.47959 -0.08971
(‘0.20057’) (0.18403) (0.22347) (0.1426)
INSURANCE STATUS (EXCLUDED CATEGORY = MEDICARE)
MEDICAID -0.08647(0.02068) -0.0497 (0.0189 ) -0.02478(0.02335) 0.1198(0.06903)
PRIVATE -0.00113(0.01306) -0.01811(0.01193) -0.02074(0.01476) -0.02352(0.04388)
SELF.PAY -0.00863(0.03815) -0.0371(0.03484) -0.0866(0.03826) -0.27909(0.20312)
OTHER -0.01691(0.02288) -0.0206 (0.0209) -0.01409(0.02733) 0.10725(0.06999)
COUNTY HOSPITAL INFRASTRUCTURE
CERT. TRAUM CNTR 0.15789(0.01474) 0.09753(0.01349) 0.13947(0.0196)
LHOSPPERSQ. MILE -0.12588(0.01189) -0.04815(0.01092) -0.00084(0.01412)
L COUNTY CARDIAC PATIENTS -0.0567(0.01177) -0.08468(0.01077) -0.10222(0.01176)
COUNTY DEMOGRAPHICS
L POPULATION -0.09277(0.03064) -0.03693(0.02812) 0.0374(0.02924)
DENSITY 0.0315 (0.0055 ) 0.02544(0.00505) -0.33748(0,04916)
L INCOME PER CAP 0.10874(0.03698) 0.22698(0.03388) 0.72577(0.04689)
VCRIMERATE 6.98859(4.24895) 9.77737(3.88727) -6.69225(4.69215)
L POLICE EXP 0.06323 (0.0224) 0.03356(0.02049) -0.03753 (0.0219)
L HEALTH EXP -0.013(0.00422) -0.02067(0.00386) -0.01945(0.00403)
HOSPITAL CHARACTERISTICS
URGENT CARE CENTER -0.03722(0.01138) -0.04101 (0.0104) -0.03001(0.01389)
CATH LAB -0.03328(0.01185) -0.04442(0.01084) -0.04749(0.01375) 0.20105(0.04967)
OPENHEART FAC 0.02769(0.01243) 0.0203(0.01137) 0.02798(0.01865)
TRAUMA CNTR LEVEL -0.06379(0.01181) -0.04453(0.01079) -0.04719(0.01872)
EMERGENCY ROOM VOLUME -0.00031(0.00025) 0.00046(0.00039) -0.00073(0.00054) 0.00614(0.05292)
HOSPITAL DOCTORS 0.00023(0.00007) -0.00075(0.00023) -0.00039(0.00052) -0.01573(0.04498)
HOSPITAL RESIDENTS 0.00043(0.00043) 0.00003(0.00007) 0.00102(0.00036)
CONSTANT “ 1.241(0.31835)
OBSERVATIONS 24664.0000 24664.0000 16477.0000 1635.0000
R-SQUARED 0.7040 0.7170 0.7170 0.2774