EMERGENCY RESPONSE SERVICES: Mortality – The Case of Cardiac Arrest 6

Table 8 considers the determinants of TIME_TO_HOSP. Again, the specifications parallel Tables 6 and 7. We find that, in all specifications, counties with higher levels of 911 have shorter TIME_TO_HOSP. Again, this result holds controlling for demographic factors as well as the number of hospitals per mile (which decreases TEME_TO_HOSP sharply), as well as when large counties are excluded and when only within-county changes are considered (although the result for changes from No 911 to Basic 911 are weakened substantially in the within-county specification). In future work, we hope to consider interactions between enhanced 911 and other allocation variables.

DEPENDENT VARIABLI i = L TIME TO HOSPITAL
BASE TIME EXCLUDING ONLY COUNTIES
REGRESSION CONTROLS 4 LARGEST WITH 911 LEVEL
(OLS) (OLS) COUNTIES CHANGES
(OLS) (FIXED EFFECTS)
TIME CONTROLS
LTIMEJTCLSCENE 0.44086 0.47724 0.44745
(0.00686) (0.00837) (0.0253 >
L 71ME_AT_SCENE -0.07159 -0.07504 -0.10268
(0.00765) (0.00906) (0.02444)
911 LEVEL
N0 911 0.15649 0.10178 0.10605 0.09964
(0.01963) (0.0181 ) (0.01943) (0.07834)
BASIC 911 0.12466 0.08459 0.08718 0.07311
(0.01551) (0.01427) (0.01479) (0.04786)
PATIENT CHARACTERISTICS
MALE 0.04784 0.02903 0.02066 0.03623
(0.00959) (0.00882) (0.01085) (0.0317)
AGE 0.01282 0.00992 0.00874 0.00106
(0.00237) (0.00218) (0.00295) (0.00845)
AGE.SQUARED -0.00011 -0.00009 -0.00008 -0.00002
(0.00002) (0.00002) (0.00002) (0.00006)
CARDIAC ARREST -0.18747 -0.13073 -0.13198 -0.00151
(0.02066) (0.019 ) (0.04177) (0.03567)
DEFIB RILL ATE 0.03532 0.0224 0.03799 -0.21201
о8-Joo (0.009 ) (0.01115) (0.07646)
GLASGOW TRAUMA SCORE (15=Least Severe; 3=Most Severe; 0= ^Unknown)
GLASGOW 0 1.6977 1.14576 1.15614 -0.34525
(0.23308) (0.21527) (0.26366) (0.19073)
GLASGOW 3 1.65137 1.10733 1.11887 -0.41187 ‘
(0.23483) (0.21709) (0.26567) (0.20586)
GLASGOW 4-9 1.57387 1.00906 1.07255 -0.0466
(0.23491) (0.21707) (0.26628) (0.19352)
GLASGOW 10-12 1.73412 1.13965 1.14773 -0.30685
(0.23446) (0.2166) (0.26532) (0.15502)
GLASGOW 13-14 1.73479 1.1562 1.16163 -0.04845
(0.23255) (0.21483) (0.26326) (0.13422)
GLASGOW 15 1.8255 1.23666 1.2426 -0.10085
(0.23185) (0.21419) (0.26224) (0.12976)
INSURANCE STATUS (EXCLUDED CATEGORY = MEDICARE)
MEDICAID -0.1092(0.02391) -0.07043(0.02198) -0.07683(0.02741) -0.07046(0.04865)
PRIVATE 0.04206 (0.0151 ) 0.04077(0.01388) 0.04224(0.01732) 0.27275(0.22532)
SELF PAY 0.08497(0.04409) 0.08834(0.04053) 0.11029 (0.04492) -0.08129(0.07766)
OTHER 0.01589(0.02645) 0.02416(0.02431) -0.00221(0.03209)
COUNTY HOSPITAL INFRASTRUCTURE
CERT. TRAUM CENTER 0.15252(0.01704) 0.07711 (0.0157 ) 0.05555(0.02305)
L HOSP PER SQ. MILE *0.18727(0.01374) -0.12268(0.01269) -0.09829(0.01656)
L COUNTY CARDIAC PATIENTS 0.0448(0.01361) 0.06252(0.01254) 0.09978(0.01382)
COUNTY DEMOGRAPHICS
L POPULATION 0.00389(0.03542) 0.07585(0.03272) 0.06252(0.03432)
DENSITY -0.01008(0.00636) -0.02905(0.00587) 0.18259(0.05779)
L INCOME PER CAP -0.44325(0.04275) -0.5054(0.03932) -0.46603(0.05533)
VCRIMERATE 5.65587(4.91153) 5.09363(4.52272) 2.34351(5.50937)
L POLICE EXP 0.01922(0.02589) -0.02139(0.02383) -0.08667 (0.0257)
L HEALTH EXP 0.01653(0.00488) 0.02102(0.00449) 0.02104(0.00473)
HOSPITAL CHARACTERISTICS
URGENT CARE CENTER -0.00081(0.01316) 0.0134 (0.0121 ) 0.00072(0.01631) 0.16509(0.05522)
CATHLAB 0.06756(0.0137) 0.08813(0.01261) 0.10653(0.01613)
OPENHEART FAC -0.00712(0.01437) -0.02461(0.01322) -0.01003 (0.0219)
TRAUMA CENTER LEVEL -0.05772(0.01366) -0.02935(0.01256) -0.05217(0.02198) -0.02545 (0.0587 )
EMERGENCY ROOM VOLUME 0.00025(0.00049) 0.00012(0.00045) -0.00144(0.00063) 0.02418(0.04989)
HOSPITAL DOCTORS 0.00126(0.00029) 0.00138(0.00027) 0.00244(0.00061) 0.01174(0.00942)
HOSPITALRESIDENTS 0.00073(0.00008) 0.00065(0.00008) 0.00135(0.00043) 1.67951(0.33885)
CONSTANT 3.20254(0.33705)
OBSERVATIONS 24664.000 24664.000 . 16477.000 1635.000
R-SQUARED 0.704 0.717 0.717

We find that travel times are longer for patients allocated to hospitals with a large number of doctors, residents (indicating teaching hospitals), and with cardiac catheterization laboratories. Thus, we have some evidence that patients with more severe indications are transported to higher quality, but more distant, hospitals. This is consistent with the official protocols for patient allocation for Pennsylvania counties: according to the protocols, the most severe indications are to be transported to hospitals with appropriate capabilities, while less severe indications are to be transported to the nearest hospital.