EMERGENCY RESPONSE SERVICES: The Role of Emergency Response Systems

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As described in Sections I and П, the pre-hospital system plays an important role in allocating patients to hospitals. However, one of the most critical factors in determining a patient’s allocation is the simple availability of a hospital with advanced technologies in her county. Table 10 shows that 80% of patients in our dataset had within-county access to hospitals with cardiac catheterization laboratories, while only half had access to a certified county trauma center. Conditional on access to a hospital with a cardiac catheterization laboratory, approximately 80% of patients were allocated to such a hospital. The conditional probabilities of being allocated to hospitals with other features is substantially lower for the cardiac patients in our dataset Table 10 illustrates that, as opposed to the more common situation where the primary barrier to access derives from a patient’s insurance status, a patient’s geographical location may be the main determinant of whether a patient receives treatment in a hospital with specialized cardiac care or emergency services. Patients in poorer and less populated regions may not receive access to such care.

In Table 11, we explore further the factors which affect allocation of patients to hospitals, conditional on availability of the technology. The main result in this table is that for cardiac catheterization laboratories, the level of 911 significantly increases the probability of being admitted to a high-technology hospital (this result is robust to including controls for the number of hospitals in the county with cardiac catheterization laboratories). This is consistent with an important allocative role played by 911 centers.