title: Emergency care facility access in rural areas within the golden hour?: Western Cape case study.
abstract: BACKGROUND
  Road Safety is a major cause of death around the world and South Africa has one of the highest road fatality rates. Many measures, engineering and medical, are investigated. However, analysis of the accessibility of emergency care facilities is often overlooked. This paper aims to fill the gap between pre-crash engineering solutions and literature on trauma injuries and emergency care procedures. The focus is on the role that accessibility to emergency care facilities in rural areas plays, given that 50% of the world's population lives in rural areas, which are often omitted from international research. The Western Cape (a rural province with low population volumes and high volume roads in South Africa) is analysed as an example of access to trauma care in rural areas.
  
  
  METHODS
  It is internationally accepted that the time to emergency care facilities influences the survival chances. However, the international literature still debates the exact time period. In this paper, the 'Golden Hour' is used to analyse the accessibility of emergency care facilities in rural areas and establish a geographical analysis method which identifies risk areas. The analysis can be repeated if the international literature debates regarding the exact time period changes.
  
  
  RESULTS
  A Geographical Information System (GIS) tool revealed that 53% of the fatalities in the rural parts of the Western Cape occur outside the Golden Hour. In high risk crash areas, the fatality risk is up to nine times higher than the province's rural average.
  
  
  CONCLUSIONS
  People in need of trauma care after a road crash are most likely to survive if they receive definitive care timeously. At the time of the study, the rural areas in the Western Cape had 44 Emergency Medical Services stations and 29 medical facilities that can assist to provide definitive (trauma) care. Further optimisation of the facility locations is recommended and research has begun.More advanced geographical modelling is possible when improved data becomes available on the 'Golden Hour' theory, differential times for varying injury types or travel speeds of ambulances. This, more advanced, modelling can reduce the road crash burden in rural areas around the world further.
authors.affiliation: University of Cape Town, Centre for Transport studies, Department of Civil Engineering, Private Bag X3, Rondebosch 7700, South Africa. marianne.vanderschuren@uct.ac.za.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vanderschuren
authors.forename: Duncan
authors.initials: D
authors.lastname: McKune
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality* / Q000639:trends*; D004632:Emergency Medical Services / Q000592:standards / Q000639:trends*; D006297:Health Services Accessibility / Q000592:standards / Q000639:trends*; D006801:Humans; D012424:Rural Population / Q000639:trends*; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards / Q000639:trends*