title: Geographic Discordance Between Patient Residence and Incident Location in Emergency Medical Services Responses.
abstract: The location of a patient's residence is often used for emergency medical services (EMS) system planning. Our objective is to evaluate the association between patient residence and emergency incident zip codes for 911 calls.
  
  
  
  We used data from the 2013 National Emergency Medical Services Information System (NEMSIS) Public-Release Research Dataset. We studied all 911 calls with a valid complaint by dispatch, identifying zip codes for both the residence and incident locations (n=12,376,784). The primary outcomes were geographic and distance discordances between patient residence and incident zip codes. We used a multivariate logistic regression model to determine geographic discordance between residence and incident zip codes by dispatch complaint, age, and sex. We also measured distances between locations with geospatial processing.
  
  
  
  The overall proportion of geographic discordance for all 911 calls was 27.7% (95% confidence interval [CI] 27.7% to 27.8%) and the median distance discordance was 11.5 miles (95% CI 11.5 to 11.5 miles). Lower geographic discordance rates were found among patients aged 65 to 79 years (20.2%; 95% CI 20.1% to 20.2%) and 80 years and older (14.5%; 95% CI 14.5% to 14.6%). Motor vehicle crashes (63.5%; 95% CI 63.5% to 63.6%), industrial accidents (59.3%; 95% CI 58.0% to 60.6%), and mass casualty incidents (50.6%; 95% CI 49.6% to 51.5%) were more likely to occur outside a patient's residence zip code. Median network distance between home and incident zip centroid codes ranged from 8.6 to 23.5 miles.
  
  
  
  In NEMSIS, there was geographic discordance between patient residence zip code and call location zip code in slightly more than one quarter of EMS responses records. The geographic discordance rates between residence and incident zip codes were associated with dispatch complaints and age. Although a patient's residence might be a valid proxy for incident location for elderly patients, this relationship holds less true for other age groups and among different complaints. Our findings have important implications for EMS system planning, resource allocation, and injury surveillance.
authors: Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA. Electronic address: renee.hsia@ucsf.edu.
authors: Renee Y
authors: RY
authors: Hsia
authors: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
authors: Mengtao
authors: M
authors: Dai
authors: Department of Geography, University of Utah, Salt Lake City, UT.
authors: Ran
authors: R
authors: Wei
authors: Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA.
authors: Sarah
authors: S
authors: Sabbagh
authors: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
authors: N Clay
authors: NC
authors: Mann
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005843:Geography; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D054527:Mass Casualty Incidents / Q000706:statistics & numerical data; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012737:Sex Factors; D014481:United States; D055815:Young Adult