Factors Associated with Pre-Hospital Clinical Improvement in Non-Trauma Emergencies: A Cross-Sectional Analysis
https://doi.org/10.53770/amhj.v6i1.774
Keywords
Ambulance Response Time Australasian Triage Scale Emergency Medical Services Non-Trauma Emergency Patients Pre-Hospital CareAbstract
Ambulance response time is a key performance indicator of Emergency Medical Services (EMS) and is essential for early patient stabilization. However, evidence on factors associated with pre-hospital clinical improvement, particularly changes in the Australasian Triage Scale (ATS), remains limited in developing countries. This study aimed to identify factors associated with pre-hospital clinical improvement among non-trauma emergency patients. A cross-sectional analytical study was conducted involving 113 non-trauma emergency patients transported by ambulance to a tertiary referral hospital in Samarinda, East Kalimantan, Indonesia. ATS improvement was defined as a positive shift to a lower-acuity category between the initial assessment at the emergency scene and reassessment at the emergency department. Data were analyzed using multivariate logistic regression controlling for age, transport distance, diagnosis, and pre-hospital interventions. Ambulance response time of ≤15 minutes was the strongest factor associated with ATS improvement (p < 0.001; adjusted OR = 0.019; 95% CI = 0.003–0.122). Circulation management during pre-hospital care also significantly improved clinical status (p = 0.039), whereas age (p = 0.298) and transport distance (p = 0.114) showed no significant association. These findings indicate that rapid ambulance response and appropriate pre-hospital interventions are strongly associated with improved clinical outcomes in non-trauma emergencies. Although the cross-sectional, single-center design limits causal inference and generalizability, strengthening EMS dispatch systems and timely pre-hospital care remains essential for optimizing patient outcomes.
Downloads
References
Al-Thani, H., Mekkodathil, A., Hertelendy, A., Howland, I., Frazier, T., & El-Menyar, A. (2021). Emergency medical services transportation of trauma patients by geographic locations and in-hospital outcomes: Experience from Qatar. International Journal of Environmental Research and Public Health, 18(8), 4016. https://doi.org/10.3390/ijerph18084016
Alanazy, A., Alruwaili, A., Alswaidan, S., Alobaid, H., Al-Omran, A., Hzazi, A., & Binhotan, M. (2024). The awareness of public about the emergency medical services in the Eastern region of Saudi Arabia. PLOS ONE, 19(7), e0306878. https://doi.org/10.1371/journal.pone.0306878
Banjarnahor, E. I., Ginting, C. N., Manalu, P., & Girsang, E. (2023). Lama waktu tunggu pelayanan pasien: studi kualitatif di Puskesmas Padang Bulan. Ahmar Metastasis Health Journal, 3(1), 8–17. https://doi.org/10.53770/amhj.v3i1.182
Brown, J. B., Gestring, M. L., Guyette, F. X., Rosengart, M. R., Stassen, N. A., Forsythe, R. M., & Peitzman, A. B. (2016). Not all prehospital time is equal: Influence of scene time on mortality. Journal of Trauma and Acute Care Surgery, 81(1), 93–101. Retrieved from https://doi.org/10.1097/TA.0000000000000999
Debas, H. T., Donkor, P., Gawande, A., Jamison, D. T., Kruk, M. E., & Mock, C. N. (2015). Essential surgery: disease control priorities, third edition. Washington (DC): The International Bank for Reconstruction and Development/The World Bank.
Demirel, M., Özçelik, A., & Boğan, M. (2024). The way back home: The invisible burden of the emergency healthcare services. PLOS ONE, 19(5), e0298933. https://doi.org/10.1371/journal.pone.0298933
Edem, I. J., Dare, A. J., Byass, P., Olatosi, B., Afolabi, A., & Ologunde, R. (2019). External injuries, trauma and avoidable deaths in Agincourt, South Africa. BMJ Open, 9, e027576. https://doi.org/10.1136/bmjopen-2018-027576
Griswold, D., & Rubiano, A. (2022). Role of mHealth applications for emergency medical system activation in reducing mortality in low-income and middle-income countries. BMJ Open, 12(2), e051792. https://doi.org/10.1136/bmjopen-2021-051792
Group, R. R. (2024). Mapping the processes and information flows of a prehospital emergency care system in Rwanda: a process mapping exercise. BMJ Open, 14(6), e085064. https://doi.org/10.1136/bmjopen-2024-085064
Guan, G., Lee, C., Begg, S., Crombie, A., & Mnatzaganian, G. (2022). The use of early warning system scores in prehospital and emergency department settings to predict clinical deterioration. PLOS ONE, 17(3), e0265559. https://doi.org/10.1371/journal.pone.0265559
He, Y., Chen, L., Wei, B., Zhang, X., Li, Y., & Wang, J. (2025). Evaluation and optimization of emergency medical services accessibility based on real-world emergency calls in metropolitan China. Computational Urban Science, 5, 45. https://doi.org/10.1007/s43762-025-00204-x
Ishak, S. J., Yueniwati, Y., & Kapti, N. R. E. (2020). Factors related about family delay bring stroke patient to Emergency Departments of Labuha Hospital. IJSOC, 2, 657–672. https://doi.org/10.54783/ijsoc.v2i4.260
Israfil, I. (2024). The role of family in stroke patients in the community: a narrative review. Ahmar Metastasis Health Journal, 4(3), 154–159. https://doi.org/10.53770/amhj.v4i3.412
Jamison, D. T. (2018). Disease control priorities: improving health and reducing poverty. The Lancet, 391(10125), e11–e14. https://doi.org/10.1596/978-1-4648-0527-1
Jana, A., Sarkar, A., Parmar, V., & Saunik, S. (2023). Examining district-level disparity and determinants of timeliness of emergency medical services in Maharashtra, India. Scientific Reports, 13(1), 21239. https://doi.org/10.1038/s41598-023-48713-1
Joiner, A., Blewer, A. L., Pek, P. P., Ostbye, T., Staton, C. A., Silvalila, M., Nadarajan, G. D. (2023). Barriers and facilitators for developing a prehospital emergency care system evaluation tool (PEC-SET) for low-resource settings: a qualitative analysis. BMJ Open, 13(12), e077378. http://doi: 10.1136/bmjopen-2023-077378.
Jollis, J. G., Al-Khalidi, H. R., Roettig, M. L., Berger, P. B., Corbett, C. C., Doerfler, S. M., … Magdon-Ismail, Z. (2018). Impact of regionalization of ST-segment–elevation myocardial infarction care on treatment times and outcomes for emergency medical services–transported patients presenting to hospitals with percutaneous coronary intervention: Mission: Lifeline Accelerator. Circulation, 137(4), 376–387. https://doi.org/10.1161/CIRCULATIONAHA.117.032446
Lee, S. H., Kim, H. K., Jeong, M. H., Lee, J. M., Gwon, H. C., Chae, S. C., ... & KAMIR Investigators. (2019). Pre-hospital delay and emergency medical services in acute myocardial infarction. The Korean journal of internal medicine, 35(1), 119-132. https://doi.org/10.3904/kjim.2019.123
Lowthian, J. A., Cameron, P. A., Stoelwinder, J. U., Curtis, A., Currell, A., Cooke, M. W., & McNeil, J. J. (2011). Increasing utilisation of emergency ambulances. Australian Health Review, 35(1), 63–69. https://doi.org/10.1071/AH09866
Magnusson, C., Hagiwara, M. A., Norberg-Boysen, G., Kauppi, W., Herlitz, J., Axelsson, C., … Wibring, K. (2022). Suboptimal prehospital decision-making for referral to alternative levels of care–frequency, measurement, acceptance rate and room for improvement. BMC Emergency Medicine, 22(1), 89. https://doi.org/10.1186/s12873-022-00643-3
Mehmood, A., Rowther, A. A., Kobusingye, O., & Hyder, A. A. (2018). Assessment of pre-hospital emergency medical services in low-income settings using a health systems approach. International Journal of Emergency Medicine, 11(1), 53. https://doi.org/10.1186/s12245-018-0207-6
Næss, L. E., Krüger, A. J., Uleberg, O., Haugland, H., Dale, J., Wattø, J.-O., … Asheim, A. (2024). Using machine learning to assess the extent of busy ambulances and its impact on ambulance response times: a retrospective observational study. PLoS One, 19(1), e0296308. https://doi.org/10.1371/journal.pone.0296308
Nehme, Z., Andrew, E., & Smith, K. (2016). Factors influencing the timeliness of emergency medical service response to time critical emergencies. Prehospital Emergency Care, 20(6), 783–791. https://doi.org/10.1136/bmjopen-2020-042401
Nielsen, V. M. L., Kløjgård, T., Bruun, H., Søvsø, M. B., & Christensen, E. F. (2020). Progression of vital signs during ambulance transport categorised by a paediatric triage model: a population-based historical cohort study. BMJ Open, 10(11), e042401. https://doi.org/10.1136/bmjopen-2020-042401
O’Hara, R., Johnson, M., Hirst, E., Weyman, A., Shaw, D., Mortimer, P., … Mason, S. (2014). A qualitative study of decision making and safety in ambulance service transitions. Health and Social Care Delivery Research, 2(56), 1–138. https://doi.org/10.3310/hsdr02560
Odland, M. L., Whitaker, J., Nepogodiev, D., Aling’, C. A., Bagahirwa, I., Dushime, T., … Nkeshimana, M. (2020). Identifying, prioritizing and visually mapping barriers to injury care in Rwanda: a multi-disciplinary stakeholder exercise. World Journal of Surgery, 44(9), 2903–2918. https://doi.org/10.1007/s00268-020-05571-6
Pap, R., Lockwood, C., Stephenson, M., & Simpson, P. (2020). Development and testing of Australian prehospital care quality indicators: study protocol. BMJ Open, 10(7), e038310. https://doi.org/10.1136/bmjopen-2020-038310
Poomsaidorn, S., Laohasiriwong, W., & Soeung, K. (2021). Prehospital emergency medical services utilization for critical patients and its determinants in Thailand. J Southwest Jiaotong University, 56(5), 515–523. https://doi.org/10.35741/issn.0258-2724.56.5.47
Pouramin, P., Li, S., Busse, J. W., Sprague, S., Devereaux, P. J., Jagnoor, J., … Bhandari, M. (2020). Delays to hospital admission in 31,255 fracture patients across 18 low-middle income countries: a prospective, observational study. The Lancet. Global Health, 8(5), e711. https://doi.org/10.1016/S2214-109X(20)30067-X
Purwadi, H., Harmili, H., & Friansyah, K. A. (2024). Exploring the experience of nursing students in performing cardiopulmonary resuscitation (CPR) in Manambai Hospital: a qualitative study. Ahmar Metastasis Health Journal, 4(1), 68–75. https://doi.org/10.53770/amhj.v4i1.294
Razzak, J., Usmani, M. F., & Bhutta, Z. A. (2019). Global, regional and national burden of emergency medical diseases using specific emergency disease indicators: analysis of the 2015 Global Burden of Disease Study. BMJ Global Health, 4(2), e000733. https://doi.org/10.1136/bmjgh-2018-000733
Rogers, F. B., Rittenhouse, K. J., & Gross, B. W. (2015). The golden hour in trauma: dogma or medical folklore? Injury, 46(4), 525–527. https://doi.org/10.1016/j.injury.2014.08.043
Sampson, F. C., O’Hara, R., Long, J., & Coster, J. (2025). Understanding good communication in ambulance pre-alerts to the emergency department: findings from a qualitative study of UK emergency services. BMJ Open, 15(1), e094221. https://doi.org/10.1136/bmjopen-2024-094221
Setyarini, A., & Windarwati, H. D. (2020). Influence factors of emergency medical services (ems) prehospital time interval variety: a systematic review. Jurnal Ners, 15(1S), 440. https://doi.org/10.20473/jn.v15i1Sp.19786
Thepmanee, D., Tanaka, H., & Takyu, H. (2022). Trends in pre-hospital emergency calls and transportation data for emergency medical services in Thailand. Journal of EMS Medicine, 2(2), 45–54. https://doi.org/10.35616/jemsm.2022.00017
Whitaker, J., O'Donohoe, N., Denning, M., Poenaru, D., Guadagno, E., Leather, A. J. M., & Davies, J. I. (2021). Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments. BMJ global health, 6(5), e004324. https://doi.org/10.1136/bmjgh-2020-004324
Wiyarta, E., Hidayat, R., Kurniawan, M., Sinaga, G. H. P., & Budiman, R. A. (2025). Factors associated with prehospital and in-hospital delays in acute ischaemic stroke care in Indonesia: a systematic review. BMJ Open, 15(3), e095845. https://doi.org/10.1136/bmjopen-2024-095845
Wolthers, S. A., Blomberg, S. N. F., Breindahl, N., Anjum, S., Hägi-Pedersen, D., Ersbøll, A., Christensen, H. C. (2023). Association between using a prehospital assessment unit and hospital admission and mortality: a matched cohort study. BMJ Open, 13(9), e075592. https://doi.org/10.1136/bmjopen-2023-075592
World Health Organization. (2018). Global health estimates 2016: Global deaths by cause, age and sex, 2000–2016. World Health Organization.
Yulia, R. (2022). Hubungan lama kerja dan pelatihan dengan ketepatan waktu tanggap penanganan pasien Di IGD RSHB Batam. Ahmar Metastasis Health Journal, 2(3), 166–173. https://doi.org/10.53770/amhj.v2i3.142
Zarei, R., Downs, M. C., & Torgerson, L. (2025). Artificial intelligence in prehospital emergency care: advancing triage and destination decisions for time-critical conditions. Cureus, 17(9), e91542–e91542. https://doi.org/10.7759/cureus.91542
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ahmar Metastasis Health Journal
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
