Resumo Objetivo: Analisar o tempo de resposta e tempo de transporte dos Serviços Médicos de Emergência (EMS), dependendo da sua localização urbana ou rural, para atender vítimas de acidentes de trânsito que tiveram lugar nas diferentes áreas geográficas da Extremadura (Espanha), de 2012 a 2015. Métodos: Estudo transversal dos dados do Centro de Coordenação de Resposta a Emergências 112 (ERCC-112) sobre acidentes de trânsito atendidos pelos EMS. Definiu-se tempo de resposta como o decorrido entre receção do pedido de auxílio e chegada do EMS ao acidente, e tempo de transporte como aquele entre saída do lugar do acidente e chegada ao hospital de referência. Consideraram-se EMS rurais aqueles situados em localidades sem hospital e EMS urbanos os localizados em vilas ou cidades com um hospital. Resultados: Durante os quatro anos estudados, 5,572 acidentes de trânsito solicitaram assistência através do ERCC-112. Dos 2,875 acidentes (51,9%) em que foram mobilizados EMS, 55.4% tiveram lugar em vias urbanas e os restantes em interurbanas. Faleceram 113 pessoas (idade média 48.4 ± 19.0 anos, amplitude 15-84 anos) no lugar do acidente ou antes da chegada ao hospital, 88.5% das quais em acidentes interurbanos. O tempo de resposta médio dos EMS urbanos e rurais foi 10.7 ± 7.3 e 18.0 ± 12.6 min (p < 0.001) e o tempo de transporte médio 13.2 ± 11.7 e 45.2 ± 25.0 min (p = 0.009). O tempo de resposta superou o ótimo de 30 minutos só nas áreas mais periféricas da Extremadura, enquanto que o tempo de transporte excedeu o ótimo de 90 minutos nas regiões mais orientais de duas áreas de saúde (Cáceres e Don Benito-Villanueva). Das vítimas atendidas por EMS rurais, 19.1% foram classificadas como tendo prognóstico sério ou como tendo falecido, comparado com 11.2% (p = 0.048) das vítimas atendidas por EMS urbanos. Conclusões: A localização geográfica dos EMS na Extremadura (Espanha) garante tempos de resposta em acidentes de trânsito adequados, tanto em zonas rurais como urbanas. Porém, os tempos de transporte recomendados foram às vezes superados nas regiões mais periféricas, devido à localização dos hospitais.

Abstract Objective: To analyze the response time and transport time taken by the emergency medical services (EMS), considering their urban or rural location, to attend traffic accident casualties that occurred in the different geographical areas of Extremadura (Spain) from 2012 to 2015. Methods: This was a cross-sectional study of the data recorded by the Emergency Response Coordination Center 112 (ERCC-112) from traffic accidents attended by EMS. Response time was defined as the time elapsed from the request-for-care receipt until arrival of the EMS at the accident scene, and transport time as that from leaving the scene until arrival to the referral hospital. Rural EMS were those based in locations where there is no hospital, and urban EMS those located in towns or cities with a hospital. Results: During the 4-year period studied, 5,572 traffic accidents requested assistance through the ERCC-112. From the 2,875 accidents (51.9%) in which EMS were mobilized, 55.4% occurred in urban roads and the remaining in interurban ones. A total of 113 people (mean age 48.4 ± 19.0 years, range 15-84 years) died at the accident scene or before arrival to the hospital, 88.5% of them in interurban accidents. The average response time of urban and rural EMS was 10.7 ± 7.3 and 18.0 ± 12.6 min (p < 0.001), respectively, and the average transport time was 13.2 ± 11.7 and 45.2 ± 25.0 min (p = 0.009). Response time was longer than the 30-min optimum only in the most peripheral areas of Extremadura, while transport time exceeded the optimum of 90 min in the eastern regions of two health areas (Cáceres and Don Benito-Villanueva). 19.1% of the victims attended by rural EMS were classified as having a serious prognosis or as having died, as compared with 11.2% (p = 0.048) of those attended by urban EMS. Conclusions: The geographical location of EMS in Extremadura (Spain) guarantees adequate response times in traffic accidents, both in rural and urban areas. However, recommended transport times were occasionally exceeded in the most peripheral areas, due to hospital location.

ABSTRACT Background: Traffic accidents constitute a public health problem and are the leading cause of accidental death in the world. Analyze if the type of accident, the age of the victim or the attention provided by the emergency medicalized units (UME) are related to the morbidity and mortality due to traffic accidents in Extremadura (Spain) during the years 2012, 2013, 2014 and 2015. Methods: Descriptive study of the information in the records of the emergency response coordination center 112. A multivariate analysis was carried out. The prognostic status was introduced as a dependent variable and the type of accident, the age of the accident victims and the UME as independent variables. Results: The type of accident [odds ratio (OR)=1.745; 95% confidence interval (95% CI=1.488-2.045), the victim’s age (OR=1.016; 95% CI=1.013-1.020), UME 4-3 (OR=4.304; 95% CI=2.158-8.587), UME 4-1 (OR=2.463; 95% CI=1.414-4.291) and UME 1-4 (OR=1.990; 95% CI=1.052-3.762) are related to the prognostic status of the victims. Conclusions: Inter-urban traffic accidents, the victim’s age and three UME influence the prognostic status of the victims.

RESUMEN Fundamentos: Los accidentes de tráfico constituyen un problema de salud pública y son la principal causa de muerte accidental en el mundo. El objetivo de este trabajo fue analizar si el tipo de accidente, la edad de la víctima o la atención prestada por las unidades medicalizadas de emergencia (UME) estaban relacionados con la morbimortalidad por accidentes de tráfico en Extremadura durante los años 2012, 2013, 2014 y 2015. Sujeto y métodos: Se elaboró un estudio descriptivo de la información registrada en el Centro Coordinador de Urgencias y Emergencias-112. Se realizó un análisis multivariante, considerándose como variable dependiente el estado pronóstico y como variables independientes el tipo de accidente, la edad de los accidentados y las UME. Resultados: El tipo de accidente (odds ratio (OR)=1,745; intervalo de confianza al 95% (IC95%)=1,488-2,045], la edad de la víctima (OR=1,016; IC95%=1,013-1,020), la UME 4-3 (OR=4,304; IC95%= 2,158-8,587), la UME 4-1 (OR=2,463; IC95%=1,414-4,291) y la UME 1-4 (OR=1,990; IC95%=1,052-3,762) tuvieron relación con el estado pronóstico de las víctimas. Conclusiones: Los accidentes interurbanos, la edad de la víctima y tres UME influyen en el estado pronóstico de las víctimas.

ABSTRACT Background: Traffic accidents constitute a public health problem and are the leading cause of accidental death in the world. Analyze if the type of accident, the age of the victim or the attention provided by the emergency medicalized units (UME) are related to the morbidity and mortality due to traffic accidents in Extremadura (Spain) during the years 2012, 2013, 2014 and 2015. Methods: Descriptive study of the information in the records of the emergency response coordination center 112. A multivariate analysis was carried out. The prognostic status was introduced as a dependent variable and the type of accident, the age of the accident victims and the UME as independent variables. Results: The type of accident [odds ratio (OR)=1.745; 95% confidence interval (95% CI=1.488-2.045), the victim’s age (OR=1.016; 95% CI=1.013-1.020), UME 4-3 (OR=4.304; 95% CI=2.158-8.587), UME 4-1 (OR=2.463; 95% CI=1.414-4.291) and UME 1-4 (OR=1.990; 95% CI=1.052-3.762) are related to the prognostic status of the victims. Conclusions: Inter-urban traffic accidents, the victim’s age and three UME influence the prognostic status of the victims.

RESUMEN Fundamentos: Los accidentes de tráfico constituyen un problema de salud pública y son la principal causa de muerte accidental en el mundo. El objetivo de este trabajo fue analizar si el tipo de accidente, la edad de la víctima o la atención prestada por las unidades medicalizadas de emergencia (UME) estaban relacionados con la morbimortalidad por accidentes de tráfico en Extremadura durante los años 2012, 2013, 2014 y 2015. Sujeto y métodos: Se elaboró un estudio descriptivo de la información registrada en el Centro Coordinador de Urgencias y Emergencias-112. Se realizó un análisis multivariante, considerándose como variable dependiente el estado pronóstico y como variables independientes el tipo de accidente, la edad de los accidentados y las UME. Resultados: El tipo de accidente (odds ratio (OR)=1,745; intervalo de confianza al 95% (IC95%)=1,488-2,045], la edad de la víctima (OR=1,016; IC95%=1,013-1,020), la UME 4-3 (OR=4,304; IC95%= 2,158-8,587), la UME 4-1 (OR=2,463; IC95%=1,414-4,291) y la UME 1-4 (OR=1,990; IC95%=1,052-3,762) tuvieron relación con el estado pronóstico de las víctimas. Conclusiones: Los accidentes interurbanos, la edad de la víctima y tres UME influyen en el estado pronóstico de las víctimas.