So close, yet so far: Understanding the relationship between ambulance mobilisation times and survival from out-of-hospital cardiac arrest in rural Western Australia

Ashlea Smith; David Majewski; Gavin Pereira; Jason Belcher; Karen Stewart; Judith Finn; Stephen Ball

doi:10.1016/j.auec.2025.06.010

So close, yet so far: Understanding the relationship between ambulance mobilisation times and survival from out-of-hospital cardiac arrest in rural Western Australia

Australas Emerg Care. 2025 Jul 1:S2588-994X(25)00047-8. doi: 10.1016/j.auec.2025.06.010. Online ahead of print.

Authors

Ashlea Smith¹, David Majewski², Gavin Pereira³, Jason Belcher⁴, Karen Stewart⁴, Judith Finn⁵, Stephen Ball⁶

Affiliations

¹ Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia; St John Western Australia, Western Australia, Australia. Electronic address: ashlea.smith3@postgrad.curtin.edu.au.
² Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia.
³ Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.
⁴ St John Western Australia, Western Australia, Australia.
⁵ Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia; St John Western Australia, Western Australia, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Emergency Medicine, Medical School, The University of Western Australia, Perth, Australia.
⁶ Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia; St John Western Australia, Western Australia, Australia.

PMID: 40603205
DOI: 10.1016/j.auec.2025.06.010

Abstract

Background: Internationally, rural areas tend to have prolonged emergency medical service (EMS) response times, associated with a lower survival from out-of-hospital cardiac arrest (OHCA). We examined how the components of EMS response time to OHCA vary according to rurality in Western Australia (WA), and estimated the effect that reducing rural mobilisation times might have on OHCA survival.

Methods: Using a retrospective cohort of medical OHCAs in WA with EMS-resuscitation attempted, from 2015 to 2022, we compared the components of response time (Triage, Mobilisation, Travel to the scene and Total Response), stratified by regional remoteness and proximity to nearest town. Using only the rural subgroup, we then used counterfactual simulation methodology to estimate the number of 30-day survivors if response times were reduced in rural areas.

Results: Total EMS response time increased with increasing regional remoteness. Mobilisation time also increased with regional remoteness, even among OHCAs occurring within towns; in rural areas, median mobilisation time was 3.32 mins (1.43, 10.00) (mean 6.24, sd 6.61), with metropolitan areas having a median of 0.97 mins (0.63, 1.48) (mean 1.43, sd 2.65). If rural areas had the same mean mobilisation time as metropolitan areas, the relative increase in the estimated number of rural survivors (16.9 %) was not statistically significant.

Conclusion: Mobilisation times were significantly longer in rural areas of WA than metropolitan. These results demonstrate that the effects of rurality on OHCA response time are not simply due to rural patients having increased distance from emergency services. Efforts to improve rapid bystander interventions may be particularly beneficial in rural towns for the crucial minutes before EMS personnel arrive.

Keywords: Cardiac arrest; Emergency medical services; Emergency medicine; Epidemiology; Rural Health Services; Rural health.