Trends and Characteristics in Pre-Hospital Emergency Care in Beijing from 2008 to 2017
Pre-hospital emergency care is a critical component of the emergency medical service (EMS) system and serves as an important indicator of a society’s overall medical service level. In Beijing, the EMS system has faced significant challenges, including insufficient resources, wasted EMS capacity, and prolonged response times. This study aims to provide a comprehensive analysis of pre-hospital EMS in Beijing from 2008 to 2017, focusing on trends in EMS demand, emergency response times (ERT), and the disease spectrum. The findings are intended to inform government and medical institutions in optimizing EMS services.
Background and Context
Beijing’s EMS system, developed in the 1980s, is managed by two primary centers: the Beijing Emergency Center (emergency call number: 120) and the Beijing Red Cross Emergency Center (emergency call number: 999). These centers are responsible for all pre-hospital emergency medical care in the city. Over the past decade, Beijing has experienced rapid population growth and economic development. By the end of 2017, the population had reached 21.71 million, with a gross domestic product exceeding 2.8 trillion Chinese Yuan, reflecting increases of 28.1% and 152.3%, respectively, over the 10-year period. This growth, coupled with lifestyle changes, increased traffic, environmental pollution, and public health emergencies, has significantly impacted the demand for emergency care and posed challenges to the pre-hospital EMS system.
Methods and Data Collection
This study collected pre-hospital emergency data from 2008 to 2017 from the databases of the Beijing Emergency Medical Center and the Beijing Red Cross Emergency Center. The chief complaint in each case was classified according to the Medical Priority Dispatch System (MPDS). The geographic locations of the emergency sites were determined through geo-encoding of addresses and classified into four functional regions: Core Functional Region (Dongcheng and Xicheng districts), Function Expanding Region (Chaoyang, Haidian, Fengtai, and Shijingshan districts), Urban Development Region (Tongzhou, Shunyi, Daxing, Changping, and Fangshan districts), and Ecological Conservation Region (Mentougou, Pinggu, Huairou, Miyun, and Yanqing districts).
The study analyzed trends in EMS demand, ERT, and the disease spectrum across Beijing and within each functional region. Emergency care-related times, including active response time (ART), passive response time (PRT), and ERT, were also examined. ART was defined as the time from the emergency call to ambulance departure, PRT as the time from ambulance departure to arrival at the scene, and ERT as the total time from the emergency call to arrival at the scene.
Results
EMS Demand and Population Growth
From 2008 to 2017, a total of 4,192,870 pre-hospital EMS cases met the inclusion criteria. The demand for EMS increased significantly by 51.60%, from 311,422 cases in 2008 to 472,113 cases in 2017. This increase was positively correlated with population growth (r = 0.946, P < 0.001). However, the EMS demand rate per 100,000 population remained relatively stable, with 1907.05 in 2008 and 2172.23 in 2017 (P = 0.57).
Across the functional regions, the Function Expanding Region, Urban Development Region, and Ecological Conservation Region all experienced significant increases in EMS demand (P < 0.001). In contrast, the Core Functional Region saw stable demand from 2008 to 2017 (P = 0.723). The EMS demand rate per 100,000 population was significantly higher in the Core Functional Region compared to the other regions.
Emergency Response Times
ERT increased significantly from 19.18 minutes in 2008 to 24.51 minutes in 2016 (P = 0.001). However, in 2017, ERT decreased to 22.26 minutes. ART remained relatively stable, averaging 4.42 minutes in 2008 and 4.91 minutes in 2017 (P = 0.33). PRT, on the other hand, increased from 14.75 minutes in 2008 to 19.76 minutes in 2016 (P = 0.006) before decreasing to 17.35 minutes in 2017. The cumulative probability distribution for ERT showed that 10% of emergency cases were reached in 8.13 minutes, while 25%, 50%, 75%, and 90% were reached in 12.32, 18.32, 28.73, and 43.35 minutes, respectively.
Disease Spectrum and Functional Regions
The disease spectrum of pre-hospital EMS cases changed significantly over the study period. According to the MPDS classifications, the top five illness categories were sick person, heart problems, traumatic injuries, traffic/transportation incidents, and unconscious/fainting, accounting for 18.33%, 12.65%, 11.07%, 8.72%, and 8.51% of the total demand, respectively. The demand for 14 types of diseases increased significantly, while the demand for 19 types remained stable. Only the demand for cardiac or respiratory arrest/death decreased.
Injury-related diseases, including animal bites/attacks, burns, electrocution, traumatic injuries, and traffic/transportation injuries, accounted for a significant proportion of EMS demand. In 2017, injury-related cases numbered approximately 90,000, representing 20% of all pre-hospital EMS cases. The demand rate for injury-related diseases decreased in the Core Functional Region but increased in the sub-urban regions.
Cases of heart problems and stroke/transient ischemic attack (TIA) also increased significantly. Heart problem cases rose from 37,157 in 2008 to 58,264 in 2017, accounting for 12.34% of pre-hospital care in 2017. The demand rate for heart problems was highest in the Core Functional Region and remained stable over the study period. Stroke/TIA cases increased from 4,653 in 2008 to 12,594 in 2017, with the highest demand rate in the Core Functional Region. The demand rate for stroke/TIA increased significantly in the Ecological Conservation Region, surpassing the rates in the Urban Development Region and Function Expanding Region.
Discussion
Key Findings and Implications
The study highlights four key findings: First, pre-hospital EMS demand in Beijing increased significantly, driven primarily by population growth. Second, ERT was significantly prolonged, exceeding both international and domestic standards. Third, the disease spectrum of pre-hospital EMS changed markedly, with injury-related diseases and cardio-cerebrovascular diseases accounting for a large proportion of the demand. Finally, the characteristics and trends in EMS demand varied across the four functional regions.
Interpretation of Findings
The increase in pre-hospital EMS demand in Beijing is closely associated with population growth, aging, and improved health consciousness. The city’s population increased by 33% over the study period, and life expectancy rose by 2 years, reaching 82.15 years in 2017. An aging population, coupled with economic development and lifestyle changes, has contributed to the growing demand for EMS services.
The prolonged ERT in Beijing is a significant concern. While ART remained stable, PRT increased significantly, reflecting challenges such as traffic congestion and the need for more emergency stations. In 2016, Beijing’s ERT reached 24.51 minutes, compared to 6.0 minutes in Tokyo, 6.8 minutes in Seoul, and 7.0 minutes in Taipei. This disparity underscores the need for multi-sector efforts to reduce response times, including increasing the number of emergency stations and improving traffic management.
The changing disease spectrum reflects the evolving health challenges in Beijing. Injury-related diseases, particularly traffic injuries, accounted for a significant proportion of EMS demand, highlighting the impact of increased vehicle ownership and traffic volume. Cardio-cerebrovascular diseases, including heart problems and stroke/TIA, also saw significant increases in demand, reflecting the aging population and lifestyle changes.
Regional Differences
The study revealed significant differences in EMS demand across Beijing’s functional regions. The Core Functional Region, characterized by high population density and urbanization, had the highest EMS demand rate, which remained stable over the study period. In contrast, the Function Expanding Region, Urban Development Region, and Ecological Conservation Region experienced significant increases in EMS demand, driven by population growth and development. The demand rate for injury-related diseases decreased in the Core Functional Region but increased in the sub-urban regions, while the demand rate for heart problems and stroke/TIA was highest in the Core Functional Region and increased significantly in the Ecological Conservation Region.
Limitations
The study has several limitations. First, data documentation and entry were not standardized, potentially introducing bias. Second, incomplete documentation of emergency times may have affected the accuracy of the results. Third, the retrospective classification of cases according to the MPDS may have introduced inconsistencies. Finally, the lack of data on on-site treatment and subsequent in-hospital care limits the study’s ability to fully assess the EMS system’s effectiveness.
Conclusion
Pre-hospital EMS demand in Beijing has increased significantly, and the current system struggles to meet patients’ needs, particularly in terms of response times. To address these challenges, more funding and resources are needed for pre-hospital EMS, along with closer multi-sector cooperation. The allocation of EMS resources should be tailored to the changing disease spectrum and regional differences. The findings of this study can inform the construction and improvement of emergency systems in other large cities in China and beyond.
doi.org/10.1097/CM9.0000000000000770
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