Evidence map›Paper›PMID 41575003›Full record

ArticleTransfusion2026

Unequal access to timely care: Geographic variation in prehospital time among injured patients at risk of hemorrhagic shock.

Pawan Acharya, Timothy Hurson, Chandler Annesi, Christine Carico, Daniel Lammers, N Clay Mann, Matthew Levy, Molly P Jarman, Jeffrey D Kerby, Jan O Jansen and 2 more

Abstract read
In one paragraph

Article in Transfusion, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Pawan AcharyaDivision of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.ORCID https://orcid.org/0000-0003-1731-3196
Timothy HursonDivision of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.ORCID https://orcid.org/0009-0007-5614-183X
Chandler AnnesiDivision of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Christine CaricoDivision of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.ORCID https://orcid.org/0000-0001-7426-8200
Daniel LammersDivision of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.ORCID https://orcid.org/0000-0002-9489-3633
N Clay MannDepartment of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Matthew LevyDepartment of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.ORCID https://orcid.org/0000-0001-8144-3281
Molly P JarmanCenter for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Jeffrey D KerbyDivision of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Jan O JansenDivision of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
John B HolcombDivision of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.ORCID https://orcid.org/0000-0001-8312-9157
Zain G HashmiDivision of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Funding

Mitigating Injury Disparities with Evidence Based Trauma Systems PlanningR01MD019121 · NIMHD · BRIGHAM AND WOMEN'S HOSPITAL · PI Molly Price Jarman · 2023 to 2026
$4.2M
Disasters and Hospital Systems Serving Populations That Experience Health Disparities: Identifying the Long Term effects of Pandemics and Disasters in Order to Mitigate Future ChallengesR01MD016910 · NIMHD · BRIGHAM AND WOMEN'S HOSPITAL · PI Eric Goralnick, Joel S. Weissman · 2023 to 2026
$2.7M
Health Impacts of Prehospital Pain Management for Injured Older AdultsK01AG065414 · NIA · BRIGHAM AND WOMEN'S HOSPITAL · PI JARMAN, MOLLY PRICE · 2020 to 2024
$582k
National Institute of Allergy and Infectious DiseasesNational Institutes of Health Stimulating Access to Infectious Diseases Research in Residency 1R38AI174267NIA NIH HHS K01AG065414NIMHD NIH HHS R01MD016910NIMHD NIH HHS R01MD019121U.S. Air Force FA864922P0702U.S. Department of Defense HU00012120089U.S. Department of Defense HU00012320020U.S. Department of Defense HU00012320021U.S. Department of Defense W81XWH-16-D-0024/W81XWH20F0383
6 · The paper itself

Abstract

backgroundHemorrhage remains the leading cause of preventable traumatic deaths, with many fatalities occurring before hospital arrival. Although geographic differences in prehospital time (PHT) are recognized, contemporary national estimates and their implications for resuscitation readiness are not well defined. This study aimed to characterize geographic variation in PHT among trauma patients at risk of hemorrhagic shock to inform strategies for earlier intervention. STUDY DESIGN AND

methodsWe analyzed 2020-2023 data from the National Emergency Medical Services (EMS) Information System (NEMSIS) and included trauma patients aged ≥16 years at risk of hemorrhagic shock, defined as shock index (heart rate/systolic blood pressure) ≥1 at the scene. PHT was defined as the interval from dispatch to hospital arrival and compared across urbanicity (urban, suburban, rural, wilderness) and transport mode (ground or air).

resultsAmong 939,335 eligible encounters, the median prehospital time (PHT) differed significantly across urbanicity categories, increasing progressively from urban to wilderness regions (urban 39 min [IQR 30-51], suburban 45 [32-63], rural 50 [34-71], wilderness 56 [37-78]; p < .001). All three components of PHT-system response, scene, and transport time-were longer in rural and wilderness. Total PHTs remained stable, with only minor year-to-year variation. Air PHT was consistently longer than ground PHT (p < .001) and showed no temporal improvement across 2020-2023. DISCUSSION: National EMS data show persistently prolonged prehospital times for trauma patients at risk of hemorrhagic shock, especially in rural and wilderness areas. Bringing transfusion capability closer to patients through prehospital blood programs may be critical to reducing time-dependent mortality.

Indexed as

Emergency Medical ServicesHealth Services AccessibilityShock, HemorrhagicTime-to-TreatmentWounds and InjuriesAdultAgedFemaleHumansMaleMiddle AgedTime FactorsTreatment Delayblood transfusionemergency medical serviceshemorrhagic shockprehospital caretransport timetrauma systems

Identifiers

PMID41575003
PMCPMC13184426

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.