ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2025
Rural-urban differences in emergency medical services bypass routing of stroke in North Carolina.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
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Who cites it
5 citing papers in PubMed.
- Bypass of Local Surgical Care in North Carolina: Patient-Directed Care Destination and Utilization.The American surgeon · 2026Article
- Stroke Survivor and Caregiver Perspectives on Seeking Emergency Medical Care.Journal of patient experience · 2026Article
- Rural-Urban Differences in Emergency Department Choice for Children With Medical Complexity, 2012-2017.Pediatric emergency care · 2025Article
- The five-link theory for improving the integrated and balanced development of emergency medical care in urban and rural areas.Journal of global health · 2025Article
- Rural Emergency Medical Services Perspectives on Improving Acute Stroke Care: A Qualitative Study.Prehospital emergency care · 2025Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
purposeAcute stroke is a serious, time-sensitive condition requiring immediate medical attention. Emergency medical services (EMS) routing and direct transport of acute stroke patients to stroke centers improves timely access to care. This study aimed to describe EMS stroke routing and transports by rurality in North Carolina (NC).
methodsWe conducted a retrospective study using existing data on EMS transports of suspected stroke patients in NC in 2019. The primary study outcome was EMS bypass of the nearest hospital for transport to a nonnearest hospital, determined by geographic information systems (GIS) analysis. Incident addresses were geocoded to census tracts and classified as urban, suburban, or rural by Rural-Urban Commuting Area codes. We compared the frequency of bypass and estimated additional transport times by urban, suburban, and rural incident locations.
findingsOf 3666 patients, 1884 (51%) EMS transports bypassed the nearest hospital. Bypass occurred less often for rural EMS incidents (39%) compared to those in urban (57%) and suburban (63%) tracts. The estimated additional transport time for rural bypasses of nonendovascular-capable stroke centers for endovascular-capable stroke centers was a median of 25 min (interquartile range 13-33).
conclusionsUsing GIS analysis, we found nearly half of EMS transports of suspected stroke patients in NC bypassed the nearest hospital, including noncertified hospitals and stroke centers. Bypasses occurred less often in rural areas, though incurred significantly longer transport times, compared to urban areas. These findings are important for regional stroke system planning, especially for improving rural access to acute stroke care.
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