Introduction We noticed that COPD patients travelling long distances to our rural ED arrived in a worse condition than those living nearby. We suspected this might be due to oxygen-driven nebulisers en route: high-flow oxygen during transfer is known to increase COPD mortality.
Methods We conducted a retrospective chart review of ED patients who arrived by ambulance and were admitted with exacerbations of COPD December 2010–March 2011.
▸ 42/114 lacked ambulance records, leaving 72 cases for analysis.
▸ We calculated the NHS Early Warning Score (NEWS) on ambulance arrival at scene (“pickup”), and on arrival in ED (“arrival”), and plotted this against distance to hospital.
Results Mean NEWS score on pickup and arrival showed a gradual linear increase (6/7 to 8/9) with increasing distance from hospital.
▸ Pickup and arrival scores were similar except for patients travelling >35 miles (n=4) whose NEWS rose from 6–8 to 12.
Discussion These results support our observation that COPD patients living a long way from hospital are sicker on arrival in ED: but they are sicker to start with. Almost everyone arrives at hospital approximately as sick as they were on ambulance arrival, the exception being a small subgroup living furthest from the hospital (35–40 miles).
Our data are retrospective and preliminary: numbers are too small for statistical analysis. However, they suggest that COPD patients in rural areas are already sicker—possibly seeking help later—than those living nearby. A larger study is needed to confirm these results and investigate why: is it rural GPs, their patients, or both, who have a higher threshold for hospital admission than those living closer?
Rural PHEM service planners should consider that paramedics in rural areas not only have longer transport times to hospital, but may also be caring for sicker patients than their urban counterparts.
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