The Effects of Cellular Coverage on Patient Survival in the Rural Setting

Introduction—Cellular coverage is an essential element that contributes to the success of communication among patients, emergency dispatch centers, and first responders. Coverage is substantially limited and unreliable in rural regions compared to urban centers. Cellular telephones have largely replaced traditional landlines, with fewer than 40% of households with a dedicated landline telephone. Given the time-sensitive nature of EMS calls, this puts residents of rural communities at a disadvantage in regard to prehospital treatment and ultimate survival of cardiac arrest events. Patients in poor cellular coverage areas may be at an increased risk of death-on-arrival (DOA) status on arrival of EMS.

Objective—To review the effects of cellular coverage on DOA status on arrival of EMS.

Methods—A medium-size rural North Carolina county (located within a metropolitan statistical area) reported EMS call data from January 2015 through December 2017. Patients with a primary dispatch disposition of “cardiac arrest” were included. Multivariate logistic regression with time-fixed effects was conducted. Control variables included mean age, sex proportion, minority proportion, poverty rate, and median home price at the zip code level. To quantify cellular coverage, GIS (geographic information system) analyses were performed on publicly available cellular coverage maps and grouped into four categories: excellent, above average, below average, and poor.

Results—There were 532 cardiac arrest patients who met inclusionary criteria, with a DOA of EMS rate of 37%. Overall 21% of patients were located in areas with excellent cellular coverage and 29% in poor cellular coverage areas. Statistical analysis revealed a negative correlation between cellular coverage and DOA status. Patients in poor coverage areas were 64% more likely to be DOA (OR 1.6409; 95% CI, 0.3614–1.0276, p=0.063) than those in an excellent coverage area. This finding is statistically significant at a 10% alpha level.

Conclusion—Cardiac arrest is an incredibly time-sensitive condition, and patient survival is highly dependent on how quickly treatment arrives. Rural areas, such as the county in this study, disproportionately experience limited cellular coverage. The results of this study show that patients in rural areas are at an unnecessarily increased risk of cardiac arrest death prior to arrival of EMS. Further study is needed to expand the geographic area of analysis and drive policy change within the telecommunications sector.