The cardiovascular and cerebrovascular disease mortality rate increased significantly in the past 5 years. The good news is, despite high mortality in all regions, the gaps among regions became smaller and smaller. Guidelines for the primary prevention of stroke showed that changes in diet with an increased intake of total calories, fat, meat and sugar-sweetened beverages is the main determinant of high cardiovascular and cerebrovascular disease levels in China . In recent years, China’s rapid economic development, especially in the western region, has led to the great changes in diet.
The gap of injury and digestive system disease mortality among different regions was evident; the poorer western region continued to have a higher mortality rate than the richer central and eastern regions.
Road injury was identified as a leading cause of premature death in China. The research on the road traffic injury in China from Ma S, et al. showed that most road injury deaths were among pedestrians and motorcyclists . Meanwhile, a large part of residents used a motorcycle as the main method of travel in the poorer western region. In developed countries, deaths caused by digestive diseases were infrequent . However, in China, especially in the poorer regions, the acute gastrointestinal tract and infectious diseases induced by unclean food were common.
EMS utilization in the eastern region was better than that in the western and central regions. Moreover, EMS facility distribution by geography showed extreme inequity the Gini coefficient, which was overall higher than 0.5. Namely, the western and central regions were demonstrated high needs, low utilization, and low offer situations. However, the starting point of EMS fundamental should fit the needs of people. Whether China’s EMS has met patients’ needs and how to distribute EMS resources reasonably should be taken into consideration.
Unlike other medical resources, EMS requires a small service radius and emergency response time [22–24]. Of the areas with a relatively perfect emergency medical system, the emergency response time is 4 to 6 minutes in the United States, 4 minutes in Japan, and 7 to 10 minutes in Germany. As for China, the emergency response time is 12 min in Beijing, 11 min in Shanghai, and 12 min in Guangzhou. In accordance with the requirement of the National Health and Family Planning Commission of PRC, the service radius of an emergency medical sub-station is about three to five kilometers, and is decreased to some extent in the densely populated areas . In view of the high cardiovascular and cerebrovascular disease mortality rates and high growth rate in the nation as a whole, an emergency station is supposed to set very three kilometers in richer regions. Ordinarily, an emergency station is supposed to set every five kilometers. For remote, mountainous regions, problems of longer emergency response time could be made up through the popularity of CPR and other basic first-aid skills , and the training of mutual aid consciousness of the masses. In fact, the popularity of emergency knowledge should be not only implemented in remote areas, but also across the whole nation. After breathing and the heartbeat stop, the mortality rate increases by 10% for every 1 minute delayed. In 2012, Shanghai started to collocate automated external defibrillator in schools and subway stations; such a policy should be promoted nationwide.
The quality of pre-hospital emergency care can affect the outcome of the patient’s condition radically. When the emergency ambulance is equipped with an experienced physician, completed rescue equipment, and medicine, effective treatment can be provided for critically ill patients. After the vital signs become stable, the patients can be transferred to the relevant department or intensive care unit directly. According to the regional death spectrum, rescue equipment and medicine should be adapted to suit the local conditions. Through the analysis of a certain hospital’s 3210 emergency visits, Li Dengkai found that most visits only played the role of transition. Highly trained medical staff were often only given a simple dressing and bleeding and external fixation process, which is a huge waste from a health economics point of view . With the depth of medical reform, ambulance configuration has been improved. However, in poorer regions, shortage of drugs and equipment in ambulance emergencies still limits the ambulance’s ability to play a greater role. In view of the above circumstances for the poorer regions, the ambulance should be equipped with not only cross box, outer box, medical oxygen cylinders, cars stretcher, circulatory system emergency kit, emergency medicine, and vehicle-carried communication system, but also with ventilator, suction, a portable electrocardiogram machine, surgical trauma emergency kit, debridement package, gastrointestinal decompression package, antibiotics, antidotes, analgesics, local anesthetics, and hormone drugs in the western region, and ventilator, ECG monitor, automatic defibrillator, vasopressors, antihypertensive drugs, cardiac drugs, antiarrhythmic drugs, vasodilator, diuretic dehydration drugs and tracheotomy package in the central region .
With the increasing demand for EMS needs, the lack of emergency physicians recently became one of the top dilemmas. Compared to moderately developed countries that have one emergency doctor per 10,000 people, China has one emergency doctor per 110,000 people. By 2020, the shortfall of emergency physicians will increase to 131,800. The emergency physician shortage is a burning problem . In order to alleviate the current difficulties, the state implemented an additional extra marks policy in 2015 for emergency physicians in examination of medical practitioners, but this implementation is far from enough. The training and cultivation of emergency medical technicians must be improved immediately, especially in the poorer regions [30, 31]. This growth can be achieved through the following four points after studying China’s health care reform. First, in reference to Chinese rural doctor training mode with funding support from the financial sector, enrollment targets from education departments, and training resources from medical colleges to establish an emergency physician orientation cultivation [32–34]. Second, in consideration of the actual characteristics of emergency medical work, the 3-year resident standardization training should be shortened to 2 years with the residents proceeding emergency professional training in the third year . Third, favored promotion and treatment policies for emergency doctors should be formulated. Emergency medical performance bonuses should not be lower than the average level of the various departments of the hospital [32, 36]. Lastly, the health administrative departments should provide an emergency medical outflow policy to address emergency medical work problems brought on by the increase of age in consideration of the work stress in the emergency department is too high, and emergency physicians over the age of 40 can choose whether to go to the small intensity work department, which can reduce worries for emergency doctors.
There are several main limitations in this study. First, the EMS-related data in this study are derived from the Health Statistics Yearbook. The sample errors and non-sample errors in the Health Statistical Yearbook also apply this. For example, the cause of death in an out-of-hospital death case may not be accurately accounted for. Second, gender equity is an important component in health services analysis, but due to the limitations of data sources, we have not been able to obtain data on emergency medical services for patients of different genders, so this study is not able to compare the equity of emergency medical services from the gender perspective. Third, from 2010 to 2012, the National Disease Surveillance System reported the mortality of cardiovascular and cerebrovascular diseases. From 2013 to 2014, the mortality rates of heart disease and cerebrovascular disease were reported separately. In this case, the death rate of heart disease and cerebrovascular disease were added together to represent the mortality of cardiovascular and cerebrovascular diseases in that year.