• Matthieu Heidet, Benoit Frattini, Daniel Jost, Éric Mermet, Wulfran Bougouin, Xavier Lesaffre, Mathys Wohl, Eloi Marijon, Alain Cariou, Xavier Jouven, Florence Dumas, Éric Lecarpentier, Charlotte Chollet-Xémard, Julien Vaux, Mehdi Khellaf, Sami Souihi, Benoît Vivien, Sean Sinden, Brian Grunau, Stéphane Travers, and Étienne Audureau.
• Assistance Publique - Hôpitaux de Paris (AP-HP), SAMU 94.
• Eur J Emerg Med. 2025 Feb 1; 32 (1): 526152-61.

Background And ImportanceProlonged emergency medical services' response times (EMS-RT) are associated with poorer outcomes in out-of-hospital cardiac arrest (OHCA). The patient access time interval (PATI), from vehicle stop until contact with patient, may be increased in areas with low socioeconomic status (SES).ObjectivesThe objective of this study is to identify predictors of prolonged EMS-RT intervals, and to evaluate associations with clinical outcomes in OHCAs occurring in the largest metropolitan area in France.DesignUsing the Utstein-style, prospectively implemented, population-based SDEC registry for OHCAs, we conducted a multicenter, region-wide, retrospective cohort study of EMS dispatches for OHCA cases occurring in the 124 cities of the Greater Paris area, France, between January 1, 2017 and December 31, 2018.Settings And ParticipantsAdult, nontraumatic, EMS-assessed, non-EMS witnessed OHCAs.ExposureGeographic location and scene-level SES.Outcome Measures And AnalysisThe primary outcome was the EMS-RT interval, from activation until arrival at patient's side. As secondary outcomes, we evaluated patient access outcomes of: (1) dispatch-to-patient contact interval ('EMS-RT'); and (2) vehicle scene arrival-to-patient contact interval (PATI); and patient clinical outcomes of: (1) death; and (2) unfavorable neurological status, both at 30 days. Area-level SES was assessed at census tract level using the European Deprivation Index (EDI; continuous, and divided into quintiles, Q5 = most deprived). We fitted multilevel mixed-effects regression models to identify predictors of patient access outcomes, and their association with clinical outcomes.Main ResultsWe included 4082 cases; the median EMS-RT was 10.85 min (interquartile range [8.87-13.15]), and 138 (3.4%) survived to hospital discharge. Independent predictors of increased EMS-RT and PATI were age >65, female sex, residential location, occurrence at elevated floors, arrest unwitnessed by a bystander, and low EDI (all P < 0.018). After multivariable analysis, an overall EMS-RT interval >8 min was associated with higher mortality and poorer neurological status at hospital discharge (both P < 0.001).ConclusionIn OHCA cases occurring in the Greater Paris metropolitan area, after adjustment for scene characteristics, EMS delays until patient contact were longer in neighborhoods of low SES, and were associated with poorer clinical outcomes.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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