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Background: Emergency medical services play a key role in the healthcare system. An ageing population, economic challenges, and technological advances require emergency prehospital care to be flexible, efficient, and equal. We investigated emergency ambulance services in Västerbotten County, a sparsely populated region in northern Sweden, with the aim of understanding the spatio-temporal distribution of alarms and identifying factors that explain the response times of priority-1 alarms.

Methods: We analysed 11,764 priority-1 alarms between 2022 and 2023 in Västerbotten County. The spatial and temporal distributions of the alarms were examined at various levels of aggregation, with a particular focus on age and gender. Response times were investigated together with its three components: dispatch time, preparation time, and travel time. Multivariate regression was used to analyse the components, considering six binary factors: age, gender, alarm location, season, time of the day, and day of the week.

Results: The alarm incidence increased with age, with a sharp increase around 60–70 years of age, where the increase in alarm incidence was 13% (p 0.001) higher among men than women. The alarm incidence varied significantly over time, with the highest frequencies observed during daytime, weekdays, and winter season. The county’s median response time for priority-1 (MRT1) alarms was 14.6 minutes, with high variation between municipalities and even larger differences across rural, suburban, and urban districts. Elderly patients (60+) had 10% (p 0.001) longer MRT1 than younger patients (0–59). This resulted from elderly patients having longer dispatch and travel times, which could be attributed to the location of alarms. Interestingly, regardless of age, women had approximately 8% (p 0.001) longer dispatch times than men.

Conclusion: From the age of 60, alarm incidence increases substantially, with a greater rise among men than women. A central finding of this study is that the EMS process times, including response times, are associated with the age and gender of the patients. These results are partly attributed to the spatial distribution of the alarms, but for the dispatch time the gender and age differences are arguably causal. Hence, an ageing population will result in more alarms and potentially longer missions, which will demand flexible and efficient EMS systems.