ORIGINAL ARTICLE Improving Rural Emergency Medical Service Response Time With Global Positioning System Navigation Richard P. Gonzalez, MD, Glenn R. Cummings, MBA/HCM, RN, Madhuri S. Mulekar, PhD, Shana M. Harlan, MSN, and Charles B. Rodning, MD, PhD Objective: Rural emergency medical services (EMS) often serves expansive areas that many EMS personnel are unfamiliar with. EMS response time is increased in rural areas, which has been suggested as a contributing factor to increased mortality rates from motor vehicle crashes (MVCs) and nontrau- matic emergencies. The purpose of this study was to assess the effect of a global positioning system (GPS) on rural EMS response time. Methods: GPS units were placed in ambulances of a rural EMS provider. The GPS units were set for fastest route (not shortest distance) to the scene that depends on traffic lights and posted road speed. During a 1-year period from September 2006 to August 2007, EMS response time and mileage to the scene were recorded for MVCs and other emergencies. Response times and mileage to the scene were then compared with data from the same EMS provider during a similar 1-year period when GPS technology was not used. EMS calls less than 1-mile were removed from both data sets because GPS was infrequently used for short travel distances. Results: During the 1-year period before utilization of GPS, 893 EMS calls greater than 1 mile were recorded and 791 calls recorded with GPS. The mean EMS response time for MVCs was 8.5 minutes without GPS and 7.6 minutes with GPS (p  0.0001). When MVCs were matched for miles traveled, mean EMS response time without GPS was 13.7 minutes versus 9.9 minutes with GPS (p  0.001). Conclusion: GPS technology can significantly improve EMS response time to the scene of MVCs and nontraumatic emergencies. Key Words: Rural trauma; Global positioning system; GPS; Response time; EMS; Motor vehicle crashes. (J Trauma. 2009;67: 899 –902) M ortality rates from rural vehicular trauma have been shown to be significantly higher than mortality rates in urban areas. 1– 4 Rural emergency medical services (EMS) re- sponse time and total EMS prehospital time have been shown previously to be contributing factors to the higher mortality rates. 3–5 Grossman et al. 5 found EMS response time to be greater in the rural setting. The Center for the Study of Rural Vehicular Trauma at the University of South Alabama has recently shown significant correlation between EMS response time and rural vehicular mortality. 3,4 The factors contributing to increased rural EMS response time are EMS availability, increased travel dis- tances, and EMS unfamiliarity with remote rural areas. In contrast to their urban counterparts, rural EMS providers must often travel long distances to provide care in emergencies, which contributes to increased prehospital time. Long travel distances are often unavoidable in rural areas because of paucity of EMS providers in large geographical areas. Although these long dis- tances are unavoidable, the time taken to travel these distances can be optimized with concrete knowledge of the destination and quickest route to the destination. Unnamed roads and roads that are unfamiliar to EMS providers can be identified with geo- graphical coordinates using global positioning system (GPS) technology and GPS-mapping software that recognizes names of roads. Furthermore, GPS technology can provide quickest route to a destination, though it is often not the shortest distance. Quickest routes to a destination often involve longer distances on roads with higher speed limits and fewer traffic lights. The purpose of this study was to evaluate whether GPS technology could improve EMS response time to rural vehicular crashes and nontraumatic emergencies. METHODS The Center for the Study of Rural Vehicular Trauma at the University of South Alabama selected and contracted with a rural EMS provider in Alabama for this prospective study of GPS technology effect on response time. The EMS provider was the only EMS provider in a rural county of Southwest Alabama and operated out of one ambulance station. The entire county was considered rural as defined by the United States Bureau of Census definition. 4,6 GPS units (Garmin; Streetpilot 7200, Olathe, KS) were placed in the ambulances of the EMS pro- vider. Six ambulances were outfitted with GPS units. Individual EMT-basics and EMT-paramedics were trained on the use of the GPS units before initiation of the study. The individual GPS units were set for fastest route to the scene rather than shortest distance. Fastest route to the scene is dependent on the number of traffic lights encountered en route and posted road speed. During the 1-year period from September 2006 through August 2007, data were prospectively collected with utilization of GPS Submitted for publication January 5, 2009. Accepted for publication August 14, 2009. Copyright © 2009 by Lippincott Williams & Wilkins From the Department of Surgery (R.P.G., G.R.C., S.M.H., C.B.R.), Center for the Study of Rural Vehicular Trauma, and Department of Mathematics and Statistics (M.S.M.), University of South Alabama, Mobile, Alabama. Presented as a poster at the 22nd Annual Meeting of the Eastern Association for the Surgery of Trauma, January 13–17, 2009, Lake Buena Vista, Florida. This work was performed under a cooperative agreement with the United States Department of Transportation/National Highway Traffic Safety Administra- tion (USDOT/NHTSA). Views expressed are those of the authors and do not represent the views of the sponsors or NHTSA. Address for reprints: Richard Gonzalez, MD, Department of Surgery, University of South Alabama, 2451 Fillingim St., Mobile, AL 36617; email: rgonzalez@ usouthal.edu. DOI: 10.1097/TA.0b013e3181bc781d The Journal of TRAUMA ® Injury, Infection, and Critical Care • Volume 67, Number 5, November 2009 899