Trends and characteristics in pre-hospital emergency care in Beijing from 2008 to 2017

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Trends and characteristics in pre-hospital emergency care in Beijing from 2008 to 2017

Beijing, a global city of over 21 million people, has undergone dramatic growth over the past decade: its population rose by 28% and GDP by 152% between 2008 and 2017. But as the city expanded, so did the demand for pre-hospital emergency medical services (EMS)—the critical care provided before a patient reaches a hospital. How has Beijing’s EMS system kept pace with this growth? A 10-year study by researchers from Peking University and Beijing’s emergency centers offers answers, with findings that could help optimize care for millions of residents.

What We Studied

The team analyzed data from Beijing’s two pre-hospital EMS systems—the Beijing Emergency Center (120) and Beijing Red Cross Emergency Center (999)—covering every emergency call from 2008 to 2017. To ensure accuracy, they:

  • Excluded duplicate records, canceled calls, and cases with missing or unclassifiable information.
  • Used the Medical Priority Dispatch System (MPDS), a global standard, to categorize chief complaints (e.g., heart problems, trauma, strokes).
  • Split Beijing into four functional regions to compare demand:
    1. Core Functional Region: Dongcheng/Xicheng (central, urbanized).
    2. Function Expanding Region: Chaoyang/Haidian/Fengtai/Shijingshan (suburban but developed).
    3. Urban Development Region: Tongzhou/Shunyi/Daxing/Changping/Fangshan (growing suburbs).
    4. Ecological Conservation Region: Mentougou/Pinggu/Huairou/Miyun/Yanqing (rural outskirts).

They focused on three key questions:

  1. How has EMS demand changed?
  2. Are emergency response times (ERT) meeting standards?
  3. What diseases are driving the most calls—and how does this vary by region?

Key Findings

1. EMS Demand Grew 51%—Tied to Population Growth

Total pre-hospital EMS cases jumped from 311,422 in 2008 to 472,113 in 2017—a 51.6% increase. The rise directly mirrored Beijing’s population growth (r=0.946, p<0.001), meaning more people = more calls. However, the demand rate per 100,000 residents stayed stable (1,907 in 2008 vs. 2,173 in 2017), suggesting the system is handling growth proportionally—for now.

Regional differences stood out:

  • Core Functional Region: Demand stayed flat (no population growth).
  • Suburbs (Function Expanding, Urban Development, Ecological Conservation): Demand surged (p<0.001) as more people moved outward.
  • The Core Region had the highest demand rate (per 100k) by far—reflecting its dense, aging population.

2. Emergency Response Times Are Too Long

Response time—from call to ambulance arrival—is a make-or-break factor for survival (e.g., cardiac arrest requires care within 8 minutes). Beijing’s ERT increased significantly from 19.2 minutes in 2008 to 24.5 minutes in 2016 (p=0.001), before dipping to 22.3 minutes in 2017.

Why the delay? Two factors:

  • Active Response Time (ART): Time from call to ambulance departure (stable at ~5 minutes—no issue here).
  • Passive Response Time (PRT): Time from departure to arrival (grew from 14.8 minutes in 2008 to 19.8 minutes in 2016).

PRT is driven by traffic congestion (Beijing has 5.9 million vehicles) and insufficient emergency stations. For context:

  • Tokyo (half Beijing’s population, 1/8 its size) has 229 ambulance stations—fewer than Beijing’s 290, but covers a smaller area.
  • Seoul’s ERT is 6.8 minutes—1/3 of Beijing’s 2016 peak.

Beijing’s ERT also exceeds China’s national standard of 15 minutes—a critical gap for time-sensitive emergencies like heart attacks or severe trauma.

3. Disease Spectrum Shifts: More Injuries, Heart Issues, and Strokes

The types of emergencies driving calls changed dramatically over 10 years:

  • Injury-related diseases (e.g., traffic accidents, burns, falls) became the largest category—accounting for 20% of all calls by 2017 (up from ~21% in 2008, but with more cases: 65,650 to ~90,000).
  • Heart problems (e.g., chest pain, arrhythmias) rose by 57% (37,157 to 58,264 cases).
  • Strokes/transient ischemic attacks (TIAs) more than doubled (4,653 to 12,594 cases).

Only one category decreased: cardiac/respiratory arrest/death—likely due to better prevention or earlier care.

Regional Disease Trends

  • Injuries: Demand dropped in the Core Region but surged in the Ecological Conservation Region (rural outskirts), surpassing all other regions by 2014. More people in suburbs = more traffic and workplace injuries.
  • Heart Problems/Strokes: Demand was highest in the Core Region (aging population) but grew fastest in the Ecological Conservation Region—suggesting rural areas need more cardiac care resources.

Why This Matters

Beijing’s EMS system faces two overlapping challenges:

  1. Aging Population: Life expectancy in Beijing rose to 82.15 years in 2017—older adults are more likely to need EMS for heart issues, strokes, or falls.
  2. Urban Sprawl: As people move to suburbs, demand shifts from the Core Region to areas with fewer emergency stations and more traffic.

The government has taken steps to improve EMS:

  • Unifying the 120 and 999 dispatch systems (calls automatically transfer if unanswered).
  • Increasing funding for ambulances and training.
  • Publishing Beijing Pre-Hospital EMS Regulations to standardize care.

But gaps remain: Response times are still too long, and resources aren’t evenly distributed across regions.

What Comes Next

The study’s authors highlight three priorities for Beijing’s EMS:

  1. Shorten Response Times: Build more emergency stations in growing suburbs and reduce traffic delays (e.g., dedicated ambulance lanes).
  2. Regionalize Resources: Allocate more EMS staff and stations to areas with rising demand (e.g., Ecological Conservation Region for injuries, Core Region for heart care).
  3. Address Disease Trends: Expand trauma care (for traffic injuries) and cardiac/stroke prevention (for aging populations).

Limitations to Note

Like all studies, this one has constraints:

  • Data Quality: Some records had missing time or classification info.
  • Retrospective Classification: The MPDS wasn’t used in Beijing during the study, so the team classified cases after the fact—possible minor errors.
  • No On-Site Treatment Data: The study didn’t track what care was provided in ambulances, so it can’t measure treatment effectiveness.

Final Takeaways

Beijing’s pre-hospital EMS system has grown with the city—but it needs to adapt smarter, not just bigger. The 10-year data show clear trends: more demand in suburbs, longer travel times, and a shift toward injury and cardiac care. By focusing on regional needs and reducing response times, Beijing can ensure its EMS system keeps pace with its growing population—saving more lives in the process.

This study isn’t just for Beijing: It’s a blueprint for other fast-growing cities in China and around the world, where EMS systems must balance growth with quality care.

Chinese Medical Journal 2020;133:1268–1275. doi: 10.1097/CM9.0000000000000770
Original study by Wei Huang et al., Peking University People’s Hospital, Beijing Emergency Center, and Beijing Red Cross Emergency Center.

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