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Introduction: The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the first component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health system of Aotearoa-New Zealand (NZ), little is known about inequities in EMS-delivered care and transport pathways to hospital-level care.Methods: This population-level cohort study on out-of-hospital care, based on national EMS data, included trauma patients

Child protection inequalities are population group differences in contact rates, experiences and outcomes of child protection systems. This article reports rates of Pasifika children's contact with the statutory child protection system at three outcomes: substantiation, having a family group conference, (FGC) or entering care (placement), and describes intersections between these outcomes and socio-economic deprivation. Including all children resident in Aotearoa New Zealand in 2019–2020 aged 0–17 years, this study compared rates between sole Pasifika, Pasifika plus other ethnicities (Pasifika+), and Non-Māori, Non-Pasifika (NMNP) children. Substantiation was twice as likely for Pasifika, even after controlling for sociodemographic factors, and Pasifika children were 25% more likely to enter care than NMNP children. As socio-economic deprivation increased, rates of substantiation increased for all groups, but most sharply for Pasifika+ children. Sole Pasifika children had the highest rate of substantiation and FGCs in the least deprived quintile of socio-economic deprivation, but the lowest FGC and placement rates in areas of highest deprivation. Pasifika+ children had double the rate of sole Pasifika children for placement in high-deprivation areas, but this was equal to the NMNP rate. Findings are analysed via theories of inequalities. Aggregated ethnic categories obscure considerable variation in within-group experiences. [ABSTRACT FROM AUTHOR]

Objective: Post-traumatic stress disorder following injuries unrelated to mass casualty events has received little research attention in New Zealand. Internationally, most studies investigating predictors of post-injury post-traumatic stress disorder focus on hospitalised patients although most survivors are not hospitalised. We compared the prevalence and predictors of symptoms suggestive of post-traumatic stress disorder 12 months following injury among hospitalised and non-hospitalised entitlement claimants in New Zealand's Accident Compensation Corporation. This government-funded universal no-fault insurance scheme replaced tort-based compensation for injuries in 1974 since when civil litigation (which can bias post-traumatic stress disorder estimates) has been rare. Methods: A total of 2220 Accident Compensation Corporation claimants aged 18–64 years recruited to the Prospective Outcomes of Injury Study were interviewed at 12 months post-injury to identify symptoms suggestive of post-traumatic stress disorder using the Impact of Events Scale. Multivariable models examined the extent to which baseline sociodemographic, injury, health status and service interaction factors predicted the risk of post-traumatic stress disorder symptoms among hospitalised and non-hospitalised groups. Results: Symptoms suggestive of post-traumatic stress disorder were reported by 17% of hospitalised and 12% of non-hospitalised participants. Perceived threat to life at the time of the injury doubled this risk among hospitalised (adjusted relative risk: 2.0; 95% confidence interval: 1.2–3.2) and non-hospitalised (relative risk: 1.8; 95% confidence interval: 1.2–2.8) participants. Among hospitalised participants, other predictors included female gender, Pacific and 'other' minority ethnic groups, pre-injury depressive symptoms, financial insecurity and perceived inadequacies in healthcare interactions, specifically information and time to discuss problems. Among non-hospitalised survivors, predictors included smoking, hazardous drinking, assault and poor expectations of recovery. Conclusion: One in six hospitalised and one in eight non-hospitalised people reported post-traumatic stress disorder symptoms 12 months following injury. Perceived threat to life was a strong predictor of this risk in both groups. Identifying early predictors of post-traumatic stress disorder, regardless of whether the injury required hospitalisation, could help target tailored interventions that can reduce longer-term psychosocial morbidity. [ABSTRACT FROM AUTHOR]