Urban Environmental Determinants and Spatiotemporal Patterns of Emergency Medical Service Response to Traumatic Injuries: A Five-Year Population-Based Study

Background: Timely prehospital management is critical for survival after traumatic injury. In rapidly growing metropolises, emergency medical service (EMS) systems often struggle to provide equitable care amid urban sprawl and traffic congestion. This study investigated spatiotemporal inequalities in trau-ma-related EMS response in a rapidly expanding capital city (Astana, Kazakh-stan) to inform healthcare optimization and urban health equity. Methods: We analyzed a five-year population-based dataset of 26,073 trauma-related EMS calls recorded between 2020 and 2024. Spatial patterns were examined using Kernel Density Estimation (KDE) and Getis–Ord Gi* hotspot analysis. Road-network modeling assessed accessibility at 3, 5, and 10-minute thresholds using a GIS-based network analyst framework. Results: Males accounted for 60.1% of utilization and had higher clinical severity (hospitalization rate: 45.5% vs 40.3%, p < .001). Demand peaked at 20:00, coinciding with peak traffic. The mean total response time was 21.63 minutes, and only 16.9% of calls met the 10-minute benchmark. Significant accessibility gaps were found in the Baikonur district (61.4% delay rate). Conclusions: The findings demonstrate that while the EMS system provides broad geographic coverage, it suffers from systemic spatio-temporal bottlenecks. Targeted infrastructure expansion in underserved pe-ripheral districts and the implementation of dynamic deployment models are necessary to enhance urban health equity and reduce preventable mortality in expanding metropolitan areas.