Promoting Emergency Medical Service Infrastructure Equality to Reduce Road Crash Fatalities

Round 1

Reviewer 1 Report

The research article is addressing a crucial issue. The focus is on promoting EMS infrastructure equality to reduce road crash fatalities is highly relevant and timely. The study's methodological framework for evaluating the government's EMS infrastructure plans, including the use of geographically weighted binary logit regression demonstrates a rigorous approach. The emphasis on informing policy-makers to cost-effectively expand EMS infrastructure and create equitable EMS response is laudable and has the potential to make a significant impact on public health and safety. There are some minor suggestion to improve English in manuscript, please revise introduction and add limitation to the study; it’s very important for previous and future study.

Good Luck 

Minor editing of English language required

Author Response

1. Summary

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections (  highlighted in red) in the re-submitted file of manuscript.

3. Point-by-point response to Comments and Suggestions for Authors

Comment 1: The research article is addressing a crucial issue. The focus is on promoting EMS infrastructure equality to reduce road crash fatalities is highly relevant and timely. The study's methodological framework for evaluating the government's EMS infrastructure plans, including the use of geographically weighted binary logit regression demonstrates a rigorous approach. The emphasis on informing policy-makers to cost-effectively expand EMS infrastructure and create equitable EMS response is laudable and has the potential to make a significant impact on public health and safety. There is some minor suggestion to improve English in manuscript, please revise introduction and add limitation to the study; it’s very important for previous and future study. Good Luck.

Response 1: The authors revised introduction and added limitation with English edit. Please see the Section 1 and the last paragraph of Section 7 in the revised manuscript. We deeply appreciate the reviewer’s comment. 

4. Response to Comments on the Quality of English Language

Point 1: Minor editing of English language required

Response 1: The authors gave the corresponding response in the point-by-point response. 

Reviewer 2 Report

The EMS service infrastructures was evaluated in this paper. The manuscript uses a variety of technical methods and obtains good results. Following issues should be addressed:

1.      Abstract: The background part is more descriptive, and it is recommended to delete it appropriately. Besides, it is suggested to add a quantitative description of the results.

2.      How is the robustness of the model verified? How does the proposed model perform if the data set is changed?

3.      Equations (x) should be mentioned in the main text. Besides, the format of the formula should also be revised.

4.      Figure 3: Is this a ranking of the importance of a variable? Please explain clearly.

5.      The layout of the diagram in the manuscript needs further correction.

6.      The image quality in the manuscript is not high, so it is recommended to use vector images so that the image sharpness will not be degraded.

7.      Modify editing of English language required.

8.      Conclusions: limitations and future works should be given.

 Moderate editing of English language required.

Author Response

Please see the attachment including "Revised Manuscript" followed by "Response to Reviewer Comments". 

Author Response File: Author Response.pdf

Reviewer 3 Report

The aim of this manuscript is to provide a methodological framework for evaluating the Korean government’s emergency medical infrastructure (EMS) services. The authors intended to develop a method that could quantitatively inform the policymaking in South Koreas based on crash victim and existing EMS infrastructure data.

However, there are few points need attention from the authors.

1.     Introduction section needs to highlight the disparities in medical resources including medical specialists in rural vs urban areas as mentioned in the last section of second paragraph.

2.     Line 52-53 mentions most EMS hospitals in Korea have suffered from a lack of medical resources, including medical specialists, equipment and number of rooms -  Here reference required.

3.     Line 109-110 mentions that recent studies have employed GIS-based techniques that model the impact of distance on EMS accessibility – references required.

4.  Line 111-112 -Most recent studies using these techniques consider road network-based temporal distance, as prehospital EMS time is affected by traffic conditions on roads and the relevant EMS vehicle speed - References required.

5.     In the review literature, the authors mentioned about many recent studies using GIS-based techniques. However, the authors need to highlight the gaps in these studies and need for conducting the present study. Similarly, the main research question addressed by the study should be clearer to the readers.

6.     Line 149 and in other places– mentions about cost-effective expansion of all types of infrastructure. However, nowhere in the manuscript the cost related information or the implications on cost of developing such infrastructure is highlighted. These can be used as limitations of the study.

Author Response

Please see the attachment including "Revised Manuscript" followed by "Response to Reviewer Comments". 

Author Response File: Author Response.pdf

Reviewer 4 Report

This work focuses on inequality of EMS infrastructure in South Korea. For that, authors propose a geographically weighted binary logit regression used to identify priority locations. The proposal is well-written and the ideas are very clear.

Overall, this is a good article. By analyzing EMS stations (hospital and emergency medical assistance) and helicopter infrastructure, they cover key aspect when attending victims of road crashes. However, in order to make it more scientific soundly, some considerations should be taken into account.

1) Some assumptions need "scientific" anchor. When authors say "It is evident that significant EMS infrastructure inequality leads to regionally pronounced service disparities.", a citation is needed (there is a vast literature supporting this claim)

When authors say "There have been no studies that quantitatively and comprehensively investigated the state of the EMS infrastructure based on casualties from road crashes in Korea", what about in other countries?

Even though Related Works address some of these concerns, they are ALSO relevant in the narrative in Introduction

2) I understand that the research focus is in Korea. BUT authors could make it broader, taking Korea as a case study. If you take the title of the article, for example, Korea is not even mentioned, but Introduction is largely constructed around the Korean case.

As a suggestion, the problem of emergency response should be taken in a broader perspective in the Introduction and Abstract sections, with Korea being mentioned as the adopted use case.

Here are some references to support the arguments of the authors in this sense:

Access to hospitals: Potential vs. observed, Cities, 100, 2020, https://doi.org/10.1016/j.cities.2020.102671

On the positioning of emergencies detection units based on geospatial data of urban response centres.

Reallocation of Heterogeneous Sensors on Road Networks for Traffic Accident Detection, IEEE Transactions on Instrumentation and Measurement , 72, 2023, https://doi.org/10.1109/TIM.2023.3291790

About the adopted dataset and the performed analyses, they are great. Authors made a good job, even considering as input the model of the helicopters in South Korea. Doing so, the results seem to be very useful (Figure 5 is a masterpiece)

Authors should discuss about reproducibility in the results discussions

Finally, conclusions are fine. Authors did a good job.

Author Response

Please see the attachment including "Revised Manuscript" followed by "Response to Reviewer Comments". 

Author Response File: Author Response.pdf

Reviewer 5 Report

This article identifies the locations for high-priority EMS infrastructure expansion, quantifies spatial coverages of the existing EMS infrastructure, and recommend the extent of which the EMS infrastructure should be expanded. This study has good practical value. However, there are still the following deficiencies that need to be corrected.

1. Abstract:：It is necessary to supplement the research results and innovation points of this paper.

2. Keywords: Can you add a keyword about the method? For example: Geographically weighted binary logit regression.

3. Figure 2, Figure 4 and Figure 5: It is suggested that the authors supplement the basic elements of the map such as scale and north pointer.

4. Line 286-294: It is suggested that the authors modify the serial number (1., 2., ...... 6.) to avoid the same as that of each chapter.

5. The authors need to add the relationship between this study and sustainable development in the text.

Author Response

Please see the attachment including "Revised Manuscript" followed by "Response to Reviewer Comments". 

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

My comments on the initial version of the manuscript have been sufficiently addressed by the authors in this revised version. I have no further comments on the technical aspects. The manuscript may be considered for publication after a proofreading.