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Volume 14
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10.3390/medsci14010056
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Association of Shift, Day, Month and Year with Mortality: Observational Study of Spanish and USA Emergency Care Cohorts

by
Álvaro Astasio-Picado
1,2,
José Luis Martín-Conty
2,3,4,
Begoña Polonio-López
2,3,4,
Cristina Rivera-Picón
2,*,
Maria Eugenia Medina Chozas
5,
Maria del Mar Palazuelos Diaz
5,
Laura Mordillo-Mateos
2,3,
Francisca Torres-Falguera
2,3,
Laura Ros Gomez
6,
Paula Alvarez Buitrago
7,
Francisco Martín-Rodríguez
8,9,† and
Ancor Sanz-García
2,3,4,*,†
1
Intensive Care Unit, Hospital Virgen del Puerto, 10600 Plasencia, Spain
2
Faculty of Health Sciences, University of Castilla-La Mancha, Avda. Real Fábrica de Seda, s/n, 45600 Talavera de la Reina, Spain
3
Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain
4
Evaluación de Cuidados de Salud (ECUSAL), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
5
Gerencia de Urgencias Emergencias y Transporte, Servicio de Salud de Castilla-La Mancha (SESCAM), 45071 Toledo, Spain
6
Servicio madrileño de salud, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain
7
Anaesthesia and Resuscitation Service, Complejo Hospitalario de Toledo, 45007 Toledo, Spain
8
Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain
9
Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain
*
Authors to whom correspondence should be addressed.
†
Joint last authors.
Med. Sci. 2026, 14(1), 56; https://doi.org/10.3390/medsci14010056 (registering DOI)
Submission received: 24 December 2025 / Revised: 13 January 2026 / Accepted: 20 January 2026 / Published: 22 January 2026
Versions Notes

Abstract

Background/Objectives: Emergency medical services (EMSs) are essential for reducing mortality among critically ill patients. This study aims to evaluate the influence of temporal factors, such as time of day, day of the week, month, and year, on mortality in EMS activations, comparing health systems in the U.S. and Spain. Methods: This multicenter observational study, which is based on two databases (Spain’s Sacyl and the U.S.’s NEMSIS), analyzed EMS activation in high-priority adult patients (>18 years) between 2018 and 2023. Demographic variables, transport characteristics, and response times were included. Short-term mortality was the primary outcome. Results: A total of 54,981 EMS activations (11,713 from the Sacyl dataset and 43,268 from the NEMSIS dataset) were analyzed. Mortality was higher among older patients and males, with significant increases during shifts from 06:00 to 12:00 and from 18:00 to 24:00. Mortality also varied by year, with higher rates in 2022 and 2023 than in 2018. Notable differences were observed between the U.S. and Spain, especially in shifts and months, with higher mortality during the 12:00 to 18:00 shift and in October in the NEMSIS cohort. Conclusions: These findings have direct implications for emergency medical service operations, suggesting that resource allocation, staffing models, and clinical protocols should be strategically optimized based on temporal risk patterns to improve patient outcomes during identified high-risk periods.
Keywords: emergency medical services; mortality; shift; month; days emergency medical services; mortality; shift; month; days

Share and Cite

MDPI and ACS Style

Astasio-Picado, Á.; Martín-Conty, J.L.; Polonio-López, B.; Rivera-Picón, C.; Medina Chozas, M.E.; Palazuelos Diaz, M.d.M.; Mordillo-Mateos, L.; Torres-Falguera, F.; Ros Gomez, L.; Buitrago, P.A.; et al. Association of Shift, Day, Month and Year with Mortality: Observational Study of Spanish and USA Emergency Care Cohorts. Med. Sci. 2026, 14, 56. https://doi.org/10.3390/medsci14010056

AMA Style

Astasio-Picado Á, Martín-Conty JL, Polonio-López B, Rivera-Picón C, Medina Chozas ME, Palazuelos Diaz MdM, Mordillo-Mateos L, Torres-Falguera F, Ros Gomez L, Buitrago PA, et al. Association of Shift, Day, Month and Year with Mortality: Observational Study of Spanish and USA Emergency Care Cohorts. Medical Sciences. 2026; 14(1):56. https://doi.org/10.3390/medsci14010056

Chicago/Turabian Style

Astasio-Picado, Álvaro, José Luis Martín-Conty, Begoña Polonio-López, Cristina Rivera-Picón, Maria Eugenia Medina Chozas, Maria del Mar Palazuelos Diaz, Laura Mordillo-Mateos, Francisca Torres-Falguera, Laura Ros Gomez, Paula Alvarez Buitrago, and et al. 2026. "Association of Shift, Day, Month and Year with Mortality: Observational Study of Spanish and USA Emergency Care Cohorts" Medical Sciences 14, no. 1: 56. https://doi.org/10.3390/medsci14010056

APA Style

Astasio-Picado, Á., Martín-Conty, J. L., Polonio-López, B., Rivera-Picón, C., Medina Chozas, M. E., Palazuelos Diaz, M. d. M., Mordillo-Mateos, L., Torres-Falguera, F., Ros Gomez, L., Buitrago, P. A., Martín-Rodríguez, F., & Sanz-García, A. (2026). Association of Shift, Day, Month and Year with Mortality: Observational Study of Spanish and USA Emergency Care Cohorts. Medical Sciences, 14(1), 56. https://doi.org/10.3390/medsci14010056

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