People are more likely to die in emergencies if they have to endure long ambulance journeys to hospital, research suggests.

As plans to close some accident and emergency departments and district hospitals in favour of larger but fewer specialist units come under increasing attack, a study finds that patients with breathing difficulties have more chance of dying the longer they stay in the ambulance.

A team from the University of Sheffield traced the results of more than 10,000 life-threatening 999 calls and concluded, in a report in the journal Emergency Medicine, that the longer the distance, the greater the likelihood of death. The risk of death for people who were unconscious, not breathing or suffering chest pain rose by one percentage point for every 6.2 miles (10km) travelled.

The researchers said that the findings could affect government plans to reconfigure emergency care into a limited number of specialist centres.

The research, which is published today and is based on data taken between 1997 and 2001, coincides with the launch of a Conservative campaign against the closure of maternity services and A&E units. Promising a “bare- knuckle” fight with the Government, David Cameron, the party leader, said yesterday that people did not understand why these services were being shut down when emergency admissions and births were rising.

Previous research, cited in government reports backing the shift to bigger, specialist emergency units, failed to find any evidence that taking patients further by ambulance had an effect on survival. The new study, by contrast, finds that they do. Those most likely to be affected are patients with severe breathing problems. Their chances of dying were 13 per cent if the distance to hospital was between 6 and 12 miles, but 20 per cent if it was more than 12 miles.

The Sheffield team, led by Professor Jon Nicholl, traced the outcome of calls to four ambulance services. Using the grid references of the call and the hospital to which the patient was taken, they worked out the straight-line distance between the two, and then compared that with the outcome for each patient. The distance to hospital varied from less than one mile to as much as 36 miles. The median was just over three miles. Of the 10,315 patients traced, 644 had died.

The results show that deaths increase with distance. Overall, 6.2 per cent of the patients died, but for the shortest journeys - fewer than six miles - the death rate was lower, at 5.8 per cent. For distances between seven and twelve miles, 7.7 per cent died, and for distances of more than 13 miles the figure was 8.8 per cent.

Other factors need to be included in any decision to relocate A&E services. For example, bigger specialised units might make up for the greater distance travelled by offering better care on arrival. Professor Nicholl said: “Decisions regarding reconfiguration of acute services are complex and require consideration of many conflicting factors. Our data suggests that any changes that increase journey distances to hospital for all emergency patients may lead to an increase in mortality for some.”

Explore Health

• Expert Advice

• Health Features

• Mental Health

• Alternative Medicine

• Child Health

• Health Club