When buildings become barriers: assessing the impact of building height on the equality of emergency medical services accessibility-a dual-trip study in Wuhan, China.

Background: As urbanization accelerates, the height of urban buildings continues to rise, which may influence the provision of Emergency Medical Services (EMS). However, a current limitation is that related studies often neglect the impact of spatial variations in building height on EMS accessibility equality. Most scholars have focused primarily on EMS road travel-either the Departure Road Trip (DRT) or the Transport Trip (TT)-while overlooking the effects of building height on the in-building EMS trip, known as the Patient Access Trip (PAT).

Methods: EMS accessibility was measured using a proximity-based method and a Gaussian two-step floating catchment area (G-2SFCA) model under two scenarios: Scenario 1 considered only DRT, whereas Scenario 2 incorporated both DRT and PAT influenced by building heights. DRT travel times were simulated using Baidu Map's Application Programming Interface (API), and PAT times were calculated based on building elevator/stairs characteristics. Accessibility equality was assessed using multi-ring buffer analysis, Lorenz curves, and Gini coefficients.

Results: According to the empirical study in Wuhan, China, first, the spatial variations in building height was evident across the city. The building heights in city centre and sub-centres are generally taller compared to those in suburban areas. Second, the variations in building height can obviously affect EMS accessibility. However, the impact of building height on EMS accessibility varies across different regions. The effect is particularly pronounced in sub-centres located around 14 km from the city centre, whereas it is relatively limited in suburban areas. Third, the incorporation of spatial disparities in building height into EMS accessibility modeling reveals increased inequality in EMS provision across the city.

Conclusion: Spatial disparities in building heights across a city significantly influence EMS accessibility inequality. Given the widespread differences in building heights worldwide, this study provides valuable findings for healthcare policymakers to improve EMS systems.