Abstract: Objective To explore geographic difference and its causes in pre-hospital first aid ability for promoting pre-hospital first aid level in China.Methods Pre-hospital response time was selected as a paramount indicator; data were collected from WanFang Database and websites of medical emergency centres from January 1996 through September 2015 and a pre-hospital aid dataset was constructed.Meta-analysis was adopted to analyze geographic differences in pre-hospital response time.Results During the 20-year period the pre-hospital response time prolonged by 4.649 minutes (min) from 11.206 min to 15.855 min in eastern urban regions of China;while in central urban regions the time remained stable at 15.500 min approximately.In western urban regions,the pre-hospital response time changed with the variation in first-aid service radius and the response time was shortened by 18.427 min (from 31.959 min between 1996-2000 to 13.712 min between 2005-2010) but then prolonged by 17.665 during another 5-year period.Conclusion The pre-hospital response time is longer than the expected in all regions in Eastern,Central and Western China,suggesting that adjustments are needed in traffic control,police-hospital linkage,number of first-aid site,spots and pre-hospital care training to improve the situation.