Access to trauma center care: A statewide system-based approach

doi:10.1097/TA.0000000000004002

Access to trauma center care: A statewide system-based approach

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Abstract

BACKGROUND Timely access to specialized trauma care is a vital element in patient outcome after severe and critical injury requiring the skills of trauma teams in levels I and II trauma centers to avoid preventable mortality. We used system-based models to estimate timely access to care. METHODS Trauma system models consisted of ground emergency medical services, helicopter emergency medical services, and designated levels I to V trauma centers were constructed for five states. These models incorporated geographic information systems along with traffic data and census block group data to estimate population access to trauma care within the "golden hour."Trauma systems were further analyzed to identify the optimal location for an additional level I or II trauma center that would provide the greatest increase in access. RESULTS The population of the states studied totaled 23 million people, of which 20 million (87%) had access to a level I or II trauma center within 60 minutes. Statewide-specific access ranged from 60% to 100%. Including levels III to V trauma centers, access within 60 minutes increased to 22 million (96%), ranging from 95% to 100%. The addition of a levels I and II trauma center in an optimized location in each state would provide timely access to a higher trauma capability for an additional 1.1 million, increasing total access to approximately 21.1 million people (92%). CONCLUSION This analysis demonstrates that nearly universal access to trauma care is present in these states when including levels I to V trauma centers. However, concerning gaps remain in timely access to levels I and II trauma centers. This study provides an approach to determine more robust statewide estimates of access to care. It highlights the need for a national trauma system, one in which all components of state-managed trauma systems are assembled in a national data set to accurately identify gaps in care. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.

Original language	English
Pages (from-to)	242-248
Number of pages	7
Journal	Journal of Trauma and Acute Care Surgery
Volume	95
Issue number	2
DOIs	https://doi.org/10.1097/TA.0000000000004002
State	Published - Aug 1 2023

Bibliographical note

Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.

Funding

This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Defense Medical Research and Development Program under award number W81XWH-17-2-0010. The views, opinions, and/or findings contained in this report are those of the author(s) and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation. In the conduct of research where humans are the subjects, the investigator(s) adhered to the policies regarding the protection of human subjects as prescribed by Code of Federal Regulations Title 45, Volume 1, Part 46; Title 32, Chapter 1, Part 219; and Title 21, Chapter 1, Part 50 (Protection of Human Subjects). DISCLOSURE

Funders	Funder number
Defense Medical Research and Development Program	W81XWH-17-2-0010
Office of the Assistant Secretary of Defense for Health Affairs

Keywords

Prehospital
access to care
trauma
trauma system

ASJC Scopus subject areas

Surgery
Critical Care and Intensive Care Medicine

Access to Document

10.1097/TA.0000000000004002

Cite this

@article{265bde29826d40f695db5f0c3da8f80e,

title = "Access to trauma center care: A statewide system-based approach",

abstract = "BACKGROUND Timely access to specialized trauma care is a vital element in patient outcome after severe and critical injury requiring the skills of trauma teams in levels I and II trauma centers to avoid preventable mortality. We used system-based models to estimate timely access to care. METHODS Trauma system models consisted of ground emergency medical services, helicopter emergency medical services, and designated levels I to V trauma centers were constructed for five states. These models incorporated geographic information systems along with traffic data and census block group data to estimate population access to trauma care within the {"}golden hour.{"}Trauma systems were further analyzed to identify the optimal location for an additional level I or II trauma center that would provide the greatest increase in access. RESULTS The population of the states studied totaled 23 million people, of which 20 million (87%) had access to a level I or II trauma center within 60 minutes. Statewide-specific access ranged from 60% to 100%. Including levels III to V trauma centers, access within 60 minutes increased to 22 million (96%), ranging from 95% to 100%. The addition of a levels I and II trauma center in an optimized location in each state would provide timely access to a higher trauma capability for an additional 1.1 million, increasing total access to approximately 21.1 million people (92%). CONCLUSION This analysis demonstrates that nearly universal access to trauma care is present in these states when including levels I to V trauma centers. However, concerning gaps remain in timely access to levels I and II trauma centers. This study provides an approach to determine more robust statewide estimates of access to care. It highlights the need for a national trauma system, one in which all components of state-managed trauma systems are assembled in a national data set to accurately identify gaps in care. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.",

keywords = "Prehospital, access to care, trauma, trauma system",

author = "Medrano, {Nicolas W.} and Villarreal, {Cynthia Lizette} and Price, {Michelle A.} and Bixby, {Pamela J.} and Bulger, {Eileen M.} and Eastridge, {Brian J.} and Albrecht, {Roxie M.} and Bailey, {Jeffrey A.} and Benjamin, {Elizabeth R.} and Bernard, {Andrew C.} and Blackwell, {Thomas H.} and Braithwaite, {Sabina A.} and Brasel, {Karen J.} and Brice, {Jane H.} and Burlew, {Clay C.} and Butler, {Frank K.} and Callaway, {David W.} and Cannon, {Jeremy W.} and Champion, {Howard R.} and Michael Chang and Coimbra, {Raul S.} and Davis, {Gregory G.} and Demarest, {Gerald B.} and Dorlac, {Warren C.} and Drake, {Stacy A.} and Eastman, {Alex L.} and Elster, {Eric A.} and Eric Epley and Esposito, {Thomas J.} and Ficke, {James R.} and Fisher, {Andrew D.} and Fowler, {David R.} and Gaines, {Barbara A.} and Gallagher, {John M.} and Gary, {Joshua L.} and Gestring, {Mark L.} and Gill, {James R.} and Goodloe, {Jeffrey M.} and Gurney, {Jennifer M.} and Harrell, {Andrew J.} and Henry, {Sharon M.} and Holcomb, {John B.} and Jenkins, {Donald H.} and Johannigman, {Jay A.} and Kerby, {Jeffrey D.} and Kharod, {Chetan U.} and Kotwal, {Russ S.} and Kozar, {Rosemary A.} and Kuhls, {Deborah A.} and Lathrop, {Sarah L.}",

year = "2023",

month = aug,

day = "1",

doi = "10.1097/TA.0000000000004002",

language = "English",

volume = "95",

pages = "242--248",

number = "2",

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TY - JOUR

T1 - Access to trauma center care

T2 - A statewide system-based approach

AU - Medrano, Nicolas W.

AU - Villarreal, Cynthia Lizette

AU - Price, Michelle A.

AU - Bixby, Pamela J.

AU - Bulger, Eileen M.

AU - Eastridge, Brian J.

AU - Albrecht, Roxie M.

AU - Bailey, Jeffrey A.

AU - Benjamin, Elizabeth R.

AU - Bernard, Andrew C.

AU - Blackwell, Thomas H.

AU - Braithwaite, Sabina A.

AU - Brasel, Karen J.

AU - Brice, Jane H.

AU - Burlew, Clay C.

AU - Butler, Frank K.

AU - Callaway, David W.

AU - Cannon, Jeremy W.

AU - Champion, Howard R.

AU - Chang, Michael

AU - Coimbra, Raul S.

AU - Davis, Gregory G.

AU - Demarest, Gerald B.

AU - Dorlac, Warren C.

AU - Drake, Stacy A.

AU - Eastman, Alex L.

AU - Elster, Eric A.

AU - Epley, Eric

AU - Esposito, Thomas J.

AU - Ficke, James R.

AU - Fisher, Andrew D.

AU - Fowler, David R.

AU - Gaines, Barbara A.

AU - Gallagher, John M.

AU - Gary, Joshua L.

AU - Gestring, Mark L.

AU - Gill, James R.

AU - Goodloe, Jeffrey M.

AU - Gurney, Jennifer M.

AU - Harrell, Andrew J.

AU - Henry, Sharon M.

AU - Holcomb, John B.

AU - Jenkins, Donald H.

AU - Johannigman, Jay A.

AU - Kerby, Jeffrey D.

AU - Kharod, Chetan U.

AU - Kotwal, Russ S.

AU - Kozar, Rosemary A.

AU - Kuhls, Deborah A.

AU - Lathrop, Sarah L.

PY - 2023/8/1

Y1 - 2023/8/1

N2 - BACKGROUND Timely access to specialized trauma care is a vital element in patient outcome after severe and critical injury requiring the skills of trauma teams in levels I and II trauma centers to avoid preventable mortality. We used system-based models to estimate timely access to care. METHODS Trauma system models consisted of ground emergency medical services, helicopter emergency medical services, and designated levels I to V trauma centers were constructed for five states. These models incorporated geographic information systems along with traffic data and census block group data to estimate population access to trauma care within the "golden hour."Trauma systems were further analyzed to identify the optimal location for an additional level I or II trauma center that would provide the greatest increase in access. RESULTS The population of the states studied totaled 23 million people, of which 20 million (87%) had access to a level I or II trauma center within 60 minutes. Statewide-specific access ranged from 60% to 100%. Including levels III to V trauma centers, access within 60 minutes increased to 22 million (96%), ranging from 95% to 100%. The addition of a levels I and II trauma center in an optimized location in each state would provide timely access to a higher trauma capability for an additional 1.1 million, increasing total access to approximately 21.1 million people (92%). CONCLUSION This analysis demonstrates that nearly universal access to trauma care is present in these states when including levels I to V trauma centers. However, concerning gaps remain in timely access to levels I and II trauma centers. This study provides an approach to determine more robust statewide estimates of access to care. It highlights the need for a national trauma system, one in which all components of state-managed trauma systems are assembled in a national data set to accurately identify gaps in care. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.

AB - BACKGROUND Timely access to specialized trauma care is a vital element in patient outcome after severe and critical injury requiring the skills of trauma teams in levels I and II trauma centers to avoid preventable mortality. We used system-based models to estimate timely access to care. METHODS Trauma system models consisted of ground emergency medical services, helicopter emergency medical services, and designated levels I to V trauma centers were constructed for five states. These models incorporated geographic information systems along with traffic data and census block group data to estimate population access to trauma care within the "golden hour."Trauma systems were further analyzed to identify the optimal location for an additional level I or II trauma center that would provide the greatest increase in access. RESULTS The population of the states studied totaled 23 million people, of which 20 million (87%) had access to a level I or II trauma center within 60 minutes. Statewide-specific access ranged from 60% to 100%. Including levels III to V trauma centers, access within 60 minutes increased to 22 million (96%), ranging from 95% to 100%. The addition of a levels I and II trauma center in an optimized location in each state would provide timely access to a higher trauma capability for an additional 1.1 million, increasing total access to approximately 21.1 million people (92%). CONCLUSION This analysis demonstrates that nearly universal access to trauma care is present in these states when including levels I to V trauma centers. However, concerning gaps remain in timely access to levels I and II trauma centers. This study provides an approach to determine more robust statewide estimates of access to care. It highlights the need for a national trauma system, one in which all components of state-managed trauma systems are assembled in a national data set to accurately identify gaps in care. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.

KW - Prehospital

KW - access to care

KW - trauma

KW - trauma system

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DO - 10.1097/TA.0000000000004002

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SN - 2163-0755

VL - 95

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EP - 248

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

IS - 2

ER -

Access to trauma center care: A statewide system-based approach

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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