Access to trauma centers for road crashes in the United States

Introduction: Existing research indicates that around 90% of all U.S. residents have access to at least one level I or II trauma center within 60 min. However, a limitation of these estimates lies in that they are based on where people live and not where people are injured, which may overestimate the access to trauma centers for seriously injured patients in fatal crashes. Method: In this study, the Fatality Analysis Reporting System (FARS) data between 2013 and 2014 were collected and analyzed to quantify the access of injured patients to trauma centers for fatal crashes across states. Two types of distance, linear distance and route distance, were calculated using ArcGIS. The estimated transport time to the nearest level I/II trauma center was also calculated and compared to the recorded on-scene and transport time. Results and Conclusions: The Northeast region had the nearest average linear and route distance between fatal crash and trauma center (25.3 km and 31.7 km, respectively), followed by the Midwest (44.4 km and 54.1 km), the South (47.3 km and 57.0 km), and the West (50.9 km and 67.5 km). The comparison between the estimated and actual transport time revealed that the different states adopted different trauma triage protocols, resulting in different utilization rates of the level I/II trauma center among states. A linear regression analysis demonstrated that the longer the average route distance, the less the seriously injured patients in fatal crashes were taken to level I/II trauma center directly. Practical applications: These findings may help to identify the access to trauma centers for road crashes and the variation of delivery ratio to trauma center among the states, therefore a better utilization of trauma centers for road crashes can be achieved for the emergency medical services (EMS) systems.