Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-06-02T18:39:48.155Z Has data issue: false hasContentIssue false

A Geographical Analysis of Access to Trauma Centers from US National Parks in 2018

Published online by Cambridge University Press:  20 October 2022

Lily Y. Lu
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA
Sabrina N. Robichaud
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA Tufts University School of Medicine, Boston, Massachusetts USA
Krislyn M. Boggs
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA
Brandon R. Bedell
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA Boston University School of Medicine, Boston, Massachusetts USA
Rebecca E. Cash
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA
Ashley F. Sullivan
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA
N. Stuart Harris
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA
Carlos A. Camargo Jr.*
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts USA
*
Correspondence: Carlos A. Camargo, Jr., MD, DrPH Department of Emergency Medicine Massachusetts General Hospital 125 Nashua St, Suite 920 Boston, Massachusetts 02114-1101 USA E-mail: ccamargo@partners.org

Abstract

Introduction:

Millions of people visit US national parks annually to engage in recreational wilderness activities, which can occasionally result in traumatic injuries that require timely, high-level care. However, no study to date has specifically examined timely access to trauma centers from national parks. This study aimed to examine the accessibility of trauma care from national parks by calculating the travel time by ground and air from each park to its nearest trauma center. Using these calculations, the percentage of parks by census region with timely access to a trauma center was determined.

Methods:

This was a cross-sectional study analyzing travel times by ground and air transport between national parks and their closest adult advanced trauma center (ATC) in 2018. A list of parks was compiled from the National Parks Service (NPS) website, and the location of trauma centers from the 2018 National Emergency Department Inventory (NEDI)-USA database. Ground and air transport times were calculated using Google Maps and ArcGIS, with medians and interquartile ranges reported by US census region. Percentage of parks by region with timely trauma center access—defined as access within 60 minutes of travel time—were determined based on these calculated travel times.

Results:

In 2018, 83% of national parks had access to an adult ATC within 60 minutes of air travel, while only 26% had timely access by ground. Trauma center access varied by region, with median travel times highest in the West for both air and ground transport. At a national level, national parks were unequally distributed, with the West housing the most parks of all regions.

Conclusion:

While most national parks had timely access to a trauma center by air travel, significant gaps in access remain for ground, the extent of which varies greatly by region. To improve the accessibility of trauma center expertise from national parks, the study highlights the potential that increased implementation of trauma telehealth in emergency departments (EDs) may have in bridging these gaps.

Type
Original Research
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Note: Lily Y. Lu and Sabrina N. Robichaud should be considered joint first authors.

References

National Park Service. Statistical abstract: 2016. Natural Resource Data Series. https://irma.nps.gov/DataStore/Reference/Profile/2239338. Published 2017. Accessed March 20, 2022.Google Scholar
National Park Service. Statistical abstract: 2017. Natural Resource Data Series. https://irma.nps.gov/DataStore/Reference/Profile/2252643. Published 2018. Accessed March 20, 2022.Google Scholar
National Park Service. Statistical abstract: 2018. Natural Resource Data Series. https://irma.nps.gov/DataStore/Reference/Profile/2259799. Published 2019. Accessed March 20, 2022.Google Scholar
National Park Service. Statistical abstract: 2019. Natural Resource Data Series. https://irma.nps.gov/DataStore/Reference/Profile/2272525. Published 2020. Accessed March 20, 2022.Google Scholar
National Park Service. Statistical abstract: 2020. Natural Resource Data Series. https://irma.nps.gov/DataStore/Reference/Profile/2285418. Published 2021. Accessed March 20, 2022.Google Scholar
What’s in a Name? Discover National Park System Designations. National Park Service. Web site. https://www.nps.gov/articles/nps-designations.htm. Accessed February 26, 2022.Google Scholar
Lane, JP, Taylor, B, Smith, WR, Wheeler, AR. Emergency Medical Service in the US National Park Service: a characterization and two-year review, 2012–2013. Wilderness Environ Med. 2015;26(4):531535.Google Scholar
Heggie, TW, Heggie, TM. Search and rescue trends and the Emergency Medical Service workload in Utah’s national parks. Wilderness Environ Med. 2008;19(3):164171.CrossRefGoogle ScholarPubMed
Heggie, TW. Search and rescue in Alaska’s national parks. Travel Med Infect Dis. 2008;6(6):355361.CrossRefGoogle ScholarPubMed
Young, M, Kim, T, Lessard, E, et al. Emergency Medical Services and remote medical oversight in Sequoia and Kings Canyon National Parks, 2011-2013. Wilderness Environ Med. 2018;29(4):453462.CrossRefGoogle ScholarPubMed
MacKenzie, EJ, Rivara, FP, Jurkovich, GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366378.CrossRefGoogle ScholarPubMed
Dodson, BK, Braswell, M, David, AP, et al. Adult and elderly population access to trauma centers: an ecological analysis evaluating the relationship between injury-related mortality and geographic proximity in the United States in 2010. J Public Health (Oxf). 2018;40(4):848857.CrossRefGoogle ScholarPubMed
Hashmi, ZG, Jarman, MP, Uribe-Leitz, T, et al. Access delayed is access denied: relationship between access to trauma center care and prehospital death. J Am Coll Surg. 2019;228(1):920.CrossRefGoogle Scholar
Branas, CC, MacKenzie, EJ, Williams, JC, et al. Access to trauma centers in the United States. JAMA. 2005;293(21):26262633.CrossRefGoogle ScholarPubMed
Carr, BG, Bowman, AJ, Wolff, CS, et al. Disparities in access to trauma care in the United States: a population-based analysis. Injury. 2017;48(2):332338.CrossRefGoogle ScholarPubMed
Carr, BG, Nance, ML. Access to pediatric trauma care: alignment of providers and health systems. Curr Opin Pediatr. 2010;22(3):326331.CrossRefGoogle ScholarPubMed
United States Census Bureau. 2019 Census Bureau Region and Division Codes and State FIPS Codes. https://www.census.gov/geographies/reference-files/2019/demo/popest/2019-fips.html. Published 2020. Accessed February 13, 2022.Google Scholar
Sullivan, AF, Richman, IB, Ahn, CJ, et al. A profile of US emergency departments in 2001. Ann Emerg Med. 2006;48(6):694701.CrossRefGoogle ScholarPubMed
Bedell, BB, Boggs, KM, Espinola, JA, et al. Development of a unified national trauma center database, 2018 [abstract]. Ann Emerg Med. 2020;76(4S):S92S93.CrossRefGoogle Scholar
Home - findERnow App. Emergency Medicine Network. Web site. https://findernow.massgeneral.org. Accessed March 20, 2022.Google Scholar
Carr, BG, Caplan, JM, Pryor, JP, Branas, CC. A meta-analysis of prehospital care times for trauma. Prehosp Emerg Care. 2006;10(2):198206.CrossRefGoogle ScholarPubMed
Lerner, EB, Moscati, RM. The golden hour: scientific fact or medical “urban legend”? Acad Emerg Med. 2001;8(7):758760.CrossRefGoogle ScholarPubMed
Newgard, CD, Schmicker, RH, Hedges, JR, et al. Emergency Medical Services intervals and survival in trauma: assessment of the “golden hour” in a North American prospective cohort. Ann Emerg Med. 2010;55(3):235246.e4.CrossRefGoogle Scholar
Dinh, MM, Bein, K, Roncal, S, Byrne, CM, Petchell, J, Brennan, J. Redefining the golden hour for severe head injury in an urban setting: the effect of prehospital arrival times on patient outcomes. Injury. 2013;44(5):606610.Google Scholar
Hsia, R, Shen, YC. Possible geographical barriers to trauma center access for vulnerable patients in the United States. Arch Surg. 2011;146(1):4652.CrossRefGoogle ScholarPubMed
National Park Service. 2018 National Park Service Acreage Fiscal Year Report. https://www.nps.gov/subjects/lwcf/acreagereports.htm. Published 2018. Accessed February 23, 2022.Google Scholar
Steenhoff, TC, Siddiqui, DI, Zohn, SF. EMS Air Medical Transport. Treasure Island, Florida USA: StatPearls Publishing; 2021.Google Scholar
Taheri, PA, Butz, DA, Lottenberg, L, Clawson, A, Flint, LM. The cost of trauma center readiness. Am J Surg. 2004;187(1):713.CrossRefGoogle ScholarPubMed
Latifi, R, Weinstein, RS, Porter, JM, et al. Telemedicine and telepresence for trauma and emergency care management. Scand J Surg. 2007;96(4):281289.CrossRefGoogle ScholarPubMed
Duchesne, JC, Kyle, A, Simmons, J, et al. Impact of telemedicine upon rural trauma care. J Trauma. 2008;64(1):9297.Google ScholarPubMed
Wesson, JB, Kupperschmidt, B. Rural trauma telemedicine. J Trauma Nurs. 2013;20(4):199202.CrossRefGoogle ScholarPubMed
Supplementary material: File

Lu et al. supplementary material

Lu et al. supplementary material 1

Download Lu et al. supplementary material(File)
File 28.7 KB
Supplementary material: Image

Lu et al. supplementary material

Lu et al. supplementary material 2

Download Lu et al. supplementary material(Image)
Image 15.2 MB
Supplementary material: Image

Lu et al. supplementary material

Lu et al. supplementary material 3

Download Lu et al. supplementary material(Image)
Image 897.7 KB