Skip to main content

Trauma Center Drive Time Distances and Fatal Outcomes among Gunshot Wound Victims


Despite nation-wide decreases in crime, urban gun violence remains a serious and pressing issue in many cities. Victim survival in these incidents is often contingent on the speed and quality of care provided. Increasingly, new research has identified the role that specialized trauma care plays in victim survival from firearm-related injuries. Using nearly four years of data on shooting victimizations in Philadelphia we test whether distance to the nearest level 1 trauma center is associated with victim survival. We employ different distance measures based on straight-line Euclidian distance, street network distances, and drive-time estimates—comparing the predictive accuracy of each. Our results find that victims who are shot farther from trauma centers have an increased likelihood of death, and drive time distances provide the most accurate predictions. We discuss the practical implications of this research as it applies to urban public health.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. 1.

    Data is publicly available at

  2. 2.


  1. American Trauma Society. (2019). Trauma Center Levels Explained. Retrieved from:

  2. Amram, O., Schuurman, N., & Hameed, S. M. (2011). Mass casualty modelling: a spatial tool to support triage decision making. International Journal of Health Geographics, 10(1), 40.

    Article  Google Scholar 

  3. Anselin, L. (1995). Local indicators of spatial association—LISA. Geographical Analysis, 27(2), 93–115.

    Article  Google Scholar 

  4. Bartlett, C. S. (2003). Clinical update: gunshot wound ballistics. Clinical Orthopaedics and Related Research®, 408, 28–57.

    Article  Google Scholar 

  5. Beard, J. H., Resnick, S., Maher, Z., Seamon, M. J., Morrison, C. N., Sims, C. A., ... Goldberg, A. J. (2019). Clustered arrivals of firearm-injured patients in an urban trauma system: a silent epidemic. Journal of the American College of Surgeons.

  6. Braga, A. A., Pierce, G. L., McDevitt, J., Bond, B. J., & Cronin, S. (2008). The strategic prevention of gun violence among gang‐involved offenders. Justice Quarterly, 25(1), 132–162.

    Article  Google Scholar 

  7. Braga, A. A., Papachristos, A. V., & Hureau, D. M. (2010). The concentration and stability of gun violence at micro places in Boston, 1980–2008. Journal of Quantitative Criminology, 26(1), 33–53.

    Article  Google Scholar 

  8. Braga, A. A., & Cook, P. J. (2018). The association of firearm caliber with likelihood of death from gunshot injury in criminal assaults. JAMA network open, 1(3), e180833–e180833.

    Article  Google Scholar 

  9. Burnham, K. P., & Anderson, D. R. (2004). Multimodel inference: understanding AIC and BIC in model selection. Sociological methods & research, 33(2), 261–304.

    Article  Google Scholar 

  10. Caniglia, E. C., Zash, R., Swanson, S. A., Wirth, K. E., Diseko, M., Mayondi, G., ... Kponee-Shovein, K. Z. (2019). Methodological Challenges When Studying Distance to Care as an Exposure in Health Research. American Journal of Epidemiology.

  11. Chanta, S., Mayorga, M. E., & McLay, L. A. (2014). The minimum p-envy location problem with requirement on minimum survival rate. Computers & Industrial Engineering, 74, 228–239.

    Article  Google Scholar 

  12. Chanta, S., Mayorga, M. E., Kurz, M. E., & McLay, L. A. (2011). The minimum p-envy location problem: a new model for equitable distribution of emergency resources. IIE Transactions on Healthcare Systems Engineering, 1(2), 101–115.

    Article  Google Scholar 

  13. Circo, G. M. (2019). Distance to trauma centres among gunshot wound victims: identifying trauma ‘deserts’ and ‘oases’ in Detroit. Injury prevention, injuryprev-2019.

  14. Cook, P. J., & Ludwig, J. (2000). Gun violence: The real costs. Oxford University Press on Demand.

  15. Crandall, M., Sharp, D., Unger, E., Straus, D., Brasel, K., Hsia, R., & Esposito, T. (2013). Trauma deserts: distance from a trauma center, transport times, and mortality from gunshot wounds in Chicago. American Journal of Public Health, 103(6), 1103–1109.

    Article  Google Scholar 

  16. Crandall, M., Sharp, D., Wei, X., Nathens, A., & Hsia, R. Y. (2016). Effects of closure of an urban level 1 trauma centre on adjacent hospitals and local injury mortality: a retrospective, observational study. British Medical Journal Open, 6(5), e011700.

    Google Scholar 

  17. Friedson, M., & Sharkey, P. (2015). Violence and neighborhood disadvantage after the crime decline. The Annals of the American Academy of Political and Social Science, 660(1), 341–358.

    Article  Google Scholar 

  18. Google Maps Platform. (2020). Retrieved from:

  19. Grommon, E., & Rydberg, J. (2015). Elaborating the correlates of firearm injury severity: combining criminological and public health concerns. Victims & Offenders, 10(3), 318–340.

    Article  Google Scholar 

  20. Harrell, F., Jr. (2001). Regression modelling strategies: With applications to linear models, logistic regression, and survival analysis. New York: Springer-Verlag.

    Book  Google Scholar 

  21. Hameed, S. M., Schuurman, N., Razek, T., Boone, D., Van Heest, R., Taulu, T., ... Stelfox, H. T. (2010). Access to trauma systems in Canada. Journal of Trauma and Acute Care Surgery, 69(6), 1350–1361.

  22. Hipple, N., & Magee, L. (2017). The difference between living and dying: victim characteristics and motive among nonfatal shootings and gun homicides. Violence and Victims, 32(6), 977–997.

    Article  Google Scholar 

  23. Hosler, R., Liu, X., Carter, J., & Saper, M. (2019).RaspBary: Hawkes Point Process Wasserstein Barycenters as a Service. Available at

  24. Joseph, B., Aziz, H., Pandit, V., Kulvatunyou, N., O’Keeffe, T., Wynne, J., ... Rhee, P. (2014). Improving survival rates after civilian gunshot wounds to the brain. Journal of the American College of Surgeons, 218(1), 58–65.

  25. Kellermann, A. L. (2004). Treating gun violence before the 911 call. Annals of Emergency Medicine, 43(6), 743–745.

    Article  Google Scholar 

  26. Lale, A., Krajewski, A., & Friedman, L. S. (2017). Undertriage of firearm-related injuries in a major metropolitan area. JAMA surgery, 152(5), 467–474.

    Article  Google Scholar 

  27. MacKenzie, E. J., Rivara, F. P., Jurkovich, G. J., Nathens, A. B., Frey, K. P., Egleston, B. L., ... Scharfstein, D. O. (2006). A national evaluation of the effect of trauma-center care on mortality. New England Journal of Medicine, 354(4), 366–378.

  28. Manley, N. R., Fabian, T. C., Sharpe, J. P., Magnotti, L. J., & Croce, M. A. (2018). Good news, bad news: an analysis of 11,294 gunshot wounds (GSWs) over two decades in a single center. Journal of Trauma and Acute Care Surgery, 84(1), 58–65.

    Article  Google Scholar 

  29. Nicholl, J. P. (1999). Optimal use of resources for the treatment and prevention of injuries. British Medical Bulletin, 55(4), 713–725.

    Article  Google Scholar 

  30. Roberto, E., Braga, A. A., & Papachristos, A. V. (2018). Closer to guns: the role of street gangs in facilitating access to illegal firearms. Journal of Urban Health, 95(3), 372–382.

    Article  Google Scholar 

  31. Sall, L., Hayward, R. D., Fessler, M. M., & Edhayan, E. (2018). Between-hospital and between-neighbourhood variance in trauma outcomes: cross-sectional observational evidence from the Detroit metropolitan area. British Medical Journal Open, 8(11), e022090.

    Google Scholar 

  32. Seamon, M. J., Fisher, C. A., Gaughan, J., Lloyd, M., Bradley, K. M., Santora, T. A., ... Goldberg, A. J. (2007). Prehospital procedures before emergency department thoracotomy:“scoop and run” saves lives. Journal of Trauma and Acute Care Surgery, 63(1), 113–120.

  33. Tansley, G., Schuurman, N., Bowes, M., Erdogan, M., Green, R., Asbridge, M., & Yanchar, N. (2019). Effect of predicted travel time to trauma care on mortality in major trauma patients in Nova Scotia. Canadian journal of surgery, 62(2), 123.

    Article  Google Scholar 

  34. Wandling, M., Behrens, J., Hsia, R., & Crandall, M. (2016). Geographic disparities in access to urban trauma care: defining the problem and identifying a solution for gunshot wound victims in Chicago. The American Journal of Surgery, 212(4), 587–591.

    Article  Google Scholar 

  35. Wiebe, D. J. (2003). Homicide and suicide risks associated with firearms in the home: a national case-control study. Annals of emergency medicine, 41(6), 771–782.

    Article  Google Scholar 

  36. Wood, S. N. (2017). Generalized additive models: an introduction with R. CRC press.

  37. Vlahov, D. (2018). Building the evidence base to prevent firearm deaths and injuries. Journal of Urban Health, 95(3), 293–294.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Giovanni M. Circo.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Circo, G.M., Wheeler, A.P. Trauma Center Drive Time Distances and Fatal Outcomes among Gunshot Wound Victims. Appl. Spatial Analysis 14, 379–393 (2021).

Download citation


  • Gun-violence
  • Street-network
  • Emergency-response
  • Fatality