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.
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American Trauma Society. (2019). Trauma Center Levels Explained. Retrieved from: https://www.amtrauma.org/page/traumalevels?
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.
Anselin, L. (1995). Local indicators of spatial association—LISA. Geographical Analysis, 27(2), 93–115.
Bartlett, C. S. (2003). Clinical update: gunshot wound ballistics. Clinical Orthopaedics and Related Research®, 408, 28–57.
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.
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.
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.
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.
Burnham, K. P., & Anderson, D. R. (2004). Multimodel inference: understanding AIC and BIC in model selection. Sociological methods & research, 33(2), 261–304.
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.
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.
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.
Circo, G. M. (2019). Distance to trauma centres among gunshot wound victims: identifying trauma ‘deserts’ and ‘oases’ in Detroit. Injury prevention, injuryprev-2019.
Cook, P. J., & Ludwig, J. (2000). Gun violence: The real costs. Oxford University Press on Demand.
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.
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.
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.
Google Maps Platform. (2020). Retrieved from: https://cloud.google.com/maps-platform
Grommon, E., & Rydberg, J. (2015). Elaborating the correlates of firearm injury severity: combining criminological and public health concerns. Victims & Offenders, 10(3), 318–340.
Harrell, F., Jr. (2001). Regression modelling strategies: With applications to linear models, logistic regression, and survival analysis. New York: Springer-Verlag.
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.
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.
Hosler, R., Liu, X., Carter, J., & Saper, M. (2019).RaspBary: Hawkes Point Process Wasserstein Barycenters as a Service. Available at https://www.researchgate.net/profile/George_Mohler/publication/327212089_Raspbary_Hawkes_Point_Process_Wasserstein_Barycenters_as_a_Service/links/5b805ab192851c1e122f57a4/Raspbary-Hawkes-Point-Process-Wasserstein-Barycenters-as-a-Service.pdf.
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.
Kellermann, A. L. (2004). Treating gun violence before the 911 call. Annals of Emergency Medicine, 43(6), 743–745.
Lale, A., Krajewski, A., & Friedman, L. S. (2017). Undertriage of firearm-related injuries in a major metropolitan area. JAMA surgery, 152(5), 467–474.
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.
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.
Nicholl, J. P. (1999). Optimal use of resources for the treatment and prevention of injuries. British Medical Bulletin, 55(4), 713–725.
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.
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.
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.
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.
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.
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.
Wood, S. N. (2017). Generalized additive models: an introduction with R. CRC press.
Vlahov, D. (2018). Building the evidence base to prevent firearm deaths and injuries. Journal of Urban Health, 95(3), 293–294.
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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). https://doi.org/10.1007/s12061-020-09362-3