Improving access to trauma care for victims of firearm violence

Boston University Medical Campus, Boston MA

Investigators

Abstract

PROJECT ABSTRACT Firearm homicide (FH) rates have risen to levels not seen in four decades.1-4 Nationally, Black and Hispanic Americans represent about 77% of FH deaths and face disparities in access to life-saving trauma care.5 Such disparities are specifically known to exist in Massachusetts. Black and Hispanic people make up only 43% of the Boston population but 84% of FV deaths while white residents represent half the population but less than 4% of FV deaths.6-9 Both time and distance from a trauma center (TC) are associated with death from a gunshot wound, mediated by temporal delays in expert care and the major resources centralized in trauma centers.8-15 Trauma centers, which save lives, are not evenly distributed. Our group has identified unadjusted relationships for both time and distance in Boston, as well as racial and ethnic differences in trauma center access.8,9 The overarching goal of this proposal is to assess a proposed solution to address these differences in access to care and improve survival of the most shooting victims. Specifically, this K08 proposes to test whether the conversion of a non-trauma center into a trauma center can save time and lives after a shooting. This study has three parts. The first is identifying the relationship of time to care with outcomes after a gunshot wound in Massachusetts while accounting for injury characteristics and identifying individual disparities in time to care and survival (Aim 1). Second, we will assess the relationship of time to care and neighborhood characteristics to evaluate disparities in trauma care access. We will then simulate the conversion of an acute care hospital whose catchment contains highest concentration of poverty and experiences the most firearm violence into a trauma center while estimating the time and lives saved from this simulation (Aim 3). This proposal builds upon Dr. Scantling’s past work as a paramedic and his research on access to trauma care and health disparities. He will pursue the following training goals to prepare him for this research and for his future career as a leader in disparities work; (1) further training in geospatial analysis, (2) health disparities epidemiology and (3) professional development as a surgeon-scientist.