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Optimally Locating Level I Trauma Centers and Aeromedical Depots for Rural Regions of the State of Ohio

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2017, Doctor of Philosophy, University of Toledo, Spatially Integrated Social Science.
Fifty years ago, trauma was called a public health crisis by the National Academy of Science. Their report was the stimulus to create an organized trauma system in the United States. Experience from the Korean War led to the inclusion of helicopter transport in the early 1970’s. Also in the early 1970’s, standards for hospital and physician trauma qualifications were developed by the American College of Surgeons Committee on Trauma with the goal of having a tiered, integrated and multilayered system to improve patient survival. As of six years ago, most states have some type of multi-level trauma system but trauma continues to be the leading cause of death in people under the age of 50. This is despite over forty years of trauma system development and technological advancements in medicine and automobile safety. This significantly high mortality is partly related to the poor placement of the trauma resources themselves. This problem of access impacts those living in the state of Ohio, particularly those living in rural areas and approximately 3% of Ohio’s population, or over 340,000 people, do not have access to a Level I trauma center (TC) within an hour. Sixteen counties in Ohio had insufficient access to Level I TCs within one hour although there are 11 Level I TCs and 32 staffed helipads (ADs). The objective of this study was to use a resource allocation model to optimally locate Level I TCs and ADs in Ohio such that the rural population in the state (those currently being underserved) could access definitive care within sixty minutes. By utilizing the vertex substitution method, it was hypothesized that full population coverage could be achieved in Ohio with the same number or fewer resources. The patient population was limited to adults with an Injury Severity Score (ISS) of 15 or higher. The patient’s home zip code was used as a proxy for injury location. Only those resources available in the state were included for model simplicity. There were two phases to the study. In the first phase, Euclidean distances were calculated from existing AD resources to weighted zip code centroids. Then, times were calculated from the zip code centroids to all existing hospitals and the optimal location was selected based on lowest cost (time). The model was initially run trying to optimize 11 TC locations, the current number in the state, then once results were obtained, the number of TCs was incrementally decreased until a feasible solution could not be obtained. In the second phase of the study, all current airfields and helipads in Ohio were considered as potential staffed AD locations and the optimal AD sites were calculated, and then incrementally decreased. Those optimal ADs were then set and then optimal TC locations were obtained. Again, the number of TCs were incrementally decreased until no feasible solution could be calculated. Full coverage for rural populations in Ohio was able to obtained in both phases of the study given the existing number of resources or even fewer resources. The fewest facilities able to fully cover the state were obtained in the second phase of the study with 17 optimal ADs and 4 TCs. The number of TCs was not realistic given that urban populations would not have been served by 4 TCs, but even by adding resources to urban areas not covered, full coverage could still be achieved with 9 or 10 optimal TCs; one or two less than what currently exist. Across both parts of the study, the number of TCs were consistently at least one less than the existing 11. Since results were so readily obtained with fewer resources, it is evident that if resources in Ohio were fairly and optimally located, all patients in Ohio, particularly underserved rural populations, could reach definitive care within one hour.
Peter Lindquist, Ph.D. (Committee Chair)
Neil Reid, Ph.D. (Committee Member)
Patricia Case, Ph.D. (Committee Member)
Sunday Ubokudom, Ph.D. (Committee Member)
Daniel Hammel, Ph.D. (Committee Member)
91 p.

Recommended Citations

Citations

  • Pepe, L. R. (2017). Optimally Locating Level I Trauma Centers and Aeromedical Depots for Rural Regions of the State of Ohio [Doctoral dissertation, University of Toledo]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1493197364277033

    APA Style (7th edition)

  • Pepe, Linda. Optimally Locating Level I Trauma Centers and Aeromedical Depots for Rural Regions of the State of Ohio. 2017. University of Toledo, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=toledo1493197364277033.

    MLA Style (8th edition)

  • Pepe, Linda. "Optimally Locating Level I Trauma Centers and Aeromedical Depots for Rural Regions of the State of Ohio." Doctoral dissertation, University of Toledo, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1493197364277033

    Chicago Manual of Style (17th edition)