Geographic Disparity in Distance to Trauma Care in Secondary Schools across the United States

Abstract

Context: Geographic disparities exist in trauma care (i.e., “trauma center desert”) within the United States. An athletic trainer (AT) on-site at secondary schools (SSs) may help enhance collaboration with emergency medical systems and potentially lead to better outcomes following catastrophic injuries. However, access to AT services relative to the location of Level I or II (i.e., tertiary) trauma centers remain unknown. Objective: To visualize and describe SSs distance to trauma centers and compare access to AT services across the United States. Design: Cross-sectional study Setting: Public and private secondary schools with interscholastic athletics program in the United States Patients or other Participants: Survey data obtained through the Athletic Training Locations and Services (ATLAS) project database between September 2019 and April 2023 Main Outcome Measure(s): The minimum distance from each SS to tertiary trauma centers was calculated on Tableau Desktop by geocoding with longitude and latitude. The status and level of AT employment were obtained from ATLAS project database. The odds and percentage of access to AT services were examined by distance ranges. Results: A total of 18,244 SSs were included in the analyses. Seventy-five percent of SSs (n=13,613) were located within 50 miles from tertiary trauma center. The odds of access to AT services were 2.74 [CI: 2.56-2.93] times greater in SSs located within 50 miles from tertiary trauma center (P<0.001). Additionally, SSs located > 60 miles from tertiary trauma center have decreased access to AT services (R2= 0.9192). Conclusion: This study highlights geographic disparity in distance to trauma care for SSs in the United States. SSs located > 60 miles from trauma centers were at reduced odds of access to AT services. Identification of geographic trends of AT services relative to the location of tertiary trauma centers is a critical first step to prevent fatal consequences of catastrophic injuries.