From NCEMSF: Where You Get Hurt Matters

Is it better to disperse EMS resources evenly throughout a state, or cluster them based on population density?

Joshua Brown, MD, MSc, FACS, discussed the regionalization of trauma care, helicopter EMS, and ambulance bases during his presentation Where you Get Hurt Matters: Geographic Organization of Trauma Systems on Saturday morning Feb. 22, 2025 during the National Collegiate EMS Foundation's Annual Conference, held at the Wyndham Grand Hotel Pittsburgh.

Brown was an EMS provider for eight years, working for Rural/Metro Medical Services in Buffalo, NY, and served as the Director of Operations for the University of Rochester Medical Emergency Response Team in Rochester, NY. He now serves as a trauma and general surgeon at University of Pittsburgh.

With modern GIS technology, we can study epidemiology and outcomes, optimize delivery of care, and analyze clusters and “hot spots” of specific calls and injuries, Brown told his audience. Spatial modeling can predict epidemiology and outbreaks.

Brown’s research interest lies in improving trauma care on a system level by allocating resources based on injury mortality data.

Brown authored a paper in 2015 that found that geographic distribution of trauma centers correlates with injury mortality, but not in the way they initially thought. Despite the authors’ early hypothesis that states with evenly dispersed trauma centers would have lower morality rates, the opposite was true. States with clustered trauma centers—in which the centers are concentrated in high population areas—actually had lower injury mortality on a system-wide level.

Extrapolating this finding to EMS, Brown reported that research out of the University of Maine finds that 4.5 million people live in “ambulance deserts.” And similar to proximity to trauma centers, states that concentrate their EMS resources based on population density have better mortality outcomes than those that disperse their resources uniformly based on geography.

What can trauma systems do with this data? More thoughtful placement of trauma centers, EMS bases and helicopter bases can save lives, Brown said. As one example, his team ran a simulation in which two Pennsylvania helicopter bases were moved to areas of higher mortality rates from vehicle crashes. The simulation found that these two relocations would result in a 12% overall relative reduction in fatality rates from motor vehicle collisions system-wide.

Brown’s research team is actively mapping the locations of ambulance and air medical bases across the country—even calling each EMS agency for their physical address—to get a better understanding of coverage and access to air and ground EMS services. The hope is this data will lead to data-driven decisions on where resources can be added or relocated in the hope of saving more lives.