No Time to Spare: Improving Access to Trauma Care

Since the September 11 attacks, policymakers are paying increasing attention to the adequacy of the U.S. trauma care system to handle potential mass casualty incidents. This attention has led to questions about how well the trauma system covers the population for day-to-day trauma, such as motor vehicle accidents and gunshot wounds. Although the number of trauma centers has increased in the last decade, no national plan exists to assure that everyone has timely access to a specialized trauma center if needed. This Issue Brief summarizes a new study that estimates the proportion of residents that can reach a trauma center by ground or air ambulance within one hour of where they live, using objective measures of travel times and distances

Time, Distance, and Access to Emergency Care in the United States

As national health care reform advances, increasing attention is being paid to the adequacy of existing resources to meet health care needs. Do we have the right mix of providers and facilities? Are they located and organized efficiently? These persistent questions are especially relevant to the provision of emergency care, in which timely access can save lives. This Issue Brief describes the first national study of population access to emergency care, taking into account the locations of emergency departments (EDs), people, and transportation

To the Rescue: Optimally Locating Trauma Hospitals and Helicopters

Injury (trauma) is the leading cause of death in the United States for people younger than 45 years of age. Each day, more than 170,000 men, women, and children are injured severely enough to seek medical care. About 400 of these people will die and another 200 will sustain a long-term disability as a result of their injuries. An estimated 20-40% of trauma-related deaths could be prevented if all Americans lived in communities that were served by a well-organized system of trauma care. This Issue Brief describes a new computer model that can help State and regional policymakers decide where to place designated trauma hospitals and helicopter depots to maximize their residents’ access to trauma care

Guatemala & the University of Pennsylvania: Meeting in the Middle

The GUATEMALA-PENN relationship is a partnership that is borne from more than a century of research, service and scholarship. Our goal, with this book and with our programs, is to grow this partnership based upon the reciprocal needs of our Guatemalan stakeholders and the mission of the university. Guatemala is only one country away from the US. Our shared heritage and joint economic and social interests make it critical to foster a strong and mutually beneficial relationship between our two countries. Our connections have evolved over time in response to new knowledge gained about each other. This book is a testament to our collective past, present and future. For more information or to donate visit: http://www.med.upenn.edu/globalhealth/guatemalapartners.shtm

Guatemala & the University of Pennsylvania: Meeting in the Middle

The GUATEMALA-PENN relationship is a partnership that is borne from more than a century of research, service and scholarship. Our goal, with this book and with our programs, is to grow this partnership based upon the reciprocal needs of our Guatemalan stakeholders and the mission of the university. Guatemala is only one country away from the US. Our shared heritage and joint economic and social interests make it critical to foster a strong and mutually beneficial relationship between our two countries. Our connections have evolved over time in response to new knowledge gained about each other. This book is a testament to our collective past, present and future. For more information or to donate visit: http://www.med.upenn.edu/globalhealth/guatemalapartners.shtm

Hospital-Reported Pneumococcal Susceptibility to Penicillin

Geographic variation in drug susceptibility among isolates of Streptococcus pneumoniae has influenced national treatment guidelines for community-acquired pneumonia. Whether individual hospital susceptibility data provide reliable and valid information for providers is unclear. We examined the geographic and temporal variability in hospital-reported rates of pneumococcal susceptibility. We surveyed all 52 hospitals that provided acute adult care in the five counties surrounding Philadelphia and collected data on levels of penicillin susceptibility among all pneumococcal blood isolates from 1998 to 2000. In 1998, pneumococcal nonsusceptibility to penicillin varied from 0% to 67% of all blood isolates across the 33 hospitals with ≥10 isolates in that year. Hospital location did not correlate with the level of reported pneumococcal susceptibility (p = 0.8). In addition, correlations were not significant in reported pneumococcal susceptibility to penicillin within individual hospitals during the 3 years

Trauma Center-Community Partnerships to Address Firearm Injury: It can be Done

Firearm violence is often framed as a problem of the inner cities and of the criminal justice system. However, this focus may direct attention away from smaller communities that also face firearm violence, including suicide. Ten years ago, the Firearm and Injury Center at Penn (FICAP) developed and implemented a model program in three smaller cities, using trauma centers to spearhead community partnerships. This Issue Brief describes the development and implementation of these partnerships, and highlights one community’s ongoing activities to reduce firearm injury

Acute Alcohol Consumption, Alcohol Outlets, and Gun Suicide

A case-control study of 149 intentionally self-inflicted gun injury cases (including completed gun suicides) and 302 population-based controls was conducted from 2003 to 2006 in a major US city. Two focal independent variables, acute alcohol consumption and alcohol outlet availability, were measured. Conditional logistic regression was adjusted for confounding variables. Gun suicide risk to individuals in areas of high alcohol outlet availability was less than the gun suicide risk they incurred from acute alcohol consumption, especially to excess. This corroborates prior work but also uncovers new information about the relationships between acute alcohol consumption, alcohol outlets, and gun suicide. Study limitations and implications are discussed

Novel Linkage of Individual and Geographic Data to Study Firearm Violence

Firearm violence is the end result of a causative web of individual-level and geographic risk factors. Few, if any, studies of firearm violence have been able to simultaneously determine the population-based relative risks that individuals experience as a result of what they were doing at a specific point in time and where they were, geographically, at a specific point in time. This paper describes the linkage of individual and geographic data that was undertaken as part of a population-based case-control study of firearm violence in Philadelphia. New methods and applications of these linked data relevant to researchers and policymakers interested in firearm violence are also discussed

Examination of Carotid Arteries with Quantitative Color Doppler Flow Imaging

The results of conventional duplex scanning were compared with QCDFI. A total of 224 consecutive patients comprising 442 unilateral carotid systems were examined by conventional duplex techniques. MPSV, as determined by QCDFI, were recorded for each of the 442 carotid segments and grouped according to the previously determined degrees of stenosis. The predictive value of QCDFI was confirmed by angiography with an overall accuracy of 91%. Results obtained by duplex scanning correlated with angiography 89% of the time. Based on QCDFI data, a scale to grade carotid stenosis was developed