Geographic Access To Burn Center Hospitals

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JAMA. Author manuscript; available in PMC 2011 February 27.
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JAMA. 2009 October 28; 302(16): 17741781. doi:10.1001/jama.2009.1548.
Geographic Access to Burn Center Hospitals

Matthew B. Klein, MD, MS, C. Bradley Kramer, MPA, Jason Nelson, MPH, Frederick P.
Rivara, MD, MPH, Nicole S. Gibran, MD, and Thomas Concannon, PhD
Burn Center (Drs Klein and Gibran and Mr Kramer), Division of Plastic Surgery (Dr Klein),
Department of Pediatrics and Harborview Injury Research and Prevention Center (Dr Rivara),
University of Washington, Seattle; and Institute for Clinical Research and Health Policy Studies,
Tufts University School of Medicine and Tufts Medical Center, Boston, Massachusetts (Mr Nelson
and Dr Concannon)
Abstract
ContextThe delivery of burn care is a resource-intensive endeavor that requires specialized

personnel and equipment. The optimal geographic distribution of burn centers has long been
debated; however, the current distribution of centers relative to geographic area and population is
unknown.
ObjectiveTo estimate the proportion of the US population living within 1 and 2 hours by
rotary air transport (helicopter) or ground transport of a burn care facility.
Design and SettingA cross-sectional analysis of geographic access to US burn centers
utilizing the 2000 US census, road and speed limit data, the Atlas and Database of Air Medical
Services database, and the 2008 American Burn Association Directory.
Main Outcome MeasureThe proportion of state, regional, and national population living
within 1 and 2 hours by air transport or ground transport of a burn care facility.
ResultsIn 2008, there were 128 self-reported burn centers in the United States including 51
American Burn Associationverified centers. An estimated 25.1% and 46.3% of the US
population live within 1 and 2 hours by ground transport, respectively, of a verified burn center.
By air, 53.9% and 79.0% of the population live within 1 and 2 hours, respectively, of a verified
center. There was significant regional variation in access to verified burn centers by both ground
and rotary air transport. The greatest proportion of the population with access was highest in the
northeast region and lowest in the southern United States.
Corresponding Author: Matthew B. Klein, MD, MS, UW Burn Center, Harborview Medical Center, 325 Ninth Ave, PO Box
359796, Seattle, WA 98104 (mbklein@u.washington.edu).
Author Contributions: Dr Klein had full access to all of the data in the study and takes responsibility for the integrity of the data and
the accuracy of the data analysis.
Study concept and design: Klein, Kramer, Rivara, Gibran, Concannon.
Acquisition of data: Klein, Kramer, Nelson, Concannon. Analysis and interpretation of data: Klein, Kramer, Nelson, Concannon.
Drafting of the manuscript: Klein.
Critical revision of the manuscript for important intellectual content: Klein, Kramer, Nelson, Rivara, Gibran, Concannon.
Statistical analysis: Klein, Kramer, Nelson, Concannon. Obtained funding: Klein.
Administrative, technical, or material support: Klein, Kramer, Nelson, Concannon.
Study supervision: Klein, Concannon.
Financial Disclosures: None reported.
Additional Information: Interactive maps showing the ground and rotary air transport service areas for US burn centers are available
at http://www.jama.com.
Disclaimer: Dr Rivara, an editorial board member for JAMA, was not involved in the editorial review of or decision to publish this
article.
Klein et al.
Page 2
ConclusionNearly 80% of the US population lives within 2 hours by ground or rotary air
transport of a verified burn center; however, there is both state and regional variation in
geographic access to these centers.
According to the American Burn Association, more than 500 000 burn injuries occur in the
United States each year, causing approximately 4000 burn-related deaths.1 Death most
commonly results from residential fires with smaller numbers from motor vehicle collisions,
electrical injuries, or other burn etiologies. More than 40 000 patients are admitted to
hospitals each year for treatment of burn injury.1 The delivery of optimal burn care to these
patients is a resource-intensive endeavor requiring specialized equipment and experienced
personnel. These resources are typically available only at dedicated burn centers.
In 2008, there were 128 self-identified burn centers in the United States, of which only 51
were verified by the American Burn Association.2 A recent analysis reported that only 22%
of patients admitted to a hospital for burn care are admitted to verified burn centers.3 The
verification process is the only recognized mechanism by which the quality of burn care
provided at a center can be assessed and confirmed. Verified centers are located in 25 states
and the District of Columbia and proximity to a verified burn center varies greatly around
the country. Therefore, long-range transport of an individual who sustains a burn injury may
be necessary to obtain definitive specialized care.
The optimal distribution of burn centers has long been debated.4 Several aspects of early
postinjury burn care including airway assessment, estimation of burn extent and depth, and
initiation of fluid administration are important to initial survival. Errors by physicians in
estimating burn size and depth occur commonly and may lead to complications associated
with either overresuscitation or underresuscitation.59 Therefore, timely access to a burn
center may benefit burn patients. In addition, with an anticipated shortage of qualified burn
surgeons and the increasing complexity of medical and surgical aspects of burn care,10 there
is a need to determine how best to ensure that all US residents have access to quality
definitive care.
As a first and necessary step in this process, we sought to evaluate state, regional, and
national access to burn centers in the United States. We assessed access to both verified and
nonverified centers by ground and rotary air transport using national census, air medical
transport, and street network databases.
METHODS
We performed a cross-sectional analysis of access to burn centers, using US census tractlevel data from 2000. We used approaches from previous resource allocation models to
conduct our analyses.11,12 We estimated the percentage of the population living within 1 or
2 hours by ground transport and 1 or 2 hours by ground or rotary air transport of a burn care
facility. We also assessed whether extended transport of 4 hours by ground transport could
reach significantly more of the population than in the rotary air analyses. We assumed all
transport occurred from an individuals home to the nearest burn center, measured by travel
time. Our analysis included all US residents (N=281 421 906), excluding those living in US
territories.
We examined access to burn centers that were verified by the American Burn Association as
of 2008.2 We separately examined access to self-reported burn centers (ie, all centers listed
in the American Burn Association directory), whether verified or not. Hospitals latitude and
longitude coordinates were obtained from the 2008 American Hospital Association annual
survey. Each center was entered into a geographic information system (GIS) (Environmental
Systems Research Institute ArcMap 9.2, Red-lands, California) for subsequent analyses.
Klein et al.
Page 3
We summarized population data at the census tract level and entered it into the GIS. The
population of each census tract was assigned to the tracts centroid (the geographic location
that represents the mean center of a polygon). Tract-level data were aggregated at the
state, regional, and national levels in separate analyses. For regional analyses, we used the 4
census regions: Midwest, Northeast, South, and West. Tracts were divided into 3 groups:
urban, suburban, and rural, corresponding to tertiles of population density measured in
people per square mile. We used these groups to adjust prehospital elapsed time estimates by
urban density.
We also examined the number of burn care beds in each state relative to population. Bed
numbers are self-reported in the American Burn Association directory and may represent
either total number of dedicated beds for burn patients or potentially available burn beds
given an unexpected surge in patients.
Ground Transport Analysis
To determine the shortest driving times between census tract centroids and burn centers, we
analyzed road network and speed limit data from the ArcGIS Street-Map data set using the
ArcEditor (Environmental Systems Research Institute ArcMap 9.2) network analyst
extension. For each estimated trip, we added extra time to account for dispatch of the
emergency medical service (EMS) vehicle (1.4 minutes for urban and suburban tracts and
2.9 minutes for rural tracts), time from EMS depot to scene (total time was multiplied by a
constant of 1.6, 1.5, or 1.4 for urban, suburban, or rural tracts, respectively), and time spent
on scene (13.5 minutes for urban and suburban tracts and 15.1 minutes for rural tracts).
These constants were derived in a meta-analysis of empirically determined prehospital care
times for trauma.13
Rotary Air Transport Analysis
We used Atlas and Database of Air Medical Services (ADAMS) 2007 address and
coordinate data to identify helipad locations and to estimate straight-line distances between
3 points: (1) base helipad, (2) tract centroid, and (3) burn center. Air Medical Services
typically serve multiple hospitals with different aircraft.14 The ADAMS database allowed us
to match burn centers, air medical service providers, base helipads, and available
helicopters. Helicopter speed was estimated by taking the average speed of the service
providers fleet as recorded by ADAMS. Burn centers that were not matched with specific
air medical service providers in the ADAMS database were matched with all base helipads
located within the 1- or 2-hour travel time limit. We added a set of constants to account for
dispatch time (3.5 minutes) and time spent preparing a landing zone (21.6 minutes).13 We
assumed that ground transport could be dispatched concurrently with rotary transport,
allowing air and ground vehicles to meet at the scene.15 Maps of the ground and rotary air
coverage areas for verified and nonverified centers were generated using ArcMap version
9.2 software.
RESULTS
In 2008, there were 51 verified and 128 self-reported burn centers in the United States. A
total of 782 helipads and 804 rotary wing helicopters served these centers. Nationally,
25.1%, 46.3%, and 67.7% of the US population lived within 1, 2 and 4 hours by ground
transport, respectively, of a verified center and 41.1%, 68.4%, and 90.9% lived within 4
hours of any center, whether verified or not (Table 1). By air transport, 53.9% and 79.0% of
the population lived within 1 and 2 hours, respectively, of a verified center, and 75.3% lived
within 1 hour and more than 96.4% lived within 2 hours of any self-reported center (Table
1).
Klein et al.
Page 4
Access by ground transport to verified and self-reported burn centers varied by region
(Table 1). Coverage was highest in the Northeast, with 40.2%, 72.7%, and 94.1% of the
population living within 1, 2, and 4 hours by ground transport to a verified center. Coverage
was lowest in the South, with 10.7%, 23.5%, and 46.2% living within 1, 2, and 4 hours,
respectively, of a verified center. Access by ground transport to any self-reported burn
center was highest in the Northeast (52.7%, 83.1%, and 98.0%) and lowest in the South
(27.4%, 54.8%, and 87.6%).
Access by air transport followed the same regional pattern (Table 1). Coverage was highest
in the Northeast, with 82.8% and 99.2% of the population living with 1 and 2 hours of a
verified center. In the South, 30.2% and 62.0% lived within 1 and 2 hours of a verified
center. Access by air transport to any self-reported burn center was also highest in the
Northeast (89.9% and 99.9%) and lowest in the South (63.5% and 96.2%).
Geographic access to burn centers also varied by state (Table 1). None of the population in
18 states lived within 2 hours by ground transport of a verified burn center, whereas more
than 80% of the population in 5 other states and the District of Columbia lived within 2
hours by ground transport of a verified center. More than 90% of the population of
Connecticut, Massachusetts, New Jersey, Rhode Island, and the District of Columbia lived
within 2 hours by ground transport of any self-reported center, whereas none of the
population of Montana and North Dakota lived within 2 hours of any self-reported center by
ground or air transport.
None of the population in 6 states had 2-hour access by air transport to a verified center
while 80% or more of the population in 29 states and the District of Columbia had 2-hour
access by air transport. The entire population of 20 states and the District of Columbia lived
within 2 hours by air transport of any self-reported center. Less than 20% of the population
in 3 states had 2-hour access by air transport to any self-reported center.
Overall, the number of burn care beds was 0.65 beds per 100 000 US population. The
number of beds varied by region, from 0.54 in the South to 0.81 in the Midwest. There was
also variability in the number of beds by state, from 1.64 beds/100 000 population in
Nebraska to no beds in the states Delaware, Idaho, Mississippi, Montana, New Hampshire,
North Dakota, and Wyoming (Table 2).
COMMENT
Geograhic access to verified burn centers and to self-designated burn facilities varies greatly
across states and regions in the United States. A minority of the US population lives within 2
hours by ground transport of an American Burn Association verified burn center or within
1 hour by ground transport of both verified and nonverified burn centers. To reach a verified
burn care center within 2 hours, one-third of the US population must be transported by air.
Extended transport of up to 4 hours by ground offers poorer coverage than 2-hour air
transport. Population coverage is highest in the Northeast and lowest in the South, and there
is substantial variation within regions. When including non-verified centers in the analysis,
the proportion of population living near a burn facility increased by both ground transport
and air transport, with more than 68% of the population living within 2 hours by ground
transport of any center and more than 96% living within 2 hours by rotary air transport.
The ideal geographic distribution of burn centers has long been debated. The Figure
illustrates that some regions are well served by verified centers, whereas others are relatively
underserved (see also interactive maps at http://www.jama.com). In fact, Zonies et al
recently reported that more than half of the US population with burn injuries in 2001 and
2004 received definitive care at either nonverified burn centers or other hospitals not listed
Klein et al.
Page 5
in the American Burn Association directory.3 This finding is likely attributable in part to
geographic access to centers.
While this study did not address quality of care, MacKenzie, et al16 have previously
demonstrated that trauma care provided at nondesignated centers was associated with worse
outcomes than care at level I trauma centers. To our knowledge, there are no studies
comparing long-term outcomes of burn injury based on verification status of treatment
facility. However, the verification process is currently the only recognized mechanism by
which quality of burn care can be assessed and ensured. Verification criteria include a
number of specific requirements, including minimum number of acute burn admissions (50
annually); dedicated staff of physical and occupational therapists, psychologists, dietitians
and social workers; prehospital triage and transfer guidelines; processes for quality of care
review; and a director who has sufficient training or experience in burn care. In addition,
verification must be renewed every 3 years.17 Although any hospital can designate itself a
burn care facility, quality of care according to American Burn Association standards can be
ensured only at centers that have successfully undergone the verification process. During the
past decade, the number of verified centers has increased from 34 in 2000 to 51 in 2008;
however, there are still more self-designated facilities than verified centers.
To address the need for better access to verified centers in some regions of the country and
the apparent excess of centers in other regions, Warden and Heimbach4 have advocated that
a system of regionalized burn care be developed to ensure a rational distribution of verified
centers relative to population density. Regionalization may be reasonable from a resource
distribution standpoint including both personnel and equipment; however, defining the
optimum number of centers per population or per geographic area will prove challenging.
The variation in baseline geographic access rates found in this study may be an influential
predictor of optimal regionalization strategy. For states and regions with a relatively high
baseline rate of access, the best strategy for improving access and reducing time to definitive
care may involve optimization of air and ground EMS systems. For states and regions with a
relatively low baseline rate of access, the best strategy may involve construction or
verification of new regional burn care facilities. Although we did not find burn centers that
had no rotary air transport coverage, this strategy would be one way to increase coverage in
the future if that were the case. To understand the best strategies for specific regions, one
approach would be to model the predicted effect of system change on patient access rates,
quality of care, and outcomes.
In addition to issues related to geographic distribution of centers, the optimum period in

which burn patients require access to burn centers also remains to be defined. Burn care
differs from other types of trauma in that there is no golden hour, but several aspects of
early care can be critical to good outcomes. Failure to secure an airway adequately or
diagnose related trauma can lead to adverse outcomes, including death. Inadequate burn size
estimates occur commonly by health care professionals who are relatively inexperienced in
the care of burn patients. These incorrect estimates can lead to underresuscitation and
overresuscitation. Underresuscitation can lead to hypovolemic shock and renal failure,
whereas overresuscitation can lead to abdominal and extremity compartment syndromes, as
well as pulmonary edema and acute respiratory distress syndrome.1821
Based on the findings of this study, several hours of transport may be required for a burn
patient to reach a verified or nonverified burn center. In addition, several centers provide
coverage for large geographic regions particularly in the western part of the United States.
General trauma patients with delays in receipt of definitive care at trauma centers experience
longer intensive care unit or hospital lengths of stay, increased number of complications,
Klein et al.
Page 6
hospital changes, and mortality.2226 In one study, pediatric burn patients with delayed
transfer to a verified burn center had longer lengths of stay and higher rates of infectious
outcomes.27 However, in previous studies, we reported that a regional transfer and out-ofhospital transport protocol could be implemented safely for burn patients requiring long
transport times to a verified center so that the critical aspects of acute postinjury care could
be guided by clinicians who are experienced in caring for patients with burn injuries.28,29 As
a result of these well-established protocols, patients with burns who were transferred to our
verified burn center several hours after initial assessment at preliminary care facilities had
outcomes similar to patients who were admitted directly to our center.29
There are several limitations to this study. First, fixed-wing transport data were not available
nationally. Fixed-wing aircraft are typically used for patients requiring transport over longer
distances and also tend to travel at higher speeds. Therefore, a larger geographic area could
be covered within 2 hours by fixed-wing aircraft rather than by rotary aircraft. Additional
factors that need to be considered in calculating access by fixed-wing aircraft include warmup time prior to takeoff and need for appropriate landing zones. Nonetheless, larger
geographic areas could be covered in shorter time. Second, listings of verified centers in the
American Burn Association directory change from year to year, and our results would
change if a substantial number of nonverified centers were to become verified. Finally, the
data on burn bed availability are self-reported and have not been verified. It is possible that
these reported numbers may not accurately reflect available staff to care for patients if all
beds were filled.
CONCLUSION
In conclusion, this study demonstrates that nearly 80% of the population lives within 2 hours
by ground transport or rotary air transport of a verified burn center. However, there exists
substantial state and regional variation in geographic access to these centers. While the
optimal distribution of burn centers relative to population and area remains to be
determined, these data provide important information about population access that may be
used to guide resource allocation in burn care.
Acknowledgments
Funding/Support: This work was supported by the National Center for Research Resources grant
1KL2RR025015-01, Harborview Injury Prevention and Research Center (HIPRC) grant R49/CE000197 from the
Centers for Disease Control and Prevention, and by the David and Nancy Auth-Washington Research Foundation
Endowment.
Role of the Sponsor: The study sponsors had no role in the design and conduct of the study; in the collection,
analysis, management, and interpretation of the data; or in the preparation, review, or approval of the manuscript.
REFERENCES
1. Burn incidence and treatment in the US: 2007 fact sheet. American Burn Association Web site.
[Accessed August 22, 2009]. http://www.ameriburn.org/resources_factsheet.php
2. Burn care facilities: United States. American Burn Association Web site. [Access verified October 2
2009]. http://www.ameriburn.org
3. Zonies D, Mack C, Kramer CB, Rivara FP, Klein MB. Verified centers, non-verified centers or
other facilities: a national analysis of burn patient treatment location [abstract presented at the
Proceedings of the American Burn Association: 41st Annual Meeting; March 2427, 2009; San
Antonio, TX]. J Burn Care Res 2009;30(2):S85.
4. Warden GD, Heimbach D. Regionalization of burn carea concept whose time has come. J Burn
Care Rehabil 2003;24(3):173174. [PubMed: 12792241]
Klein et al.
Page 7

5. Berkebile BL, Goldfarb IW, Slater H. Comparison of burn size estimates between prehospital
reports and burn center evaluations. J Burn Care Rehabil 1986;7(5):411412. [PubMed: 3639879]
6. Hammond JS, Ward CG. Transfer from the emergency room to burn center: errors in burn size
estimate. J Trauma 1987;27(10):11611165. [PubMed: 3669110]
7. Palmer JH, Sutherland AB. Problems associated with transfer of patients to a regional burns unit.
Injury 1987;18(4):250257. [PubMed: 3508864]
8. Saffle JR, Edelman L, Morris SE. Regional air transport of burn patients: a case for telemedicine? J
Trauma 2004;57(1):5764. [PubMed: 15284549]
9. Wong K, Heath T, Maitz P, Kennedy P. Early in-hospital management of burn injuries in Australia.
ANZ J Surg 2004;74(5):318323. [PubMed: 15144249]
10. Faucher LD. Are we headed for a shortage of burn surgeons? J Burn Care Rehabil 2004;25(6):464
467. [PubMed: 15534451]
11. Branas CC. No time to spare: improving access to trauma care. LDI Issue Brief 2005;11(1):14.
[PubMed: 16211794]
12. Branas CC, MacKenzie EJ, ReVelle CS. A trauma resource allocation model for ambulances and
hospitals. Health Serv Res 2000;35(2):489507. [PubMed: 10857473]
13. Carr BG, Caplan JM, Pryor JP, Branas CC. A meta-analysis of prehospital care times for trauma.
Prehosp Emerg Care 2006;10(2):198206. [PubMed: 16531377]
14. Center for Transportation Injury Research; Association of Air Medical Services; National Highway
Traffic Safety Administration. Atlas and Database of Air Medical Services: A National GIS
Database. 4th ed.. Buffalo, NY: Center for Transportation Injury Research; 2006.
15. Diaz MA, Hendey GW, Bivins HG. When is the helicopter faster? a comparison of helicopter and
ground ambulance transport times. J Trauma 2005;58(1):148153. [PubMed: 15674165]
16. MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center
care on mortality. N Engl J Med 2006;354(4):366378. [PubMed: 16436768]
17. American College of Surgeons. Resources for Optimal Care of the Injured Patient. Chicago, IL:
American College of Surgeons; 2006.
18. Ivy ME, Atweh NA, Palmer J, Possenti PP, Pineau M, DAiuto M. Intra-abdominal hypertension
and abdominal compartment syndrome in burn patients. J Trauma 2000;49(3):387391. [PubMed:
11003313]
19. OMara MS, Slater H, Goldfarb IW, Caushaj PF. A prospective, randomized evaluation of intraabdominal pressures with crystalloid and colloid resuscitation in burn patients. J Trauma
2005;58(5):10111018. [PubMed: 15920417]
20. Pruitt BA Jr. The effectiveness of fluid resuscitation. J Trauma 1979;19 suppl(11):868870.
[PubMed: 490704]
21. Pruitt BA Jr. Protection from excessive resuscitation: pushing the pendulum back.. J Trauma
2000;49(3):567568. [PubMed: 11003341]
22. Falcone RE, Herron H, Werman H, Bonta M. Air medical transport of the injured patient: scene
versus referring hospital. Air Med J 1998;17(4):161165. [PubMed: 10185097]
23. Kearney PA, Terry L, Burney RE. Outcome of patients with blunt trauma transferred after
diagnostic or treatment procedures or four-hour delay. Ann Emerg Med 1991;20(8):882886.
[PubMed: 1854073]
24. Rogers FB, Osler TM, Shackford SR, Cohen M, Camp L, Lesage M. Study of the outcome of
patients transferred to a level I hospital after stabilization at an outlying hospital in a rural setting. J
Trauma 1999;46(2):328333. [PubMed: 10029042]
25. Stone JL, Lowe RJ, Jonasson O, et al. Acute subdural hematoma: direct admission to a trauma
center yields improved results. J Trauma 1986;26(5):445450. [PubMed: 3701893]
26. Young JS, Bassam D, Cephas GA, Brady WJ, Butler K, Pomphrey M. Interhospital versus direct
scene transfer of major trauma patients in a rural trauma system. Am Surg 1998;64(1):8891.
Medline: 9457044. [PubMed: 9457044]
27. Sheridan R, Weber J, Prelack K, Petras L, Lydon M, Tompkins R. Early burn center transfer
shortens the length of hospitalization and reduces complications in children with serious burn
injuries. J Burn Care Rehabil 1999;20(5):347350. [PubMed: 10501318]
Klein et al.
Page 8
28. Klein MB, Nathens AB, Emerson D, Heimbach DM, Gibran NS. An analysis of the long-distance
transport of burn patients to a regional burn center. J Burn Care Res 2007;28(1):4955. [PubMed:
17211200]
29. Klein MB, Nathens AB, Heimbach DM, Gibran NS. An outcome analysis of patients transferred to
a regional burn center: transfer status does not impact survival. Burns 2006;32(8):940945.
[PubMed: 17011131]

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Figure. Ground and Rotary Air Transport Service Areas for US Burn Centers
Census tracts with very low population density are geographically very large. Inclusion of
those tracts makes some of the service area polygons in our analysis highly irregular in
shape. This irregularity represents an artifact of variation in census tracts and not
misclassification in our analysis. Interactive maps are available at http://www.jama.com.


0.0
37.2
0.0
47.3
50.9
36.6
0.0
0.0
28.7
42.0
26.3
6.5
16.1
31.3
45.2
0.0
47.3
0.0
39.9
0.0
7.3
New Hampshire
New Jersey
New York
Pennsylvania
Rhode Island
Vermont
Midwest
Illinois
Indiana
Iowa
Kansas
Michigan
Minnesota
Missouri
Nebraska
North Dakota
Ohio
South Dakota
Wisconsin
30.6
Connecticut
Massachusetts
40.2
Northeast
Maine
25.1
United States

20.5
0.0
82.2
0.0
58.9
0.0
60.1
57.4
23.6
26.4
60.1
67.5
52.1
0.0
73.8
66.0
71.2
92.8
52.1
82.5
1.2
83.3
72.7
46.3
76.6
3.5
98.7
0.0
79.1
2.4
80.8
87.1
45.0
83.8
92.5
82.0
76.0
14.5
99.0
95.5
93.3
100.0
94.6
99.2
45.5
100.0
94.1
67.7
Verified Centers (n = 51)
31.1
20.0
51.7
0.0
47.3
49.8
47.5
45.3
37.6
6.5
28.8
47.0
41.8
21.5
79.9
37.8
72.6
52.4
0.0
50.4
18.6
30.6
52.7
41.1
58.2
30.3
89.4
0.0
58.9
71.8
64.2
85.1
57.2
26.6
67.1
76.6
71.5
52.2
99.0
66.9
86.8
94.9
58.0
92.2
53.6
95.4
83.1
68.5
92.2
51.5
99.9
0.0
80.7
97.2
88.3
93.8
87.4
88.4
99.4
98.9
93.8
94.1
99.0
96.9
98.1
100.0
97.3
99.2
84.8
100.0
98.0
90.9
All Centers (n = 128)
Ground Transport
56.2
0.0
87.9
0.0
58.8
0.0
69.6
62.8
26.5
35.0
81.0
69.3
60.5
0.0
72.4
86.8
81.5
97.2
46.4
85.4
0.0
97.9
82.8
53.9
97.8
40.2
100.0
0.0
89.3
32.8
94.8
91.4
96.2
97.2
100.0
90.8
88.2
89.2
100.0
100.0
98.8
100.0
99.8
100.0
90.1
100.0
99.2
79.0
Verified (n = 51)
60.9
28.1
96.5
0.0
58.8
81.0
73.8
85.6
64.0
36.1
86.8
80.1
77.8
61.0
95.5
88.9
89.6
99.2
53.2
91.3
56.0
99.7
89.9
75.3
99.4
62.6
100.0
17.6
92.4
100.0
97.1
94.1
96.2
98.5
100.0
100.0
97.1
100.0
100.0
100.0
100.0
100.0
100.0
100.0
94.4
100.0
99.9
96.4
Air or Ground Transport
% of Population by Hours in Transit
Population Access to Burn Centers by Ground or Rotary Air Transport
Table 1
Klein et al.
Page 10

Delaware
0.0
0.0
0.0
0.0
Hawaii
Idaho
Montana
12.0
Virginia
41.3
17.9
Texas
Colorado
0.0
Tennessee
California
0.0
South Carolina
42.4
0.0
Oklahoma
Arizona
4.4
North Carolina
0.0
0.0
Mississippi
Alaska
57.9
Maryland
0.0
0.0
Louisiana
31.6
7.0
Kentucky
West Virginia
0.0
Georgia
West
7.7
Florida
100.0
35.0
Arkansas
District of Columbia
0.0
14.5
Alabama
10.7
South

0.0
0.0
0.0
0.0
70.5
61.7
0.0
54.3
4.4
28.0
43.6
0.0
0.0
0.3
21.4
0.0
87.5
0.0
9.9
0.0
23.3
100.0
62.5
30.6
0.0
23.5
0.0
1.1
0.0
0.0
91.9
83.5
0.0
71.1
40.2
56.1
78.0
7.6
0.8
12.9
67.2
1.5
96.8
0.0
54.3
2.4
54.0
100.0
83.8
61.0
0.0
46.2
0.0
0.0
59.1
48.3
63.0
55.5
8.9
52.4
5.5
37.7
27.8
31.9
10.9
39.4
9.8
2.1
57.9
16.6
34.2
28.3
29.3
100.0
35.0
16.0
22.6
27.4
0.0
8.2
71.2
69.0
86.3
78.3
9.7
74.6
25.7
71.5
56.3
53.3
20.3
62.0
39.4
14.1
87.5
32.9
58.8
61.2
66.7
100.0
62.5
35.5
44.4
54.8
0.2
18.3
71.2
86.8
96.6
87.8
9.7
86.9
87.9
95.3
80.4
87.1
86.0
94.8
87.0
50.3
97.1
93.6
94.8
84.2
95.3
100.0
83.8
77.5
90.7
87.6
Ground Transport

0.0
0.0
0.0
0.0
79.5
64.0
0.0
60.4
19.3
33.8
60.5
0.0
0.0
0.0
25.7
0.0
98.0
0.0
22.0
0.0
28.8
100.0
94.9
33.7
0.0
30.2
0.0
23.8
0.0
0.0
99.3
97.2
0.0
79.5
95.9
94.9
89.1
13.6
10.2
77.2
76.4
12.8
100.0
9.7
84.8
5.9
70.8
100.0
100.0
92.5
0.0
62.0
Verified (n = 51)
0.0
9.7
72.3
78.9
90.6
81.4
11.7
78.8
49.1
81.2
64.3
62.1
25.5
63.9
61.4
12.4
98.0
45.9
73.0
67.6
70.2
100.0
94.9
41.1
49.1
63.5
14.0
44.5
91.7
93.9
99.4
98.1
14.1
92.9
100.0
100.0
89.3
100.0
100.0
99.1
99.2
71.2
100.0
99.3
100.0
96.7
98.7
100.0
100.0
99.6
97.2
96.2
Klein et al.
Page 11

0.0
Wyoming
Utah
32.0
30.5
Oregon
Washington
0.0
36.6
New Mexico
0.0
Nevada
0.0
62.7
76.8
54.3
0.0
0.0
5.1
77.5
87.8
73.6
5.2
16.9
0.0
38.5
30.5
36.6
30.2
65.6
2.1
70.4
76.8
54.3
44.1
67.6
29.4
88.2
91.4
73.6
62.3
87.1
Ground Transport

0.0
72.4
81.3
54.9
0.0
0.0
7.7
95.6
91.1
79.4
6.1
40.0
Verified (n = 51)
1.2
80.1
81.3
54.9
48.4
59.1
34.2
100.0
91.1
80.2
74.3
95.2
Klein et al.
Page 12

2926324
2688418
9938444
4919479
5595211
1711263
642200
Iowa
Kansas
Michigan
Minnesota
Missouri
Nebraska
North Dakota
Alabama
4447100
100236820
Wisconsin
South
754844
5363675
South Dakota
11353140
6080485
Indiana
Ohio
12419293
608827
Vermont
Illinois
1048319
Rhode Island
64392776
12281054
Pennsylvania
Midwest
8414350
1235786
New Hampshire
18976457
6349097
Massachusetts
New York
1274923
New Jersey
3405565
Maine
53594378
Northeast
Connecticut
281421906
United States
Population
133944
2292668
145267
199934
106692
183402
200284
180867
218906
149958
212889
145708
94276
145814
1983996
24872
2707
117482
125775
19446
23983
21168
83299
12890
431622
9288990
Area, km2
11
19
11
51
Verified
25
20
15
77
Self-reported
Total Centers
216
14
78
28
34
26
11
16
24
37
268
47
65
30
52
15
209
902
Verified
52
321
17
41
84
15
53
12
28
256
25
77
17
138
917
Self-reported
Total Beds
1.17
0.54
0.58
0.79
1.05
0.00
1.64
1.50
1.00
0.79
0.86
0.55
0.39
0.52
0.81
1.48
0.57
0.59
0.75
0.36
0.00
1.09
0.31
0.44
0.65
0.65
Beds/100 000
Population
US Distribution of Designated Burn Centers and Beds by Census Region and State Population
Table 2
Klein et al.
Page 13
626932
5130632
33871648
4301261
1211537
1293953
902195
1998257
1819046
3421399
2233169
Alaska
Arizona
California
Colorado
Hawaii
Idaho
Montana
Nevada
New Mexico
Oregon
Utah
63197932
1808344
West Virginia
West
7078515
4012012
South Carolina
Virginia
3450654
Oklahoma
5689283
8049313
North Carolina
20851820
2844658
Mississippi
Texas
5296486
Maryland
Tennessee
4468976
4041769
Kentucky
Louisiana
8186453
Georgia
572059
District of Columbia
15982378
783600
Delaware
Florida
2673400
Arkansas

219817
251421
315349
286634
381363
215860
16527
269620
408638
294515
1493372
4580705
62753
103133
684886
109018
79945
181307
127034
123333
25226
118715
104428
151848
144560
171
5322
137044
Area,

Population
10
Verified
17
Self-reported
Total Centers
12
16
99
38
209
115
21
20
33
17
10
Verified
10
12
27
126
12
202
44
14
36
33
28
19
48
30
Self-reported
Total Beds

km2
0.54
0.47
0.55
0.60
0.00
0.00
0.25
0.63
0.66
0.97
0.96
0.65
0.22
0.62
0.62
0.63
0.17
0.96
0.34
0.00
0.38
0.63
0.47
0.59
0.39
2.97
0.00
0.37
Beds/100 000
Population
Klein et al.
Page 14
5894121
493782
Washington
Wyoming
253309
174280
Area,

Population
Verified
Self-reported
Total Centers
44
Verified
Self-reported
Total Beds

km2
0.00
0.85
Beds/100 000
Population
Klein et al.
Page 15

Geographic Access To Burn Center Hospitals

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