Access to Trauma Care in a Rural State: A Descriptive Geographic and Demographic Analysis

J Emerg Med. 2024 Jan;66(1):e20-e26. doi: 10.1016/j.jemermed.2023.08.011. Epub 2023 Aug 24.


Background: Montana is a rural state with limited access to higher-level trauma care; it also has higher injury fatality rates compared with the rest of the country.

Objectives: The purpose of this study was to utilize Geographic Information System methodology to assess proximity to trauma care and identify the demographic characteristics of regions without trauma access.

Methods: Maptitude® Geographic Information System software (Caliper Corporation, Newton, MA) was used to identify regions in Montana within 60 min of trauma care; this included access to a Level II or Level III trauma center with general surgery capabilities and access to any level of trauma care. Demographic characteristics are reported to identify population groups lacking access to trauma care.

Results: Of the 1.1 million residents of Montana, 63% of residents live within 60 driving min of a higher-level trauma center, and 83% of residents live within 60 driving min of any level of trauma center. Elderly residents over age 65 years of age and American Indians had reduced access to both higher-level trauma care and any level trauma care.

Conclusions: Prompt access to trauma care is significantly lower in Montana than in other parts of the country, with dramatic disparities for American Indians. In a rural state, it is important to ensure that all hospitals are equipped to provide some level of trauma care to reduce these disparities.

Keywords: emergency medical services; geographic information system; health disparities; rural trauma; trauma system.

MeSH terms

  • Aged
  • Demography
  • Health Services Accessibility*
  • Humans
  • Rural Population
  • Trauma Centers*