Introduction

The US has one of the highest rates of gun violence and mass shootings among industrialized nations. Rapid prehospital response and transport to a hospital equipped to handle these mass casualty events are critical. The objective of this study was to assess geographic disparities in mass shootings and access to trauma centers.

Methods

Data on locations of adult Level I and II trauma centers were extracted from the online registries maintained by the American College of Surgeons and the Trauma Centers of America. Lists of trauma centers from each data source were combined and de-duplicated. Mass shooting event data were taken from an open source database, Gun Violence Archive. Mass shooting was defined as 4 or more people shot at a single event. Data were visualized using ArcGIS.

Results

A total of 564 trauma centers and 1,672 mass shooting incidents were included. Ratios of the number of mass shooting incidents vs trauma centers per state ranged from 0 to 11.0 mass shootings per trauma center. After Louisiana and New Mexico (ratios of 11.0 each), the next top states are: Tennessee (9.7), Alabama (8.4), and Mississippi (7.0).

Conclusions

States in the southern regions of the US experience the greatest disparity through a high burden of mass shootings with less access to trauma centers. Interventions are needed to increase access to trauma care and to reduce the social determinants driving the high frequency of mass shootings in these medically underserved areas.