Healthcare and Access: Crash Fatalities in Georgia Bradford Johnson (bdjohns@uga.edu) and Lauren Anderson (leanders@uga.edu)

Background This study seeks to determine the vulnerability of highway travelers relative to the availability of health services following crashes. From 2003 to 2012, 5,683 traffic incidents within ½ mile of Georgia interstates and U.S. highways resulted in the death of at least one motorist. Many of these crashes occurred in rural areas away from sufficient medical services. We hypothesize that motorists involved in accidents occurring at large distances from sufficient medical care are vulnerable to slower response times and higher incidences of fatality. The Georgia Hospital Association lists four tiers of trauma centers, and these are considered, for the sake of this study, to provide higher levels of proficient care in high speed crash scenarios.

Conclusions • In general, rural motorists are most vulnerable. Distance

to nearest hospitals exceeds 30 miles in several areas across Georgia.

• A consecutive 40-mile stretch of I-20 between Atlanta and Augusta is between 18 and 30 miles from the nearest hospital. This stretch also has one of the highest fatality per Vehicle Miles Traveled rates in the state.

• Higher RT clusters are consistently found on rural interstates but not US highways.

• Despite the close proximity to several hospitals and trauma centers, RT in downtown Atlanta is among the highest in the state during fatal accidents when normalized by distance to the nearest hospital at over 60 minutes per mile (not pictured). This is likely due to inaccessibility for emergency vehicles following traffic incidents.

Areas such as the those identified along rural I-20 and in the southeastern part of the state are significant in that they highlight places where a lack of access may be influential in the number of crash fatalities. Future research may include expansion of this analysis to regional and national scales.

Note: Southeast Georgia has the largest distances from any of the trauma units in state; however, this may be somewhat misrepresentative near the I-95 corridor. Jacksonville, FL is located about 30 miles south of the FL/GA border.

Results Hot spot analysis (Figure 2) showed that lower RTs generally tend to cluster in urban areas whereas higher times occur in more rural areas. These hot spots and cold spots can be seen to correspond with lower and higher distances to hospitals, respectively. A scatter plot of distance to nearest hospital (X) and RT for fatal crashes (Y) does not show an overwhelming positive trend (R2 = 0.09); however, the instances with the highest relative distance to hospital and RT (selected in red on the plot and map) largely occur along a stretch of I-20 between Augusta and Athens. The county map of fatal crash incidences per VMT shows the highest rate of fatal crashes occurred in the Southeastern counties and other primarily rural counties. In the Atlanta metro region, significant clustering of low RTs are prevalent (Figure 3). As motorists travel to the edges and outside of the area, susceptibility to longer RTs increases.

Methods A database of fatal traffic incidents was obtained for the entire state from 2003 to 2012 and clipped to within a ½ mile buffer of all Georgia interstates and US highways. ● A response time (RT) variable (amount of

elapsed time between initial notification of emergency services and arrival at hospital) and distance to closest trauma center and hospital were calculated for each incident. Histograms are included below.

● Crash Incidences were spatially joined to counties and fields added for number of fatal crashes per county and Vehicle Miles Travelled (VMT) per county (2000 - 2006).

To explore the relationship between fatal crash incidences, RT, and distance to hospital/trauma centers, hot spot analysis and local Moran’s I tests were performed for fatal crash RTs using a zone of indifference conceptualization of space. Euclidean distance surface maps were produced for distances from nearest hospitals and trauma centers relative to crash sites.

To gain an understanding of relative frequency of fatalities, the number of fatal crashes per county were normalized by VMT and symbolized by standard deviation.

Data Sources • Georgia Department of Community Health via GA GIS

Clearinghouse - 2008 (Hospitals) • Census.gov - 2012 (Counties; Roads) • National Highway Traffic Safety Administration -

2003-2012 (Crash fatalities) • Georgia Hospital Association - 2013 (Trauma Centers)

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

DISTANCE TO NEAREST HOSPITAL

AND RESPONSE TIME 2003 - 2012

DISTANCE (MI)

TIM

E (M

IN)

Photo courtesy of uptownmagazine.com