Research shows that rural residents have an elevated risk of traumatic injury and are 14% more likely to die after traumatic injury compared with nonrural residents, with distance from trauma centers and travel time likely significant contributors to this disparity. Recent analyses by the Maine Rural Health Research Center of 41 states found over 4 million people were living in ambulance deserts in 2020-2021, defined as residential locations more than a 25-minute drive from where an ambulance station is located. Currently, the impact on trauma outcomes for patients residing in an ambulance desert has not been assessed. This project will use the 2020 State Emergency Department Databases (SEDD) and State Inpatient Database (SID) to examine differences in trauma outcomes for patients residing in ambulance deserts. We will select 12-16 states (3-4 per Census region) based on their rural populations and percentage of residents who live in ambulance deserts. SEDD and SID data will be linked to ambulance desert information using residential county codes.

Data will be extracted on:

• The emergency department trauma designation
• Mechanism of injury (blunt vs. penetrating)
• Injury severity status
• Comorbidities
• Demographics (age, sex, race, and ethnicity)
• Rurality
• Insurance status
• Patient income

The primary outcome will be mortality following a traumatic injury. We will also examine case specific injuries, especially penetrating injuries that are most likely to benefit from rapid delivery of definitive care.