75 Geographic Location-Allocation Modeling to Optimize National Burn Care Delivery and Disaster Planning

Abstract

Abstract Introduction The study country has a disproportionally high burn incidence rate compared to other low- and middle-income countries. Preventable death and disability are common due to poor population-level spatial access to organized burn care, including no organized system of ground or aeromedical transport. Currently, severe burns are referred to a single facility nationwide, often with suboptimal stabilization and/or significant care delay. Therefore, we aimed to identify existing candidate hospitals that would optimize population-level access to acute burn care if burn stabilization capabilities were strengthened in each hospital. Methods The 175 general hospitals that referred patients to the single national burn referral center between 2016–2020 were designated as candidate hospitals. Demand points for location-allocation modelling were derived from a 2020 estimated population density grid for the country (total population 30,184,338). Road network and national speed limit data were extracted from publicly available geodata to inform travel distance and time. Six models were developed (Models A-F) using cost-distance and network analyses to identify the 3 vs 5 candidate hospitals that would optimize population-level spatial access if their initial burn stabilization capabilities were strengthened. Three travel time thresholds (≤2, 6, and 12 hours) were used for both sets of models. Results Currently, 6,151,298 people (20.3% of the national population) have access to organized burn care within 2 hours of travel, 11,240,957 (37.2%) within 6 hours and 21,925,928 (72.6%) within 12 hours [Table 1]. If acute burn stabilization capabilities were strengthened, Models A-C of 3 chosen hospitals would increase population-level burn care access to 45.2%, 89.4%, and 99.8% of the national population at ≤2, 6, and 12 travel-hours, respectively. Models D-F demonstrated that 5 chosen hospitals would increase population-level burn care access to 53.4%, 95.0%, and 99.9% of national the population at ≤2, 6, and 12 travel-hours, respectively. Conclusions This exercise demonstrates two sets of models for increasing population-level access to acute burn stabilization in the study country. If acute burn stabilization capabilities were strengthened in the identified hospitals, approximately 90% of the national population would have access to burn care within 6 travel-hours in both the 3 and 5 hospital scenarios. Although the models with 5 strengthened hospitals reduce mean travel time, the percent of population with improved travel time access is only marginally higher. Strategic, organized efforts to increase burn stabilization capabilities might reduce the rates of preventable burn-related death and disability country-wide by reducing delays.