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Matthew B. Klein, MD, MS; C. Bradley Kramer, MPA; Jason Nelson, MPH; Frederick P. Rivara, MD, MPH; Nicole S. Gibran, MD; Thomas Concannon, PhD

JAMA. 2009;302(16):1774-1781.

Context  The delivery of burn care is a resource-intensive endeavor that requires specialized personnel and equipment. The optimal geographic distribution of burn centers has long been debated; however, the current distribution of centers relative to geographic area and population is unknown.

Objective  To estimate the proportion of the US population living within 1 and 2 hours by rotary air transport (helicopter) or ground transport of a burn care facility.

Design and Setting  A cross-sectional analysis of geographic access to US burn centers utilizing the 2000 US census, road and speed limit data, the Atlas and Database of Air Medical Services database, and the 2008 American Burn Association Directory.

Main Outcome Measure  The proportion of state, regional, and national population living within 1 and 2 hours by air transport or ground transport of a burn care facility.

Results  In 2008, there were 128 self-reported burn centers in the United States including 51 American Burn Association–verified centers. An estimated 25.1% and 46.3% of the US population live within 1 and 2 hours by ground transport, respectively, of a verified burn center. By air, 53.9% and 79.0% of the population live within 1 and 2 hours, respectively, of a verified center. There was significant regional variation in access to verified burn centers by both ground and rotary air transport. The greatest proportion of the population with access was highest in the northeast region and lowest in the southern United States.

Conclusion  Nearly 80% of the US population lives within 2 hours by ground or rotary air transport of a verified burn center; however, there is both state and regional variation in geographic access to these centers.

Author Affiliations: Burn Center (Drs Klein and Gibran and Mr Kramer), Division of Plastic Surgery (Dr Klein), Department of Pediatrics and Harborview Injury Research and Prevention Center (Dr Rivara), University of Washington, Seattle; and Institute for Clinical Research and Health Policy Studies, Tufts University School of Medicine and Tufts Medical Center, Boston, Massachusetts (Mr Nelson and Dr Concannon).

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