113 Not Another Mass Casualty: Using Simulation to Increase Physician Comfort With the Unique Challenges of Protest Medicine

Abstract

Study Objectives: Each year there are millions of visits to US national parks, which result in the need for emergency medical services. Our objective was to determine the transit time from each US national park to the nearest emergency department (ED), adult advanced trauma center (ATC), and ED that receives telehealth services (TH), and the percentage of national parks by US region that had timely access (<60 minutes) to each type of ED.Methods: The address of the main visitor center at 61 US national parks open in 2018 was identified using information publicly available on nps.gov. ED-specific information was obtained using the 2018 National ED Inventory-USA database. Driving distance and time (on a typical Saturday at noon), and approximate air transport time from each national park to the nearest ED, ATC, and ED that receives TH was determined using ArcMap 10.3 and Google Maps. In the West, 5 national parks not accessible by road were excluded from drive time calculations. We determined the median and interquartile range (IQR) of travel time and percentage of national parks in each US region that had a transit time of <60 minutes by ground or air to each type of ED.Results: Overall, 79% of US national parks had timely access (<60 minutes) by ground transit to an ED, 24% had access to an ATC, and 59% had access to an ED that receives TH. By air, 97% of national parks had timely access to an ED, 85% had access to an ATC, and 52% had access to an ED that receives TH. National parks are unequally distributed in the US, with only 1 in the East, versus 42 in the West. The median transit time to each type of ED varied regionally, with the longest ground and air transit times in the West for all types of EDs.Conclusion: Of the 61 US national parks analyzed, most had access to an ED in <60 min by ground or air. Regional differences were observed, with greater access in the Northeast, Midwest, and South regions compared to the West region for all types of EDs. To address regional disparities in timely access to trauma care, we encourage increased adoption of ED telehealth with an emphasis on advanced trauma care.