Rushing Gunshot Victims to Trauma Care: The Influence of First Responders and the Challenge of the Geography
| Author | David N. Hatten,Kevin T. Wolff |
| Published date | 01 November 2020 |
| Date | 01 November 2020 |
| DOI | http://doi.org/10.1177/1088767920916900 |
| Subject Matter | Articles |
research-article2020
Article
Homicide Studies
2020, Vol. 24(4) 377 –397
Rushing Gunshot Victims to
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of First Responders and the
Challenge of the Geography
David N. Hatten1 and Kevin T. Wolff1
Abstract
Past research exploring correlates to gunshot wound fatality have focused on the
distance between the victim/incident location and trauma care facilities. Far less is
known regarding the role of first responders in linking individuals to trauma care
services. This study introduces a new method for measuring proximity to trauma
care services and first responder locations, using the STATA OSRMTIME package
to assess this relationship. A positive and significant relationship was found between
travel time, measured in minutes, from first responder locations and the likelihood of
gunshot fatality, controlling for age, race, sex, and, injury severity.
Keywords
spatial disparities, trauma care, gunshot wound, geographic proximity, first responders
Introduction
The consequences of gun violence in the United States are far reaching and remain
a central focus of policy and national debate. From 1993 to 2012, nearly 32,000
people died and 67,000 people were injured every year due to gun violence (Fowler
et al., 2015). It has also been estimated that the annual societal costs of gun-related
crime in terms of injury leading to loss of productivity, loss of life, and policing and
incarceration costs have been estimated to be as low as US$48 billion (Fowler et al.,
2015) and as high as US$100 billion (Cook & Ludwig 2000). The existing research
on the consequences of gun violence in the criminological literature has been limited
1Graduate Center, The City University of New York, New York City, USA
Corresponding Author:
David N. Hatten, Department of Criminal Justice, John Jay College of Criminal Justice, Graduate Center,
The City University of New York, 524 W. 59th St., New York, NY 10019, USA.
Email: dhatten@jjay.cuny.edu
378
Homicide Studies 24(4)
to individual-level correlates to offending and victimization, with little discussion of
the role geography may play in influencing who lives and dies. While it is acknowl-
edged that the severity of the wound suffered is the strongest predictor of whether a
gunshot victim lives or dies, how far away that victim was from medical care, spe-
cifically trauma care, is also a significant predictor of gunshot fatality (Circo, 2019;
Crandall et al., 2013). The public health literature has attempted to explain the influ-
ence of geography on trauma outcomes by incorporating measures of proximity, in
terms of travel time and distance, in their analyses. However, the role first respond-
ers play as the link between gunshot victims to trauma care services has been less
explored. Specifically, much less is known regarding the role that public safety pro-
fessionals, who often provide immediate triage or emergency care to the victim, and
arrange for, or directly transport, gunshot victims to trauma care facilities, may play
in whether a given gunshot wound (GSW) become fatal.
In the public health literature, time to trauma care has been found to be associated
positively with gunshot fatality, suggesting that spatial and temporal dislocation con-
tributes to variation in gunshot fatality. In this article, we calculate geographic proxim-
ity of first responder locations, namely police officers and fire fighters, and trauma
care facilities, to victim location, and use these measures to explain the variation in
gunshot fatality among victims of gun violence. We hypothesize that when controlling
for other important incident-level characteristics, such as age, sex, race of the victim,
and severity of the GSW, the proximity to trauma care and first responders will be
significantly related to the probability of fatality following a GSW.
To test these hypotheses, we utilize a unique criminal shooting database provided
by the Philadelphia Police Department (PPD) and Delaware Valley Intelligence Center
(DVIC), which includes victim-level information on fatalities and injuries as a result
of shootings from the years of 2006–2018. The analyses are comprised of a series of
logistic regression models to generate fatality likelihoods based on the characteristics
of the incident. Following a more detailed description of the data and measures used
in this study, we present the results of our multivariate analysis. After discussing how
our results add to the existing literature on the topic, limitations and suggestions for
future research are presented.
Literature Review
The Role of Geography in Gunshot Fatality
Almost certainly, the severity of the wound will be the single most predictive and
influential factor in whether a person lives or dies as a result of gun violence, and this
has been borne out by previous research on the issue (Crandall et al., 2013, 2016; Hsia
& Shen, 2011). GSW victims between 18 and 44 years old make up the largest propor-
tion of all those injured, and 75% of all victims of gun violence are in economically
disadvantaged neighborhoods (Avraham et al., 2018). Indeed, past research has con-
sistently found a positive relationship between the age of the victim and GSW fatality
(Libby & Wright, 2009; Weaver et al., 2004). More recently, however, limited access
Hatten and Wolff
379
to medical care, including measures of proximity to trauma care, has garnered atten-
tion in the study of GSW victim mortality.
Although not as salient as severity of the wound, past research has shown that geog-
raphy plays an important role in influencing the likelihood of a fatality as a result of a
GSW (Circo, 2019; Crandall, 2013). Lack of access to medical care can occur for a
variety of reasons and has been found to increase the lethality of violent encounters
especially among impoverished minority groups (Doerner, 1983, 1988). For example,
lack of access to sufficient medical care has been tied to regional differences like
“Southern-ness” (Huff-Corzine et al., 1986, 1991). The lack of access to medical
resources creates inequalities in lethality for violent encounters but also any traumatic
injury that necessitates transportation. Accordingly, geographic and temporal proxim-
ity to trauma care services have been previously shown to be significant predictors of
mortality following traumatic traffic injuries (Bertoli et al., 2017; Brown et al., 2017;
Durkin et al., 2005; Hsia & Shen 2011). While many studies have focused on the rural
and urban divide in medical care, there has been an increasing number of studies
focused on spatial disparities in urban areas, specifically in Cook County, Chicago,
Illinois, due to the high rates of gun violence and relative lack of trauma care.
Researchers examining spatial health disparities have extended this line of inquiry
to victims of gun violence finding that risk of mortality increases after suffering a
GSW the farther away the victim is from trauma care services. One such study found
that individuals who had suffered a GSW had reduced likelihood of survival if farther
than 5 miles away (Crandall et al., 2013). Vulnerable populations, defined as low in
socioeconomic status, residing outside of trauma care systems set up to serve urban
patient populations are particularly at risk of higher mortality rates due to lack of prox-
imity (Hsia & Shen, 2011). In fact, Hsia and Shen (2011) also found that 12% of the
urban population in the United States do not have easy access to trauma care centers,
defined as living more than 30 miles away from the nearest trauma care facility, which
equates to nearly 25-million people. In addition, the closing of trauma care facilities,
often in disadvantaged neighborhoods, has been found to displace trauma patients to
more distant trauma facilities, thus increasing the time it takes to get to trauma facili-
ties, and increasing fatality likelihoods for GSW victims (Crandall et al., 2016).
Findings from the public health literature also suggest that older shooting victims
make up most of the GSW victims and are also likely experience longer mean trans-
port times to trauma facilities, which in turn influences the likelihood of mortality
(Wandling et al., 2016).
In addition to dislocation from care, the characteristics of the road network that
emergency services operate through influence victim mortality. For example, Poole
et al. (2018) found that the more interconnected road networks are, the lethality of
violent crime decreases. This suggests that victims in more accessible places are less
likely to succumb to their wounds than those in areas with more complicated or dis-
jointed road networks.
The existing body of work, drawn primarily from the public health literature,
does much to inform the field on the role of geography, age, and wound severity in
predicting whether a gunshot would prove fatal. This literature, however, fails to
380
Homicide Studies 24(4)
account for how individuals are linked to trauma care services, and whether that link
is essential to explaining the variation in gunshot fatalities among GSW victims.
More specifically, we propose that public safety professionals, in their role as first
responders to criminal incidents, act as a crucial...
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