Department of Bioinformatics and Medical Education, University of Washington, Seattle, USA.
Department of Surgery, University of Washington, Seattle, USA.
J Burn Care Res. 2021 Aug 4;42(4):621-626. doi: 10.1093/jbcr/irab064.
In Nepal, preventable death and disability from burn injuries are common due to poor population-level spatial access to organized burn care. Most severe burns are referred to a single facility nationwide, often after suboptimal burn stabilization and/or significant care delay. Therefore, we aimed to identify existing first-level hospitals within Nepal that would optimize population-level access as "burn stabilization points" if their acute burn care capabilities are strengthened. A location-allocation model was created using designated first-level candidate hospitals, a population density grid for Nepal, and road network/travel speed data. Six models (A-F) were developed using cost-distance and network analyses in ArcGIS to identify the three vs five candidate hospitals at ≤2, 6, and 12 travel-hour thresholds that would optimize population-level spatial access. The baseline model demonstrated that currently 20.3% of the national population has access to organized burn care within 2 hours of travel, 37.2% within 6 travel-hours, and 72.6% within 12 travel-hours. If acute burn stabilization capabilities were strengthened, models A to C of three 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. In models D to F, five chosen hospitals would bring access to 53.4, 95.0, and 99.9% of the national population at ≤2, 6, and 12 travel-hours, respectively. These models demonstrate developing capabilities in three to five hospitals can provide population-level spatial access to acute burn care for most of Nepal's population. Organized efforts to increase burn stabilization points are feasible and imperative to reduce the rates of preventable burn-related death and disability country-wide.
在尼泊尔，由于人口层面获得有组织烧伤治疗的机会有限，烧伤导致的可预防死亡和残疾较为常见。大多数严重烧伤患者被转往全国唯一的一家机构，而在此之前烧伤的稳定处理和/或严重的治疗延误情况往往已经发生。因此，我们旨在确定尼泊尔现有的一级医院，如果其急性烧伤治疗能力得到加强，将作为“烧伤稳定点”来优化人口层面的烧伤治疗机会。我们使用指定的一级候选医院、尼泊尔人口密度网格以及道路网络/旅行速度数据创建了一个位置分配模型。使用 ArcGIS 中的成本距离和网络分析，我们开发了六个模型（A-F），以确定在≤2、6 和 12 个旅行小时阈值下，三个或五个候选医院中哪三个或五个医院可以优化人口层面的空间覆盖范围。基线模型表明，目前有 20.3%的全国人口在 2 小时的旅行时间内可以获得有组织的烧伤治疗，37.2%在 6 小时内，72.6%在 12 小时内。如果急性烧伤稳定能力得到加强，选择的三个医院的模型 A 至 C 将使 45.2%、89.4%和 99.8%的全国人口在≤2、6 和 12 小时旅行时间内获得急性烧伤治疗，模型 D 至 F 中，选择的五个医院将使 53.4%、95.0%和 99.9%的全国人口在≤2、6 和 12 小时旅行时间内获得急性烧伤治疗。这些模型表明，在三到五个医院发展能力可以为尼泊尔大部分人口提供急性烧伤治疗的人口层面空间覆盖。增加烧伤稳定点的有组织努力是可行的，也是减少全国范围内可预防烧伤相关死亡和残疾发生率的必要措施。
