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Optimizing trauma system design: The GEOS (Geospatial Evaluation of Systems of Trauma Care) approach

Jansen, Jan O. FRCS, FFICM; Morrison, Jonathan J. MRCS; Wang, Handing BSc; Lawrenson, Robin MCPara, FASI; Egan, Gerry QAM, DipIMC, RCSEd; He, Shan PhD; Campbell, Marion K. PhD

Journal of Trauma and Acute Care Surgery: April 2014 - Volume 76 - Issue 4 - p 1035–1040
doi: 10.1097/TA.0000000000000196
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BACKGROUND Trauma systems have been shown to reduce death and disability from injury but must be appropriately configured. A systematic approach to trauma system design can help maximize geospatial effectiveness and reassure stakeholders that the best configuration has been chosen.

METHODS This article describes the GEOS [Geospatial Evaluation of Systems of Trauma Care] methodology, a mathematical modeling of a population-based data set, which aims to derive geospatially optimized trauma system configurations for a geographically defined setting. GEOS considers a region’s spatial injury profile and the available resources and uses a combination of travel time analysis and multiobjective optimization. The methodology is described in general and with regard to its application to our case study of Scotland.

RESULTS The primary outcome will be trauma system configuration.

CONCLUSION GEOS will contribute to the design of a trauma system for Scotland. The methodology is flexible and inherently transferable to other settings and could also be used to provide assurance that the configuration of existing trauma systems is fit for purpose.

Supplemental digital content is available in the text.

From the Department of Surgery and Intensive Care Medicine (J.O.J.), Aberdeen Royal Infirmary; Health Services Research Unit (J.O.J., M.K.C.), University of Aberdeen; and Scottish Ambulance Service (R.L., G.E.), Edinburgh; Academic Unit of Surgery (J.J.M.), Glasgow Royal Infirmary, Glasgow; Academic Department of Military Surgery & Trauma (J.J.M.), Royal Centre for Defence Medicine; and School of Computer Science (S.H.), University of Birmingham; and Key Lab of Intelligent Perception and Image Understanding (H.W.), Ministry of Education, Xidian University, Xi’an, China.

Submitted: December 9, 2013, Revised: December 24, 2013, Accepted: January 7, 2014.

This study was presented at the London Trauma Conference (2013), NHS Research Scotland Conference (2013), Scottish Emergency Medicine Forum (2013), and Trauma Symposium, Royal College of Surgeons of Edinburgh (2013).

The opinions expressed in this protocol are those of the authors alone.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Jan O. Jansen, FRCS, FFICM, Department of Surgery and Intensive Care Medicine, Ward 505, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; email:

© 2014 Lippincott Williams & Wilkins, Inc.