Geospatial Optimization of Trauma Care Resource Allocation and Timely Access for Severely Injured Patients.

Importance: Timely access to trauma care-capable hospitals is associated with decreased mortality and morbidity. However, establishing and maintaining these hospitals require substantial investment, including specialists, operating room capacity, intensive care infrastructure, and 24-hour readiness, with finite resources available. Objective: To develop and apply a geospatial optimization approach to identify trauma system configurations that improve timely access to care under fixed resource constraints and to quantify trade-offs between efficiency and equity in allocation decisions. Design, Setting, and Participants: This cross-sectional study used decision analytical modeling of a reproducible geospatial optimization approach applied to the Gyeonggi province in South Korea. The approach integrated population distribution, severe injury incidence, hospital locations, and modeled ground transport travel times with data from the 2022-2023 Gyeonggi-do Severe Trauma Transport Status report. Data were collected from January 2022 to December 2023 and analyzed from May to November 2025. Interventions: Counterfactual reallocation of trauma care capability across hospitals under constrained resource scenarios, including both expansion and withdrawal of services. Main Outcomes and Measures: The primary outcome was median travel time to trauma care-capable hospitals and population-weighted trauma access burden. A secondary analysis was performed to maximize the proportion of severely injured patients with access within 60 minutes. Results: This province-wide analysis encompassed 551 neighborhoods across 31 cities and counties in Gyeonggi province, with approximately 5825 patients with severe injury annually. At baseline, the median travel time to trauma care-capable hospitals was 59.5 (IQR, 49.0-73.6) minutes. Under efficiency-focused optimization, targeted expansion to 3 hospitals was associated with a 9.9% decrease in population-weighted trauma access burden, with diminishing marginal gains observed beyond this level of investment. Under equity-focused optimization, the same level of expansion was associated with an increase in the proportion of severely injured patients within 60 minutes from 48.5% to 67.1%. Simulated withdrawal of trauma capability from selected hospitals produced heterogeneous effects, with some configurations disproportionately worsening access. Conclusions and Relevance: In this cross-sectional study using decision analytical modeling of a regional trauma system in South Korea, trauma system performance varied substantially depending on how resources were allocated under fixed resource constraints. A geospatial optimization approach identified configurations that materially improved timely access to care and highlighted decisions that may unintentionally exacerbate inequities. Data-driven resource allocation, especially in settings with marginal resources, was associated with improvements in access and reductions in geographic disparities.