Golden Hour Divide: Trauma Care Accessibility and Resource Vulnerability in Sri Lanka
For policymakers in Sri Lanka, this study provides a data-driven roadmap to address severe trauma care inequities, though it is an incremental application of known methods to a new region.
This study evaluates trauma care accessibility across Sri Lanka's 25 districts using terrain-aware modeling and clustering, finding that spatial gaps exceed 70% in Northern and Eastern provinces, making the Golden Hour impossible. Improving accessibility by 25% in high-priority clusters could reduce the national need-gap by 9.65%.
Timely intensive care dictates survival, yet emergency infrastructure remains unevenly distributed across Sri Lanka. While pre-hospital services have expanded, the transition to definitive care remains a critical bottleneck. This study evaluates national emergency resilience by quantifying the gap between clinical demand and the availability of specialized resources across all 25 districts. Using the latest national epidemiological data and terrain-aware H3 hexagonal modeling, we analyzed accessibility for seven critical conditions based on spatial gaps, clinical need-gaps, lethality, coverage, and resource availability. Based on these metrics, unsupervised K-Means clustering was applied to categorize districts into four policy-actionable archetypes: Critical Structural Exclusion, Institutional Mirages, Operational Capacity Strain, and High-Resilience Benchmarks. Our study suggests that severe service deficits exist in the Northern and Eastern provinces, where spatial gaps exceed 70%, rendering the Golden Hour operationally impossible. Notably, specialist scarcity drives systemic pressure more than bed capacity; underserved regions effectively function as institutional mirages. This study suggests that improving accessibility by 25% in high-priority clusters would reduce the national need-gap by 9.65%, providing a roadmap for the strategic redistribution of specialists to ensure healthcare equity.