Golden Hour Divide: Trauma Care Accessibility and Resource Vulnerability in Sri Lanka

2026-06-29

AI Summary

This study addresses the critical challenge of delayed critical care for trauma patients in Sri Lanka during the golden hour, primarily due to uneven distribution of emergency medical resources. Integrating nationwide epidemiological data with terrain-aware H3 hexagonal grids, the authors develop a multidimensional healthcare accessibility assessment model incorporating spatial accessibility, demand gaps, and fatality rates. Applying unsupervised K-means clustering across 25 administrative districts and seven emergency conditions, they identify novel regional archetypes, including the newly proposed “institutional mirage.” Findings reveal that shortages of specialist physicians exert greater systemic strain than bed deficits, with over 70% of areas in the Northern and Eastern provinces exhibiting significant spatial access gaps. Simulations indicate that improving accessibility by 25% in high-need regions could reduce the national unmet demand by 9.65%, offering a quantitative foundation for targeted resource allocation.

Abstract

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.

Problem

• trauma care accessibility
• resource vulnerability
• Golden Hour
• healthcare equity
• emergency infrastructure

Innovation

• H3 hexagonal modeling
• spatial accessibility
• unsupervised clustering
• trauma care equity
• resource vulnerability