Citations

Background Traumatic injury is the fourth leading cause of death nationally; rural residents are twice as likely to die from injury as urban counterparts. On-scene mortality coverage gaps across regional trauma systems remain poorly characterized. Objective To identify geographic blind spots and time-critical, spatially advantageous on-scene deaths (2019-2023) that fall outside modeled 10-minute drive-time service areas across seven North Central state trauma regions. Methods This retrospective analysis geocoded death certificate records to ZIP Code Tabulation Areas and modeled 10-minute drive-time service areas in ArcGIS Online. EMS agency headquarters and staffing classification (volunteer, mixed, paid) were obtained from the DHS EMS Service Map. Candidate sites were identified by maximizing coverage of weighted, uncovered death centroids per region. Results Of 11,868 decedents (60.7% male; mean age 64.4 years [SD 25.6]; 49.9% fall, 26.4% firearm), 7815 had geocodable addresses. Coverage ranged from 53.5% (Western) to 87.0% (North Central); 5492 (70.3%) fell within a 10-minute service area. One candidate site per region could extend modeled coverage to 4-321 additional death locations (480 combined). Volunteer-dominant regions, where 63% of agencies reported scheduling gaps, had the lowest coverage, suggesting headquarters presence overstates availability. Conclusion Geospatial analysis identified actionable blind spots where one additional EMS resource per region could extend modeled coverage to hundreds of death locations. Because these are modeled coverage gains, not demonstrated mortality reductions, and depend in volunteer-dominant regions on staffing reliability that placement alone cannot resolve, the identified locations warrant further evaluation, not presumed survival benefit.

Abstract Aims Lithium is Food and Drug Administration‐approved for bipolar disorder (BD) and is also used in depressive disorders but is underutilized due to concerns about chronic kidney disease (CKD). We explored clinical and demographic profiles of patients on long‐term lithium therapy (LTLT) and assessed kidney function. Our aims were to identify the predictors for CKD stage ≥3 and the impact of lithium discontinuation post‐CKD diagnosis. Methods We conducted a population‐based historical cohort study of adult patients with mood disorders on LTLT at the Marshfield Clinical Health System from 1990 to 2019. Data on lithium therapy and kidney‐related information (estimated glomerular filtration rate and CKD) were extracted from electronic medical records. Results Among 1603 patients with mood disorders (mean age 42.1 years, 60% females), 15.3% ( n = 246) developed CKD stage ≥3. Patients without CKD were on lithium for 4.5 years, compared to 6.6 years for those with CKD. Hypertension, age, and BD were significant CKD risk factors. Kidney function declined linearly with lithium duration, returning to pre‐treatment trajectory in patients without CKD but showed no improvement in those with CKD after lithium discontinuation. Conclusion The findings suggest that CKD occurs in 15% of patients with mood disorder receiving LTLT, with its progression potentially influenced by existing comorbidities rather than lithium alone. These results underscore the importance of monitoring kidney function in patients on LTLT and considering individual risk factors for CKD development. In patients who developed CKD, Li discontinuation did not impact change in kidney function.