<p>In US trauma centers, firearms are the second leading cause of trauma-related death in pediatric patients. In children (&lt;18 years), firearms are associated with one of the highest case fatality rates (16.7%) of all injury mechanisms. According to the Gun Violence Archive, in 2019 alone, 3774 children experienced gun violence, including 985 killed and 2789 injured. The US Centers for Disease Control and Prevention reports multiple-victim school homicide rates have increased significantly between 2009 and 2018, following 15 years of decline. Considering the overall burden of gun violence, mass shootings are responsible for a relatively small number of deaths and injuries. However, these events also expose other residents, notably children, in the nearby communities to violence. This study examines the location of mass shootings relative to schools and places frequented by children, highlighting the potential risk of exposure to violence in our communities.</p>

<p>According to federal statistics, mass shootings have tripled in the United States in the past decade. These mass-casualty events can easily overwhelm the resources of local hospitals. As the number of persons injured increases, even a well-prepared center can be pushed beyond capacity. While trauma systems have been established throughout the United States to prioritize getting the right patient to the right place at the right time, travel distance, traffic, casualty volume, and injury severity often result in transport of patients to a hospital that is not a trauma center (TC). It is hypothesized that the nearest available hospitals to mass shooting events will commonly be non–trauma center (NTC) hospitals, where such patient loads are more likely to overwhelm capacity and advanced care options may be limited. This study evaluates the location of recent mass shooting events relative to nearest hospitals and TCs.</p>