Association between Mode of Transportation and Survival in Adult Trauma Patients with Blunt Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

Sakr, Fouad A; Bachir, Rana; Sayed, Mazen J. El

doi:10.1017/s1049023x21000510

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…Of these, 8 articles evaluated transport for penetrating trauma, 2 articles evaluated transport for blunt trauma, and 1 article evaluated both. No differences were found in mortality between EMS or police transport 20–24 . One study estimated that 64% of patients transported by police in Philadelphia may have benefited from prehospital interventions typically provided by EMS, such as intravenous fluids, spinal immobilization, or endotracheal intubation 25 …”

Section: Resultsmentioning

confidence: 99%

“…Qualitative work involving Black trauma patients transported by police observed mixed responses 26,27 . Although some patients found police transport to be a positive experience, improving their transport times and serving as evidence of public service, others described it as “dehumanizing” and emotionally traumatic 23 . Other concerns included a lack of precautionary measures (eg, spinal precautions) and occupational hazard to police of transporting patients without appropriate training or equipment, including personal protective equipment.…”

Section: Resultsmentioning

confidence: 99%

“…No differences were found in mortality between EMS or police transport. [20][21][22][23][24] One study estimated that 64% of patients transported by police in Philadelphia may have benefited from prehospital interventions typically provided by EMS, such as intravenous fluids, spinal immobilization, or endotracheal intubation. 25 Qualitative work involving Black trauma patients transported by police observed mixed responses.…”

Section: Police As Prehospital Transportmentioning

confidence: 99%

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How do current police practices impact trauma care in the prehospital setting? A scoping review

et al. 2023

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Objective: In the United States, police are often important co-responders to 911 calls with emergency medical services for medical emergencies. To date, there remains a lack of a comprehensive understanding of the mechanisms by which police response modifies time to in-hospital medical care for traumatically injured patients. Further, it remains unclear if differentials exist within or between communities. A scoping review was performed to identify studies evaluating prehospital transport of traumatically injured patients and the role or impact of police involvement.Methods: PubMed, SCOPUS, and Criminal Justice Abstracts databases were utilized to identify articles. English-language, US-based, peer-reviewed articles published on or prior to March 30, 2022 were eligible for inclusion.Results: Of 19,437 articles initially identified, 70 articles were selected for full review and 17 for final inclusion. Key findings included (1) current law enforcement practices involving scene clearance introduce the potential for delayed patient transport but to date there is little research quantifying delays; (2) police transport protocols may decrease transport times; and (3) there are no studies examining the potential impact of scene clearance practices at the patient or community level. Conclusions:Our results highlight that police are often the first on scene when responding to traumatic injuries and have an active role via scene clearance or, in some systems, patient transport. Despite the significant potential for impact on patient well-being, there remains a paucity of data examining and driving current practices.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Police As Prehospital Transportmentioning

confidence: 99%

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How do current police practices impact trauma care in the prehospital setting? A scoping review

et al. 2023

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“…The overall survival rate of adult blunt trauma patients was found to be similar for police transported and EMS transported patients (99.2%; P = 1.000). 20…”

Section: Discussionmentioning

confidence: 99%

Association between Mode of Transportation and Survival in Adult Trauma Patients with Penetrating Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

Arbid

Bachir

Sayed

2022

Prehosp. Disaster med.

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Introduction: Police transport (PT) of penetrating trauma patients has the potential to improve survival rates. There are no well-established guidelines for PT of penetrating trauma patients. Study Objective: This study examines the association between survival rate to hospital discharge of adult penetrating trauma patients and mode of transport (PT versus ground ambulance [GA]). Methods: A retrospective, matched cohort study was conducted using the United States (US) National Trauma Data Bank (NTDB). All adult penetrating injury patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by GA for analysis. Descriptive analysis was carried out. The patients’ demographic and clinical characteristics were tabulated and stratified by the transport mode. Results: Out of the 733 patients with penetrating injuries, ground Emergency Medical Services (EMS) transported 513 patients and police transported 220 patients. Most patients were 16-64 years of age with a male (95.6%) and Black/African American race (79.0%) predominance. Firearm-related injuries (68.8%) were the most common mechanism of injury with the majority of injuries involving the body extremities (62.9%). Open wounds were the most common nature of injury (75.7%). The overall survival rate to hospital discharge was similar for patients transported by GA and by police (94.5% versus 92.7%; P = .343). Conclusion: In this study, patients with penetrating trauma transported by police had similar outcomes to those transported by GA. As such, PT in penetrating trauma appears to be effective. Detailed protocols should be developed to further improve resource utilization and outcomes.

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“…9,10 Simultaneously, a growing body of literature has suggested that police transport is a safe and effective counterpart to traditional EMS-based transport. [7][8][9][10][11] Although an increasing number of cities across the United States have recognized the utility of police transport and implemented policies permitting it, Philadelphia remains the only major urban center to routinely use this practice. 6,8,12,13 Many studies have hypothesized that the benefit of police-based hospital transport lies in its efficiency.…”

mentioning

confidence: 99%

Coming in hot: Police transport and prehospital time after firearm injury

Winter

Byrne

Hynes

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:In Philadelphia, PA, police and emergency medical services (EMS) transport patients with firearm injuries. Prior studies evaluating this system have lacked reliable prehospital times. By linking police and hospital data sets, we established a complete timeline from firearm injury to outcome. We hypothesized that police-transported patients have shorter prehospital times that, in turn, are associated with improved survival and increased unexpected survivorship at 6 and 24 hours. METHODS:This retrospective study linked patient-level data from OpenDataPhilly Shooting Victims and the Pennsylvania Trauma Systems Foundation. All adults transported to a Level I or II trauma center after firearm injury in Philadelphia from 2015 to 2018 were included. Patient-level characteristics were compared between cohorts; unexpected survivors were identified using Trauma Score-Injury Severity Score. Multiple regression estimated risk-adjusted associations between transport method, prehospital time, and outcomes. RESULTS:Police-transported patients (n = 977) had significantly shorter prehospital times than EMS-transported patients (n = 320) (median, 9 minutes [interquartile range, 7-12 minutes] vs. 21 minutes [interquartile range, 16-29 minutes], respectively; p < 0.001).Police-transported patients were more often severely injured than those transported by EMS (60% vs. 50%, p = 0.002). After adjusting for confounders, police-transported patients had improved survival relative to EMS on hospital arrival (87% vs. 84%, respectively, p = 0.035), but not at 6 hours (79% vs. 78%, respectively, p = 0.126) or 24 hours after arrival (76% vs. 76%, respectively, p = 0.224). Compared with EMS, police-transported patients were significantly more likely to be unexpected survivors at 6 hours (6% vs. 2%, respectively, p < 0.001) and 24 hours (3% vs. 1%, respectively, p = 0.021). CONCLUSION:Police-transported patients had more severe injuries, shorter prehospital times, and increased likelihood of unexpected survival compared with EMS-transported patients. After controlling for confounders, patient physiology and injury severity represent meaningful determinants of mortality in our mature trauma system, indicating an ongoing opportunity to optimize in-hospital care. Future studies should investigate causes of death among unexpected early survivors to mitigate preventable mortality.

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Association between Mode of Transportation and Survival in Adult Trauma Patients with Blunt Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

Cited by 5 publications

References 17 publications

How do current police practices impact trauma care in the prehospital setting? A scoping review

How do current police practices impact trauma care in the prehospital setting? A scoping review

Association between Mode of Transportation and Survival in Adult Trauma Patients with Penetrating Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

Coming in hot: Police transport and prehospital time after firearm injury

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