Band RA, Pryor JP, Gaieski DF, et al. Injury-adjusted mortality of patients transported by police following penetrating trauma. Acad Emerg Med 18: 1-6, 2011.
More than a decade ago, the city of Philadelphia began allowing police transport of penetrating trauma patients. The objective of this study was to determine the relation between prehospital mode of transport (police department [PD] vs. Philadelphia Fire Department emergency medical services [EMS]) and survival in subjects with proximal penetrating trauma. The authors performed a retrospective cohort study of prospectively collected trauma registry data. All subjects who sustained proximal penetrating trauma and who presented to a Level I urban trauma center over a five-year period (1/1/03 to 12/31/07) were included. Mortality for subjects presenting by EMS was compared to that of those who arrived by PD transport in unadjusted and adjusted analyses. Adjusted analyses were performed using logistic regression using the Trauma Injury Severity Score (TRISS) methodology. Total hospital length of stay was examined as a secondary outcome.
Results--Of the 2,127 subjects, 26.8% were transported to the emergency department by PD, and 73.2% by EMS. The mean age of PD subjects was 26.3 years, and 92% were male, versus EMS subjects whose mean age was 31.5 years and of whom 87% were male. Overall, 70.8% sustained gunshot wounds, and 29.2% sustained stab wounds. Overall Injury Severity Score (ISS) was 11.21 (ISS for PD, 14.2; for EMS, 10.1), and 16.6% of the subjects died (PD, 21.4%; EMS, 14.8%). In unadjusted analyses, PD subjects were more likely to die than EMS subjects (OR=1.6). When adjusting for injury severity using TRISS, there was no difference in survival. Median length of hospital stay was one day and did not differ according to mode of prehospital transport. Conclusions--Although unadjusted mortality appears to be higher in PD subjects, these findings are explained by the more severely injured population transported by PD. The current practice of permitting police officers to transport penetrating trauma patients should be continued.
Proximal (head, neck, chest, abdomen, back, upper arm/leg) penetrating trauma can be the most time-critical of all injuries. Without rapid identification and control of hemorrhage, gunshot or stab wound patients can exsanguinate within minutes. The most essential of all treatments, then, is to minimize the time from injury to the operating room. In Philadelphia it is not uncommon for police to be on scene many minutes before EMS. In this study, PD-transported patients, who usually received no medical treatment en route, had the same outcomes (mortality, length of hospital stay) as EMS-transported patients.
Ambulances and EMS personnel cannot be everywhere at all times. Citizen CPR training and public access defibrillation programs get necessary treatment to cardiac arrest patients before EMS. In the same way, this innovative program takes advantage of the existing law enforcement infrastructure to extend the EMS system and shorten time to definitive emergency medical care. Although the "Golden Hour" concept remains controversial for trauma as a whole, few would question the importance of immediate and rapid transport of patients with critical penetrating injuries. EMS systems may want to evaluate whether this type of program may be helpful in their jurisdictions.
Angelo Salvucci, Jr., MD, FACEP, is medical director for the Santa Barbara County and Ventura County (CA) EMS agencies.