August 18, 2014 by dailybolusoflr
Due to the uncertainty of the benefit of out-of-hospital care for patients with penetrating trauma, over 25 years ago the city of Philadelphia began to allow police department transport of individuals with penetrating trauma to definitive care.
There was no formal policy outlining the care provided by police but anecdotally no care was most frequently provided. The police officers have no formal medical training and carried no department issued medical equipment.
Question of the day – is there a difference in mortality outcome if our patient is transported by police vs by EMS?
Study that attempted to answer that question:
Band RA, Salhi RA, Holena DN, et al. Severity-Adjusted mortality in trauma patients transported by police. Ann Emerg Med. 2014;63:608-614.
Association between mode of out-of-hospital transport (police vs EMS) and mortality among patients with proximal penetrating trauma within the city of Philadelphia
Retrospective cohort study of trauma registry data for state of Pennsylvania
Inclusion criteria: all patients with penetrating trauma to the thorax, abdomen, or proximal extremity (above the elbow or knee) within the city of Philadelphia who presented to a level 1 or 2 adult trauma center
Exclusion criteria: patients transported by private vehicle or other means or patients transferred in or out of trauma centers
Primary outcome: in hospital mortality
- Overall mortality was 27.4% with a difference in 3.3% (police 29.8 vs 26.5)
- Decreased adjusted mortality in following patients transported by police:
- Patients with severe injury (OR 0.73; 95% CI 0.59-0.9)
- Patients with gunshot wounds (OR 0.7;95% CI 0.53-0.94)
- Patients with stab wounds (OR 0.19;95% CI 0.08-0.45)
Application to other cities
No data on what out-of-hospital interventions performed
No out-of-hospital times available for police transports
No association between mode of transport and overall adjusted mortality for patients with proximal penetrating trauma but more research is necessary!!!