Medical Minute: Police vs Paramedics – transport of patients with penetrating trauma

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August 18, 2014 by dailybolusoflr

 By Amanda Crichlow, MD

CASE

23 yo male sustains a gunshot wound to his chest. 911 was called 5 mins ago. The scene is 10 mins from the hospital. The police have arrived on the scene. The paramedics are 3 mins away.
Do you want him transported by police or wait for paramedics to arrive?

BACKGROUND
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.

OBJECTIVE:
Association between mode of out-of-hospital transport (police vs EMS) and mortality among patients with proximal penetrating trauma within the city of Philadelphia

METHODS:
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

Within statistical analysis, adjusted for injury severity (TRISS score – incorporates anatomic injury score (ISS injury severity score) and physiologic score (revised trauma score)

Primary outcome: in hospital mortality

RESULTS:

  • 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)


LIMITATIONS:
Application to other cities
No data on what out-of-hospital interventions performed
No out-of-hospital times available for police transports

CONCLUSIONS:

No association between mode of transport and overall adjusted mortality for patients with proximal penetrating trauma but more research is necessary!!!

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