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Police transport versus ground EMS

A trauma system-level evaluation of prehospital care policies and their effect on clinical outcomes

Wandling, Michael W. MD; Nathens, Avery B. MD, PhD; Shapiro, Michael B. MD; Haut, Elliott R. MD, PhD

Journal of Trauma and Acute Care Surgery: November 2016 - Volume 81 - Issue 5 - p 931–935
doi: 10.1097/TA.0000000000001228
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BACKGROUND Rapid transport to definitive care (“scoop and run”) versus field stabilization in trauma remains a topic of debate and has resulted in variability in prehospital policy. We aimed to identify trauma systems frequently using a true “scoop and run” police transport approach and to compare mortality rates between police and ground emergency medical services (EMS) transport.

METHODS Using the National Trauma Databank (NTDB), we identified adult gunshot and stab wound patients presenting to Level 1 or 2 trauma centers from 2010 to 2012. Hospitals were grouped into their respective cities and regional trauma systems. Patients directly transported by police or ground EMS to trauma centers in the 100 most populous US trauma systems were included. Frequency of police transport was evaluated, identifying trauma systems with high utilization. Mortality rates and risk-adjusted odds ratio for mortality for police versus EMS transport were derived.

RESULTS Of 88,564 total patients, 86,097 (97.2%) were transported by EMS and 2,467 (2.8%) by police. Unadjusted mortality was 17.7% for police transport and 11.6% for ground EMS. After risk adjustment, patients transported by police were no more likely to die than those transported by EMS (OR = 1.00, 95% CI: 0.69–1.45). Among all police transports, 87.8% occurred in three locations (Philadelphia, Sacramento, and Detroit). Within these trauma systems, unadjusted mortality was 19.9% for police transport and 13.5% for ground EMS. Risk-adjusted mortality was no different (OR = 1.01, 95% CI: 0.68–1.50).

CONCLUSIONS Using trauma system-level analyses, patients with penetrating injuries in urban trauma systems were found to have similar mortality for police and EMS transport. The majority of prehospital police transport in penetrating trauma occurs in three trauma systems. These cities represent ideal sites for additional system-level evaluation of prehospital transport policies.

LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III.

From the Division of Trauma & Critical Care, Department of Surgery (M.W.W., M.B.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center, Department of Surgery (M.W.W.), Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Research and Optimal Patient Care (M.W.W.), American College of Surgeons, Chicago, Illinois; Department of Surgery (A.B.N.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Division of Acute Care Surgery, Department of Surgery (E.R.H.), The Johns Hopkins School of Medicine, Baltimore, Maryland; and The Johns Hopkins University School of Public Health (E.R.H.), Baltimore, Maryland.

Submitted: December 20, 2015, Revised: June 10, 2016, Accepted: June 29, 2016, Published online: August 18, 2016.

Address for reprints: Elliott R. Haut, MD, PhD, FACS, Anesthesiology/Critical Care Medicine (ACCM) and Emergency Medicine, Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, The Johns Hopkins University Bloomberg School of Public Health, Sheikh Zayed 6107C, 1800 Orleans St., Baltimore, MD 21287; email: ehaut1@jhmi.edu.

© 2016 Lippincott Williams & Wilkins, Inc.