Coming in hot: Police transport and prehospital time after firearm injury. Issue 5 (20th November 2022)

• Record Type: Journal Article
• Authors: Winter, Eric; Byrne, James P.; Hynes, Allyson M.; Geng, Zhi; Seamon, Mark J.; Holena, Daniel N.; Malhotra, Neil R.; Cannon, Jeremy W.
• Is Part Of: Journal of trauma and acute care surgery. Volume 93:Issue 5(2022)
• Page Start: 656
• Page End: 663
• Publication Date: 2022-11-20
• Subjects: Trauma surgery -- outcomes -- police transport -- prehospital time -- transport time; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000003689
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : Can police transport save lives? A recent study of 1300 patients with firearm injuries in Philadelphia, PA suggests that police transport is faster than traditional ambulance-based systems, and is associated with better survival of critically-injured individuals. Abstract : 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. LEVEL OF EVIDENCE: Prognostic/Epidemiological, Level III. Abstract :