A safe haven for the injured? Urban trauma care at the intersection of healthcare, law enforcement, and race

Abstract

Patients with traumatic injuries often interact with police before and during hospitalization, particularly when their injuries are due to violence. People of color are at highest risk for violent injuries and have the poorest outcomes after injury. The purpose of this study was to describe how injured, Black patients perceived their interactions with police and what these perceptions reveal about police involvement within trauma care systems. We combined data from two qualitative studies to achieve this aim. The first was ethnographic fieldwork that followed Black trauma patients in the hospital through the physical and emotional aftermath of their injuries. The second was a qualitative, descriptive study of how patients experienced trauma resuscitation in the emergency department (ED). Both studies were conducted between 2012 and 2015 at the Trauma Center at Penn, an academic medical center in Philadelphia, Pennsylvania, United States. The present study includes data from 24 adult, Black participants undergoing treatment for injury. We reanalyzed all interview data related to law enforcement encounters from the scene of injury through inpatient hospitalization and coded data using a constant comparative technique from grounded theory. Participants described law enforcement encounters at the scene of injury and during transport to the hospital, in the ED, and over the course of inpatient care. Injured participants valued police officers' involvement when they perceived that officers provided safety at the scene, speed of transport to the hospital, or support and information after injury. Injured participants also found police questioning to be stressful and, at times, disrespectful or conflicting with clinical care. Communities, trauma centers, and professional societies have the opportunity to enact policies that standardize law enforcement access in trauma centers and balance patients' health, privacy, and legal rights with public safety needs.

Beyond survival: the broader consequences of prehospital transport by police for penetrating trauma

“…All groups agreed that speed of transport was an advantage but identified different trade-offs and implementation challenges. Consistent with our prior research, patients reported pain and a sense of risk during police transport, 23 and were concerned that their injuries might have been worsened by transport in a vehicle not designed for injury care and stability. These concerns could be addressed by a combination of improved padding and safety restraints in police cars, by officers discussing these risks and benefits with patients in the moment, and by public education.…”

“… 19–22 Qualitative evidence has illustrated how some injured Black men associate police transport and their interactions with law enforcement prior to reaching a trauma center with additional pain and feelings of dehumanization. 23 24 Police transport may also pose underappreciated hazards to officers who provide injury first response with minimal medical training and equipment. Lastly, no studies have assessed variations in police transport and access to trauma care across a municipality or the effect on trauma care processes at a receiving center.…”

Association of Police Transport With Survival Among Patients With Penetrating Trauma in Philadelphia, Pennsylvania

“… 7 , 27 , 28 In some cases, injured Black individuals transported by police report appreciating the improved scene safety and expedited hospital transport facilitated by responding officers. 29 Moreover, police transport may help diffuse scene anxiety and allay panic by responding to bystander requests for immediate assistance. 7 , 30 Police transport programs thus have the potential to change established negative perceptions of law enforcement by demonstrating altruistic attributes of the police in their neighborhoods.…”

Police-to-Hospital Transport for Violently Injured Individuals: A Way to Save Lives?

“…In a qualitative study of traumatically injured black patients in Philadelphia, some who had experienced police hospital transport offered their view of the police role. They interpreted the speed and reassurances that officers provided en route as evidence that police were acting in service of their well-being (Jacoby et al 2017). Ongoing research in Philadelphia has similarly highlighted this perception.…”