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

Abstract

BackgroundTime to definitive hemorrhage control is a primary driver of survival after penetrating injury. For these injuries, mortality outcomes after prehospital transport by police and emergency medical service (EMS) providers are comparable. In this study we identify patient and geographic predictors of police transport relative to EMS transport and describe perceptions of police transport elicited from key stakeholders.MethodsThis mixed methods study was conducted in Philadelphia, Pennsylvania, which has the highest rate of police transport nationally. Patient data were drawn from Pennsylvania’s trauma registry and geographic data from the US Census and American Community Survey. For all 7500 adults who presented to Philadelphia trauma centers with penetrating injuries, 2006–2015, we compared how individual and geospatial characteristics predicted the odds of police versus EMS transport. Concurrently, we conducted qualitative interviews with patients, police officers and trauma clinicians to describe their perceptions of police transport in practice.ResultsPatients who were Black (OR 1.50; 1.20–1.88) and Hispanic (OR 1.38; 1.05–1.82), injured by a firearm (OR 1.58; 1.19–2.10) and at night (OR 1.48; 1.30–1.69) and who presented with decreased levels of consciousness (OR 1.18; 1.02–1.37) had higher odds of police transport. Neighborhood characteristics predicting police transport included: percent of Black population (OR 1.18; 1.05–1.32), vacant housing (OR 1.40; 1.20–1.64) and fire stations (OR 1.32; 1.20–1.44). All stakeholders perceived speed as police transport’s primary advantage. For patients, disadvantages included pain and insecurity while in transport. Police identified occupational health risks. Clinicians identified occupational safety risks and the potential for police transport to complicate the workflow.ConclusionsPolice transport may improve prompt access to trauma care but should be implemented with consideration of the equity of access and broad stakeholder perspectives in efforts to improve outcomes, safety, and efficiency.Level of evidenceEpidemiological study, level III.

An Analysis of Patients Dead on Arrival in the American College of Surgeons Trauma Quality Program Participant Use File Data Set

“…When evaluated by the total number of deaths, the largest group was 15 059 of the 33 199 total (45.4%) in the ISS ≥25 group, followed by the lowest ISS group with 13 272 (40.0%) and the smallest cohort of DOAs was in the intermediate-ISS group with 4868 (14.7%) of deaths. When evaluating the DOAs by ISS groups, the lower-ISS group [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] was more likely to be elderly (≥65 years), with 17.7% in this group (P < .001). When evaluating the ISS groups by mechanism of injury, the lower-ISS group had a higher percentage of DOAs with blunt mechanism compared to the intermediate and high-ISS groups (53.6% vs. 47.6% vs. 39.9%, P < .001).…”

“…Police officers may arrive on-scene prior to EMS in response to firearm injuries and could provide a faster mode of transport for trauma patients to TCs. Jacoby et al 12 identified police transport represented 29.8% of all penetrating trauma transports in the Philadelphia study, while 49.7% were transported via EMS. Of the police transports, there were significantly more gunshot wounds than stabbings; patients had a higher ISS (14 vs. 10) and higher mortality (28.1% vs. 20.1% via EMS).…”

Mental health outcomes from direct and indirect exposure to firearm violence: A cohort study of nonfatal shooting survivors and family members

“…Cooperation with the investigation and victim's services are often synonymous with each other. Survivors often note that officers are more concerned about the suspect than helping survivors with their injuries (Jacoby et al, 2020;Patton et al, 2019), however police -survivor contacts during the investigative period are potential missed opportunities for connection to services.…”

Association between Mode of Transportation and Survival in Adult Trauma Patients with Penetrating Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

“…These findings were described in a study performed in Philadelphia where black patients transported by police described how it "made them feel that the police cared about their well-being and survival," and similarly, the police perceived it as a chance to "save a lot of lives." 18 Furthermore, in countries that lack a structured EMS system and where the prevalence of shooting and penetrating injuries are high, police transportation can fill a gap in the prehospital system, improve health outcomes, and strengthen the relationship between the local communities and the police. 19 In addition to the benefits associated with PT of patients with penetrating injuries, a recent matched cohort study using NTDB and examining the association between the survival rate of blunt trauma patients and mode of transport among 2,469 patients showed results similar to this study.…”