How do current police practices impact trauma care in the prehospital setting? A scoping review

Abstract

Objective: In the United States, police are often important co-responders to 911 calls with emergency medical services for medical emergencies. To date, there remains a lack of a comprehensive understanding of the mechanisms by which police response modifies time to in-hospital medical care for traumatically injured patients. Further, it remains unclear if differentials exist within or between communities. A scoping review was performed to identify studies evaluating prehospital transport of traumatically injured patients and the role or impact of police involvement.Methods: PubMed, SCOPUS, and Criminal Justice Abstracts databases were utilized to identify articles. English-language, US-based, peer-reviewed articles published on or prior to March 30, 2022 were eligible for inclusion.Results: Of 19,437 articles initially identified, 70 articles were selected for full review and 17 for final inclusion. Key findings included (1) current law enforcement practices involving scene clearance introduce the potential for delayed patient transport but to date there is little research quantifying delays; (2) police transport protocols may decrease transport times; and (3) there are no studies examining the potential impact of scene clearance practices at the patient or community level. Conclusions:Our results highlight that police are often the first on scene when responding to traumatic injuries and have an active role via scene clearance or, in some systems, patient transport. Despite the significant potential for impact on patient well-being, there remains a paucity of data examining and driving current practices.

Racial and Ethnic Disparities in Patient Restraint in Emergency Departments by Police Transport Status

“…Emerging data indicate that police are increasingly involved in the transport of patients to emergency medical services, and some municipalities have codified the practice of police transport for serious penetrating wounds . Although there could be legitimate reasons for police involvement in emergency medical transport, such as decreasing transport time for penetrating traumas, studies assessing outcomes of police-involved transport are limited, and results of these analyses have been mixed and largely restricted to populations with penetrating trauma . However, nearly half of the visits with police transport to emergency medical care may involve patients with mental illnesses, a group at particular risk for restraint, even without police involvement …”

“…7,27 Although there could be legitimate reasons for police involvement in emergency medical transport, such as decreasing transport time for penetrating traumas, studies assessing outcomes of police-involved transport are limited, and results of these analyses have been mixed and largely restricted to populations with penetrating trauma. 28 However, nearly half of the visits with police transport to emergency medical care may involve patients with mental illnesses, a group at particular risk for restraint, even without police involvement. 7 Taken into context, our finding that police transport may mediate racially disparate restraint use in EDs highlights the need to further evaluate police involvement in emergency medical transport, especially in racial and ethnic minority communities and neighborhoods where there is continued reliance on law enforcement as first responders for mental health crises.…”