Patient Characteristics and Temporal Trends in Police Transport of Blunt Trauma Patients: A Multicenter Retrospective Cohort Study

Abstract

Background Police transport (PT) of penetrating trauma patients has the potential to decrease prehospital times for patients with life-threatening hemorrhage and is part of official policy in Philadelphia, Pennsylvania. We hypothesized that rates of PT of bluntly injured patients have increased over the past decade. Methods We used Pennsylvania Trauma Outcomes Study registry data from 2006–15 to identify bluntly injured adult patients transported to all 8 trauma centers in Philadelphia. PT was compared to ambulance transport, excluding transfers, burn patients, and private transport. We compared demographics, mechanism, and injury outcomes between PT and ambulance transport patients and used multivariable logistic regression to identify independent predictors of PT. We also identified physiological indicators and injury patterns that might have benefitted from prehospital intervention by EMS. Results Of 28 897 bluntly injured patients, 339 (1.2%) were transported by police and 28 558 (98.8%) by ambulance. Blunt trauma accounted for 11% of PT and penetrating trauma for 89%. PT patients were younger, more likely to be male, and more likely to be African American or Asian and were more often injured by assault or motor vehicle crash. There were no significant differences presenting physiology between PT and EMS patients. In multivariable logistic regression analysis, male sex (OR 1.89, 95%CI 1.40–2.55), African American race (OR 1.71 95%CI 1.34–2.18), and Asian race (OR 2.25, 95%CI 1.22–4.14) were independently associated with PT. Controlling for injury severity and physiology, there was no significant difference in mortality between PT and EMS. Overall, 64% of PT patients had a condition that might have benefited from prehospital intervention such as supplemental oxygen for brain injury or spine stabilization for vertebral fractures. Conclusions PT affects a small minority of blunt trauma patients, and did not appear associated with higher mortality. However, PT patients included many who might have benefited from proven, prehospital intervention. Clinicians, EMS providers, and law enforcement should collaborate to optimize use of PT within the trauma system.

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

“…broader Social and Systemic Impact beyond the potential for police scoop and run to enhance survival, there are opportunities for other beneficial outcomes to be yielded by police hospital transport. A majority of police-transported patients in the united States are young black men (Kaufman et al 2017;Wandling et al 2016). They are often injured in communities with historically strained police-citizen relationships (Johnson 2004;brunson and Miller 2006;Isom 2016;Desmond, Papachristos, and Kirk 2016).…”

“…Patients who could particularly benefit from eMS, for example, include blunt-force motor vehicle crash injuries, spinal cord injuries, and burns (Holena, Jacoby, and reilly 2017). An evaluation of nearly thirty thousand trauma patients in Philadelphia from 2006 to 2015 identified that a small minority (1.2 percent) of blunt injury patients arrived at trauma centers via police, but that of these, more than 60 percent may have benefited from prehospital procedures like supplemental oxygen and spine stabilization (Kaufman et al 2017). Public controversy over whether police can appropriately implement triage for transport in Philadelphia was highlighted in the wake of an Amtrak train derailment in 2015, which caused more than two hundred injuries and eight deaths (Whelan 2016).…”

“…A second study found that from 2003 to 2007, Philadelphia police transported 27 percent of assault victims, while eMS transported 73 percent (band et al 2011). From 2005 to 2016, an average of 30 percent of patients with penetrating injuries in Philadelphia were transported by police; by 2016, the proportion had exceeded 50 percent, in the context of a relatively stable incidence of penetrating injuries across the city in the prior decade (Kaufman et al 2017).…”

The intraosseous have it: A prospective observational study of vascular access success rates in patients in extremis using video review

“…For the majority of the 20 th century, peripheral intravenous (PIV) access complemented by venous cut-down served as the standard of care for vascular access after injury (1, 2). These intravascular access techniques were supplanted by the development of percutaneous central venous catheters (CVC) in 1952 (2, 3). Despite its development in the early 1920s(4) and subsequent use in World War II, until recently intraosseous (IO) access was uncommonly utilized for vascular access in civilian populations of adult patients.…”

“…Philadelphia is unlike many cities in the US in that police have been allowed to transport victims of penetrating injury to trauma centers since 1996 (Philadelphia Police Department Directive 3.14, available online at http://www.phillypolice.com/accountability). Increasing numbers of penetrating trauma patients are being transported by police (8) and in such cases, patients typically arrive with limited pre-notification and no vascular access (3) (9). We noted that in patients arriving in extremis, establishing successful vascular access was challenging and often resulted in multiple failed attempts with potential delays to lifesaving therapies.…”