Severity-Adjusted Mortality in Trauma Patients Transported by Police

Abstract

Study objective Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. We conduct a large, multiyear, citywide analysis of this policy. We examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia. Methods This is a retrospective cohort study of trauma registry data. Patients who sustained any proximal penetrating trauma and presented to any Level I or II trauma center in Philadelphia between January 1, 2003, and December 31, 2007, were included. Analyses were conducted with logistic regression models and were adjusted for injury severity with the Trauma and Injury Severity Score and for case mix with a modified Charlson index. Results Four thousand one hundred twenty-two subjects were identified. Overall mortality was 27.4%. In unadjusted analyses, patients transported by police were more likely to die than patients transported by ambulance (29.8% versus 26.5%; OR 1.18; 95% confidence interval [CI] 1.00 to 1.39). In adjusted models, no significant difference was observed in overall mortality between the police department and EMS groups (odds ratio [OR] 0.78; 95% CI 0.61 to 1.01). In subgroup analysis, patients with severe injury (Injury Severity Score >15) (OR 0.73; 95% CI 0.59 to 0.90), patients with gunshot wounds (OR 0.70; 95% CI 0.53 to 0.94), and patients with stab wounds (OR 0.19; 95% CI 0.08 to 0.45) were more likely to survive if transported by police. Conclusion We found no significant overall difference in adjusted mortality between patients transported by the police department compared with EMS but found increased adjusted survival among 3 key subgroups of patients transported by police. This practice may augment traditional care.

Alcohol exposure, injury, and death in trauma patients

“…Previous studies have inappropriately reported protective effects from alcohol and adjusted for injury whereas the results from this study examined injury mechanism and severity separately as intermediate outcomes from alcohol exposure 7–9, 25 . In a previous study, gunshot wounds had a three-fold higher proportion of deaths than stab wounds in a large trauma cohort 26 . Similarly, the moderate BAC group in this study had the highest odds for in-hospital death with a greater proportion of penetrating injuries, mainly gunshot wounds, than any other group.…”

A Descriptive Analysis of Tactical Casualty Care Interventions Performed by Law Enforcement Personnel in the State of Wisconsin, 2010-2015

“…24 Studies also have shown that in cases of penetrating trauma, decreased time to definitive care is associated with improved survival outcomes. [25][26][27] Conclusions The current case series demonstrates the life-saving potential for law enforcement personnel trained and equipped under current TCCC/C-TECC tactical casualty care guidelines. Although originally developed to save the lives of wounded combat personnel, in the civilian sector, the training is more likely to save victims rather than law enforcement personnel.…”

Elaborating the Correlates of Firearm Injury Severity: Combining Criminological and Public Health Concerns

“…Conveyance by ambulance or police units to trauma centers does not appear to influence victim injury severity or mortality (Band, Salhi, Holena, et al, 2014), but victims who are transported by private, non-emergency means tend to have better survival outcomes relative to victims who delivered to trauma centers by emergency services (Demetriades et al, 1996). Consistent with CEP, public health and medical researchers have made significant contributions about the relationship between response processes that occur after a criminal act and victim injury outcomes.…”