Rapid transport to definitive care versus on-scene stabilization for trauma patients has long been debated, leading to inconsistent prehospital protocols. This study investigates the frequency of “scoop and run” police transport in urban trauma systems and compares mortality rates between police and Emergency Medical Services (EMS) transport for patients with penetrating injuries.
This analysis utilized data from the National Trauma Databank (NTDB) from 2010 to 2012, focusing on adult patients with gunshot and stab wounds admitted to Level 1 or 2 trauma centers. The study examined the 100 most populous US trauma systems, comparing patients transported directly by police versus ground EMS. The prevalence of police transport was assessed, and mortality rates were analyzed to determine if there were significant differences between the two transport methods.
The study population included 88,564 patients, with the vast majority (97.2%) transported by EMS and a smaller fraction (2.8%) by police. Initial analysis showed a higher unadjusted mortality rate for police transport (17.7%) compared to ground EMS (11.6%). However, after adjusting for patient risk factors, the mortality difference between police and Ems Transport became statistically insignificant. The risk-adjusted odds ratio for mortality for police transport compared to EMS transport was 1.00 (95% CI: 0.69-1.45), indicating no increased risk of death associated with police transport.
Interestingly, the study revealed that a significant proportion (87.8%) of all police transports occurred within just three urban areas: Philadelphia, Sacramento, and Detroit. Within these specific trauma systems, while unadjusted mortality remained higher for police transport (19.9%) versus EMS (13.5%), risk-adjusted mortality again showed no significant difference (OR = 1.01, 95% CI: 0.68-1.50).
In conclusion, this trauma system-level analysis indicates that for patients with penetrating injuries in urban settings, mortality outcomes are similar whether transported by police or EMS. The concentration of police transports in Philadelphia, Sacramento, and Detroit highlights these cities as crucial locations for further in-depth evaluation of prehospital transport strategies and policies. These findings suggest that in specific urban trauma systems, police transport can be a viable option without negatively impacting patient mortality, warranting further investigation into optimal prehospital care models.
