A study from the Perelman School of Medicine at the University of Pennsylvania in America found no significant difference in survival rates between gunshot and stabbing victims in Philadelphia whether they were transported to the emergency department by the police department or the emergency medical services (EMS) division of the fire department.
The study, published online ahead of print in the Annals of Emergency Medicine, examined 4,122 patients taken to eight Level I and Level II adult trauma centres in Philadelphia between January 1, 2003 and December 31, 2007. Of these, 2,961 were transported by EMS and 1,161 by the police. The overall mortality rate was 27.4 per cent. Just over three quarters (77.9 per cent) of the victims suffered gunshot wounds, and just under a quarter (22.1 per cent) suffered stab wounds. The majority of patients in both groups (84.1 per cent) had signs of life on delivery to the hospital.
A third of patients with gunshot wounds (33.0 percent) died compared with 7.7 per cent of patients with stab wounds. Although patients transported by the police department were more likely to die compared with those transported by EMS (29.8 percent versus 26.5 per cent), these findings appear to be explained by the more severely injured population that the police typically transport to the hospital and not the mode of transport itself. Lead author Roger Band, MD, assistant professor of Emergency Medicine at the Hospital of the University of Pennsylvania, said: “This study is an examination of current pre-hospital practices with an eye toward improving patient care and is by no means intended as a criticism of the highly trained and dedicated professionals of the Philadelphia Fire Department who provide outstanding care under difficult circumstances,” “The Fire Department, the Police Department, and health care professionals all share the same goal: learn all we can in order to continually improve the care and services we provide to patients and the community.”
While previous studies suggest that trauma victims have similar mortality rates whether brought to the hospital by emergency medical services or police, the Penn study is the largest investigation to date examining the relationship between method of transport and mortality in ‘penetrating trauma‘. More than 25 years ago, the Philadelphia Police Department began allowing police department transport of individuals with penetrating trauma to the hospital, commonly referred to as a “scoop and run.” For decades, there has been debate among medical professionals on how to best balance the potentially competing priorities of fast transport to the emergency department with the benefits of transport by specially trained emergency medical personnel in expressly equipped vehicles. Previous studies have shown survival benefit for EMS-type transport in such cases as myocardial infarction (heart attack), respiratory arrest, cardiac arrest, and perhaps trauma. Senior study author, Brendan Carr, MD, MS, assistant professor Emergency Medicine and Biostatistics and Epidemiology at Penn, said: “It is critically important to remember that our study focuses on a very specific type of patient …. in a densely populated urban environment and we in no way are suggesting that patients with serious medical symptoms, such as chest pain or difficulty breathing, do anything but call 911 and await the highly trained EMS personnel who have the skill and equipment to deal with the situation and any potential problems.”