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 Those transported to urban U.S. hospitals in emergency vehicles were
62 percent more likely to die of gunshot or stab wounds than
patients with similar injuries who arrived in private vehicles,
researchers reported in JAMA Surgery.
“In this narrow population of trauma patients, emergency medical
services is not the answer,” said senior author Dr. Elliott Haut, a
professor at The Johns Hopkins University School of Medicine in
Baltimore.
When a person is critically wounded, every minute matters. The five
minutes it might take for an ambulance to arrive on the scene of a
shooting “might be the difference between life and death,” he said
in a phone interview.
Although the study findings seem counterintuitive, they were no
surprise to Haut, a trauma surgeon who regularly witnesses the
benefits when victims of penetrating trauma take the most
expeditious route to a high-level emergency room. As a result, he
has instructed his relatives that should he be shot or stabbed, they
should drive him to the closest trauma center.
But not all trauma doctors are ready to call off ambulances for
gunshot and stabbing victims.
Dr. Nick Johnson, a professor of emergency medicine at the
University of Washington Harborview Medical Center in Seattle,
cautions against friends and relatives driving wounded loved ones to
hospitals.
“Expecting an untrained layperson to be able to safely drive an
injured friend or family member with a gunshot or stab wound to the
hospital safely is unrealistic, and potentially unsafe,” he said by
email.
“We need to better understand the consequences of such a
recommendation before making any system-wide changes,” said Johnson,
who was not involved with the new study.
Haut and Johnson do agree that the findings support the fastest
possible transport to trauma centers for people who’ve been shot or
stabbed. Where they part ways is over the role of emergency medical
services prior to the trip.
Johnson acknowledged, though, that how best to care for gunshot and
stab victims before they arrive at trauma centers remains unclear.
Haut and his team examined U.S. national trauma data from 2010-2012
on more than 100,000 teens and adults treated at 298 urban hospitals
for gunshot and stab wounds.
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A disproportionate share of the patients who died as a result of
their wounds had been brought to the hospital in ground emergency
vehicles - nearly 12 percent, compared to 2 percent of those
transported in private vehicles.
“We’ve built this amazing system of trauma and trauma centers that
do a great job,” Haut said. “It turns out that maybe this
pre-hospital system isn’t as beneficial as we originally thought for
this small, narrow range of patients.”
Johnson, however, warned that driving an injured loved one to the
hospital after a gunshot wound or stabbing could carry its own
risks.
“These are very stressful situations, and the potential for
downstream problems, such as car crashes related to driving under
these circumstances, is not well understood,” he said.
Johnson and Haut both previously worked in Philadelphia, where
police officers routinely drive shooting and stabbing victims to
nearby trauma centers. Haut’s experience in Philadelphia, where he
saw police, relatives and friends regularly transport gunshot
victims to emergency rooms, compared to his experience in Baltimore,
where victims tend to wait for ambulances, prompted the research, he
said.
Johnson cautioned that Philadelphia’s system is unique.
“These are specially trained officers working in a system familiar
with this practice with very short transport times in a dense, urban
area,” he said. “It may not work in other systems.”
SOURCE: http://bit.ly/2xfDewC JAMA Surgery, online September 20,
2017.
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