Inner-city gunshot and stabbing victims had a better chance of surviving when they rode to trauma centers in private vehicles rather than in ambulances, a new study showed.
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’s 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.
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.”
Reporting by Ronnie Cohen
SOURCE: JAMA Surgery, September 20, 2017.
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