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Simpson JT, Nordham KD, Tatum D, Haut ER, Ali A, Maher Z, Goldberg AJ, Tatebe LC, Chang G, Taghavi S, Raza S, Toraih E, Mendiola Plá M, Ninokawa S, Anderson C, Maluso P, Keating J, Burruss S, Reeves M, Craugh LE, Shatz DV, Bhupathi A, Spalding MC, LaRiccia A, Bird E, Noorbakhsh MR, Babowice J, Nelson MC, Jacobson LE, Williams J, Vella M, Dellonte K, Hayward TZ, Holler E, Lieser MJ, Berne JD, Mederos DR, Askari R, Okafor B, Etchill E, Fang R, Roche SL, Whittenburg L, Bernard AC, Haan JM, Lightwine KL, Norwood SH, Murry J, Gamber MA, Carrick MM, Bugaev N, Tatar A. Stop the Bleed-Wait for the Ambulance or Get in the Car and Drive? A Post Hoc Analysis of an EAST Multicenter Trial. Am Surg 2024:31348241265135. [PMID: 39349054 DOI: 10.1177/00031348241265135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
Background: The Stop the Bleed campaign gives bystanders an active role in prehospital hemorrhage control. Whether extending bystanders' role to private vehicle transport (PVT) for urban penetrating trauma improves survival is unknown, but past research has found benefit to police and PVT. We hypothesized that for penetrating trauma in an urban environment, where prehospital procedures have been proven harmful, PVT improves outcomes compared to any EMS or advanced life support (ALS) transport.Methods: Post-hoc analysis of an EAST multicenter trial was performed on adult patients with penetrating torso/proximal extremity trauma at 25 urban trauma centers from 5/2019-5/2020. Patients were allocated to PVT and any EMS or ALS transport using nearest neighbor propensity score matching. Univariate analyses included Wilcoxon signed rank or McNemar's Test and logistic regression.Results: Of 1999 penetrating trauma patients in urban settings, 397 (19.9%) had PVT, 1433 (71.7%) ALS transport, and 169 (8.5%) basic life support (BLS) transport. Propensity matching yielded 778 patients, distributed equally into balanced groups. PVT patients were primarily male (90.5%), Black (71.2%), and sustained gunshot wounds (68.9%). ALS transport had significantly higher ED mortality (3.9% vs 1.9%, P = 0.03). There was no difference in in-hospital mortality rate, hospital LOS, or complications for all EMS or ALS only transport patients.Conclusion: Compared to PVT, ALS, which provides more prehospital procedures than BLS, provided no survival benefit for penetrating trauma patients in urban settings. Bystander education incorporating PVT for early arrival of penetrating trauma patients in urban settings to definitive care merits further investigation.
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Affiliation(s)
- John T Simpson
- Department of Surgery New Orleans, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kristen D Nordham
- Department of Surgery New Orleans, Tulane University School of Medicine, New Orleans, LA, USA
| | - Danielle Tatum
- Department of Surgery New Orleans, Tulane University School of Medicine, New Orleans, LA, USA
| | - Elliot R Haut
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ayman Ali
- Department of Surgery New Orleans, Tulane University School of Medicine, New Orleans, LA, USA
| | - Zoe Maher
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Amy J Goldberg
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Leah C Tatebe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Grace Chang
- Department of Snuggery, Mount Sinai Hospital, Chicago, IL, USA
| | - Sharven Taghavi
- Department of Surgery New Orleans, Tulane University School of Medicine, New Orleans, LA, USA
| | - Shariq Raza
- Department of Surgery New Orleans, Tulane University School of Medicine, New Orleans, LA, USA
| | - Eman Toraih
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | | | - Scott Ninokawa
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | | | - Patrick Maluso
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Jane Keating
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Sigrid Burruss
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Matthew Reeves
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Lauren E Craugh
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - David V Shatz
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | | | | | - Aimee LaRiccia
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Emily Bird
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | | | - James Babowice
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Marsha C Nelson
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | | | - Jamie Williams
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Michael Vella
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Kate Dellonte
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | | | - Emma Holler
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Mark J Lieser
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - John D Berne
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | | | - Reza Askari
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Barbara Okafor
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Eric Etchill
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Raymond Fang
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | | | | | | | - James M Haan
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | | | - Scott H Norwood
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Jason Murry
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Mark A Gamber
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | | | - Nikolay Bugaev
- EAST Prehospital Procedures in Penetrating Trauma Study Group
| | - Antony Tatar
- EAST Prehospital Procedures in Penetrating Trauma Study Group
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Goldenberg Sandau A, Field R, Hunter K. Detect, Dispatch, Drive: A Study of ShotSpotter Acoustic Technology and Transport of Gunshot Victims. J Surg Res 2024; 300:550-558. [PMID: 38906076 DOI: 10.1016/j.jss.2024.04.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Our previous work demonstrated that use of ShotSpotter (SS), a gunfire detection system, and use of police department (PD) transport decreased response and transport time for gunshot wound (GSW) victims versus events with non-ShotSpotter (NSS). The purpose of this study was to evaluate transport trends and how they are linked to SS in the period of 2016-2021 in Camden, NJ. METHODS This was a single-center, retrospective observational study. Demographics, response time, transport time, and clinical data were collected. Independent t-test, Mann-Whitney U test, chi-squared test, and linear regression to correct for transport time and method of transport were used to compare outcomes (P < 0.05). RESULTS A total of 267 GSWs were included: 77 emergency medical technicians (EMS)-SS, 41 EMS-NSS, 116 PD-SS, and 33 PD-NSS. When comparing response from 2016 to 2021, PD improved from 4 to 2 min (P = 0.001). EMS improved from 6.4 min (EMS-NSS) and 4.5 min (EMS-SS) to 5 min (EMS- NSS) and 4 min (EMS-SS) (P = 0.281). In addition, PD transport times, 5 min (SS) and 4 min (NSS), were faster than EMS, 9 min (SS and NSS) (P < 0.001). Overall PD transport volume increased with a peak in 2020 (68.3%). There was also an increase in PD-NSS transport 4% to 37.9% (P < 0.001). EMS-SS transport decreased from 54.7% to 6.9% (P < 0.001). CONCLUSION The presence of SS technology in a small urban setting continues to be associated with a higher rate of PD transport of GSW victims. The critical time of dispatch and transport for both PD and EMS has shown durable improvement.
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Affiliation(s)
| | - Ryan Field
- Cooper University Hospital, Trauma, Camden, New Jersey
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Syamal S, Tran AH, Huang CC, Badrinathan A, Bassiri A, Ho VP, Towe CW. Outcomes of Trauma "Walk-Ins" in the American College of Surgeons Trauma Quality Program Database. Am Surg 2024; 90:1037-1044. [PMID: 38085592 DOI: 10.1177/00031348231220597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND Outcomes of trauma "walk-in" patients (using private vehicles or on foot) are understudied. We compared outcomes of ground ambulance vs walk-ins, hypothesizing that delayed resuscitation and uncoordinated care may worsen walk-in outcomes. METHODS A retrospective analysis 2020 American College of Surgeons Trauma Quality Programs (ACS-TQP) databases compared outcomes between ambulance vs "walk-ins." The primary outcome was in-hospital mortality, excluding external facility transfers and air transports. Data was analyzed with descriptive statistics, bivariate, multivariable logistic regression, including an Inverse Probability Weighted Regression Adjustment with adjustments for injury severity and vital signs. The primary outcome for the 2019 (pre-COVID-19 pandemic) data was similarly analyzed. RESULTS In 2020, 707,899 patients were analyzed, 556,361 (78.59%) used ambulance, and 151,538 (21.41%) were walk-ins. We observed differences in demographics, hospital attributes, medical comorbidities, and injury mechanism. Ambulance patients had more chronic conditions and severe injuries. Walk-ins had lower in-hospital mortality (850 (.56%) vs 23,131 (4.16%)) and arrived with better vital signs. Multivariable logistic regression models (inverse probability weighting for regression adjustment), adjusting for injury severity, demographics, injury mechanism, and vital signs, confirmed that walk-in status had lower odds of mortality. For the 2019 (pre-COVID-19 pandemic) database, walk-ins also had lower in-hospital mortality. DISCUSSION Our results demonstrate better survival rates for walk-ins before and during COVID-19 pandemic. Despite limitations of patient selection bias, this study highlights the need for further research into transportation modes, geographic and socioeconomic factors affecting patient transport, and tailoring management strategies based on their mode of arrival.
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Affiliation(s)
- Sujata Syamal
- Department of Surgery, The MetroHealth System and Case Western Reserve University, Cleveland, OH, USA
| | - Andrew H Tran
- Department of Surgery, The MetroHealth System and Case Western Reserve University, Cleveland, OH, USA
| | - Chi-Ching Huang
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Avanti Badrinathan
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Aria Bassiri
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Vanessa P Ho
- Department of Surgery, The MetroHealth System and Case Western Reserve University, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
- Center for Health Equity Engagement, Education, and Research, Population Health and Equity Research Institute, The MetroHealth System and Case Western Reserve University, Cleveland, OH, USA
- Trauma Recovery Center, Institute for H.O.P.E, The MetroHealth System, Cleveland, OH, USA
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Nix J. Unveiling the Unseen: Documenting and Analyzing Nonfatal Shootings by Police. Am J Public Health 2024; 114:382-383. [PMID: 38478857 PMCID: PMC10937605 DOI: 10.2105/ajph.2024.307609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 03/17/2024]
Affiliation(s)
- Justin Nix
- Justin Nix is a distinguished associate professor in the School of Criminology and Criminal Justice at the University of Nebraska Omaha, where he co-directs the Violence Intervention and Policing Research Lab and coordinates the Master of Arts program. His research centers on policing, with emphasis on legitimacy and police use of force
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Atkins K, Schneider A, Gallaher J, Charles A. The effect of transport mode on mortality following isolated penetrating torso Trauma. Am J Surg 2023; 226:542-547. [PMID: 37453802 PMCID: PMC10528673 DOI: 10.1016/j.amjsurg.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Prehospital interventions may increase the time to definitive care. Compared to ground ambulance, we hypothesize improved mortality for patients with isolated, penetrating torso injuries transported via private vehicle. METHODS We reviewed the National Trauma Data Bank (2017-2021) for adults with isolated, penetrating torso injuries stratified by mechanism (stabbing vs. firearm) and transport mode (private vehicle vs. ground ambulance). We performed a multivariable logistic regression to estimate the effect of transport mode on mortality. RESULTS 48,444 patients met our inclusion criteria. Patients transported by ambulance, injured by stabbing (n = 26,633) and by firearm (n = 21,811) had adjusted odds ratios of 1.81 (95%CI 1.05-3.14, p = 0.03) and 1.66 (95%CI 1.32-2.09,p < 0.001) respectively for mortality compared to private vehicle transport. CONCLUSION Patients with penetrating torso injuries have nearly twice the odds of mortality when transported by ground ambulance than private vehicles, despite injury severity. The "scoop and run" strategy may confer a survival benefit in this population.
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Affiliation(s)
- Kathryn Atkins
- Department of Surgery, University of North Carolina at Chapel Hill, United States
| | - Andrew Schneider
- Department of Surgery, University of North Carolina at Chapel Hill, United States
| | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, United States
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, United States.
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Renberg M, Dahlberg M, Gellerfors M, Rostami A, Günther M, Rostami E. Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business? Scand J Trauma Resusc Emerg Med 2023; 31:45. [PMID: 37684674 PMCID: PMC10492387 DOI: 10.1186/s13049-023-01112-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Sweden is facing a surge of gun violence that mandates optimized prehospital transport approaches, and a survey of current practice is fundamental for such optimization. Management of severe, penetrating trauma is time sensitive, and there may be a survival benefit in limiting prehospital interventions. An important aspect is unregulated transportation by police or private vehicles to the hospital, which may decrease time but may also be associated with adverse outcomes. It is not known whether transport of patients with penetrating trauma occurs outside the emergency medical services (EMS) in Sweden and whether it affects outcome. METHOD This was a retrospective, descriptive nationwide study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 registered in the Swedish national trauma registry (SweTrau) between June 13, 2011, and December 31, 2019. We hypothesized that transport by police and private vehicles occurred and that it affected mortality. RESULT A total of 657 patients were included. EMS transported 612 patients (93.2%), police 10 patients (1.5%), and private vehicles 27 patients (4.1%). Gunshot wounds (GSWs) were more common in police transport, 80% (n = 8), compared with private vehicles, 59% (n = 16), and EMS, 32% (n = 198). The Glasgow coma scale score (GCS) in the emergency department (ED) was lower for patients transported by police, 11.5 (interquartile range [IQR] 3, 15), in relation to EMS, 15 (IQR 14, 15) and private vehicles 15 (IQR 12.5, 15). The 30-day mortality for EMS was 30% (n = 184), 50% (n = 5) for police transport, and 22% (n = 6) for private vehicles. Transport by private vehicle, odds ratio (OR) 0.65, (confidence interval [CI] 0.24, 1.55, p = 0.4) and police OR 2.28 (CI 0.63, 8.3, p = 0.2) were not associated with increased mortality in relation to EMS. CONCLUSION Non-EMS transports did occur, however with a low incidence and did not affect mortality. GSWs were more common in police transport, and victims had lower GCS scorescores when arriving at the ED, which warrants further investigations of the operational management of shooting victims in Sweden.
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Affiliation(s)
- Mattias Renberg
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Martin Dahlberg
- Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Gellerfors
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Rapid Response Car, Capio, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Swedish Air Ambulance (SLA), Mora, Sweden
| | - Amir Rostami
- Department for Social Work and Criminology, University of Gävle, Gävle, Sweden
| | - Mattias Günther
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden.
- Experimental Traumatology Unit, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Clinical Science and Education, Section for Anesthesiology and Intensive Care, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, S1, 118 83, Stockholm, Sweden.
| | - Elham Rostami
- Experimental Traumatology Unit, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University Hospital , Uppsala, Sweden
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Campos-Serra A, Pérez-Díaz L, Rey-Valcárcel C, Montmany-Vioque S, Artiles-Armas M, Aparicio-Sánchez D, Tallón-Aguilar L, Gutiérrez-Andreu M, Bernal-Tirapo J, Garcia-Moreno Nisa F, Vera-Mansilla C, González-Conde R, Gómez-Viana L, Titos-García A, Aranda-Narvaez J. Results of the Spanish National Polytrauma Registry. Where are we and where are we heading? Cir Esp 2023; 101:609-616. [PMID: 36940810 DOI: 10.1016/j.cireng.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/30/2022] [Indexed: 03/22/2023]
Abstract
INTRODUCTION In 2017, the Spanish National Polytrauma Registry (SNPR) was initiated in Spain with the goal to improve the quality of severe trauma management and evaluate the use of resources and treatment strategies. The objective of this study is to present the data obtained with the SNPR since its inception. METHODS We conducted an observational study with prospective data collection from the SNPR. The trauma patients included were over 14 years of age, with ISS ≥ 15 or penetrating mechanism of injury, from a total of 17 tertiary hospitals in Spain. RESULTS From 1/1/17 to 1/1/22, 2069 trauma patients were registered. The majority were men (76.4%), with a mean age of 45 years, mean ISS 22.8, and mortality 10.2%. The most common mechanism of injury was blunt trauma (80%), the most frequent being motorcycle accident (23%). Penetrating trauma was presented in 12% of patients, stab wounds being the most common (84%). On hospital arrival, 16% of patients were hemodynamically unstable. The massive transfusion protocol was activated in 14% of patients, and 53% underwent surgery. Median hospital stay was 11 days, while 73.4% of patients required intensive care unit (ICU) admission, with a median ICU stay of 5 days. CONCLUSIONS Trauma patients registered in the SNPR are predominantly middle-aged males who experience blunt trauma with a high incidence of thoracic injuries. Early addressed detection and treatment of these kind of injuries would probably improve the quality of trauma care in our environment.
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Affiliation(s)
- Andrea Campos-Serra
- Departamento de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain.
| | - Lola Pérez-Díaz
- Departamento de Cirugía General, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Rey-Valcárcel
- Departamento de Cirugía General, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sandra Montmany-Vioque
- Departamento de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - Manuel Artiles-Armas
- Departamento de Cirugía General, Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | - Luís Tallón-Aguilar
- Departamento de Cirugía General, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Julia Bernal-Tirapo
- Departamento de Cirugía General, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Cristina Vera-Mansilla
- Departamento de Cirugía General, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Ricardo González-Conde
- Departamento de Cirugía General, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Leticia Gómez-Viana
- Departamento de Cirugía General, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Alberto Titos-García
- Departamento de Cirugía General, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Jose Aranda-Narvaez
- Departamento de Cirugía General, Hospital Regional Universitario de Málaga, Málaga, Spain
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Salhi RA, Iyengar S, da Silva Bhatia B, Smith GC, Heisler M. How do current police practices impact trauma care in the prehospital setting? A scoping review. J Am Coll Emerg Physicians Open 2023; 4:e12974. [PMID: 37229183 PMCID: PMC10204184 DOI: 10.1002/emp2.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 04/08/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
Objective In the United States, police are often important co-responders to 911 calls with emergency medical services for medical emergencies. To date, there remains a lack of a comprehensive understanding of the mechanisms by which police response modifies time to in-hospital medical care for traumatically injured patients. Further, it remains unclear if differentials exist within or between communities. A scoping review was performed to identify studies evaluating prehospital transport of traumatically injured patients and the role or impact of police involvement. Methods PubMed, SCOPUS, and Criminal Justice Abstracts databases were utilized to identify articles. English-language, US-based, peer-reviewed articles published on or prior to March 30, 2022 were eligible for inclusion. Results Of 19,437 articles initially identified, 70 articles were selected for full review and 17 for final inclusion. Key findings included (1) current law enforcement practices involving scene clearance introduce the potential for delayed patient transport but to date there is little research quantifying delays; (2) police transport protocols may decrease transport times; and (3) there are no studies examining the potential impact of scene clearance practices at the patient or community level. Conclusions Our results highlight that police are often the first on scene when responding to traumatic injuries and have an active role via scene clearance or, in some systems, patient transport. Despite the significant potential for impact on patient well-being, there remains a paucity of data examining and driving current practices.
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Affiliation(s)
- Rama A. Salhi
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Sonia Iyengar
- University of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | - Graham C. Smith
- Department of Emergency MedicineUniversity of MichiganAnn ArborMichiganUSA
- Washtenaw/Livingston Medical Control AuthorityAnn ArborMichiganUSA
| | - Michele Heisler
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichiganUSA
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McGuire SS, Keim A, Blakeney CA, Brand SI, Klassen AB, Luke A, Maher SA, Wood JM, Sztajnkrycer MD. Immediate Medical Care Rendered by US Law Enforcement Officers after Officer-Involved Shootings - An Open-Access Public Domain Video Analysis. Prehosp Disaster Med 2023; 38:168-173. [PMID: 36872570 DOI: 10.1017/s1049023x23000171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND After officer-involved shootings (OIS), rapid delivery of emergency medical care is critical but may be delayed due to scene safety concerns. The purpose of this study was to describe medical care rendered by law enforcement officers (LEOs) after lethal force incidents. METHODS Retrospective analysis of open-source video footage of OIS occurring from February 15, 2013 through December 31, 2020. Frequency and nature of care provided, time until LEO and Emergency Medical Services (EMS) care, and mortality outcomes were evaluated. The study was deemed exempt by the Mayo Clinic Institutional Review Board. RESULTS Three hundred forty-two (342) videos were included in the final analysis; LEOs rendered care in 172 (50.3%) incidents. Average elapsed time from time-of-injury (TOI) to LEO-provided care was 155.8 (SD = 198.8) seconds. Hemorrhage control was the most common intervention performed. An average of 214.2 seconds elapsed between LEO care and EMS arrival. No mortality difference was identified between LEO versus EMS care (P = .1631). Subjects with truncal wounds were more likely to die than those with extremity wounds (P < .00001). CONCLUSIONS It was found that LEOs rendered medical care in one-half of all OIS incidents, initiating care on average 3.5 minutes prior to EMS arrival. Although no significant mortality difference was noted for LEO versus EMS care, this finding must be interpreted cautiously, as specific interventions, such as extremity hemorrhage control, may have impacted select patients. Future studies are needed to determine optimal LEO care for these patients.
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Affiliation(s)
- Sarayna S McGuire
- Division of Prehospital Care, Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
| | - Audrey Keim
- Mayo Clinic Alix School of Medicine, Scottsdale, ArizonaUSA
| | - Craig A Blakeney
- Division of Prehospital Care, Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
| | - Shari I Brand
- Department of Emergency Medicine, Mayo Clinic, Scottsdale, ArizonaUSA
| | - Aaron B Klassen
- Division of Prehospital Care, Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
| | - Anuradha Luke
- Division of Prehospital Care, Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
| | - Steven A Maher
- Department of Emergency Medicine, Mayo Clinic, Scottsdale, ArizonaUSA
| | - Jeffrey M Wood
- Division of Prehospital Care, Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
| | - Matthew D Sztajnkrycer
- Division of Prehospital Care, Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
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Campos-Serra A, Pérez-Díaz L, Rey-Valcárcel C, Montmany-Vioque S, Artiles-Armas M, Aparicio-Sánchez D, Tallón-Aguilar L, Gutiérrez-Andreu M, Bernal-Tirapo J, Garcia-Moreno Nisa F, Vera-Mansilla C, González-Conde R, Gómez-Viana L, Titos-García A, Aranda-Narvaez J. Resultados del Registro Nacional de Politraumatismos español ¿Dónde estamos y a dónde nos dirigimos? Cir Esp 2023. [DOI: 10.1016/j.ciresp.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Coming in hot: Police transport and prehospital time after firearm injury. J Trauma Acute Care Surg 2022; 93:656-663. [DOI: 10.1097/ta.0000000000003689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Byrne JP, Kaufman E, Scantling D, Tam V, Martin N, Raza S, Cannon JW, Schwab CW, Reilly PM, Seamon MJ. Association Between Geospatial Access to Care and Firearm Injury Mortality in Philadelphia. JAMA Surg 2022; 157:942-949. [PMID: 36001304 PMCID: PMC9403855 DOI: 10.1001/jamasurg.2022.3677] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/30/2022] [Indexed: 11/14/2022]
Abstract
Importance The burden of firearm violence in US cities continues to rise. The role of access to trauma center care as a trauma system measure with implications for firearm injury mortality has not been comprehensively evaluated. Objective To evaluate the association between geospatial access to care and firearm injury mortality in an urban trauma system. Design, Setting, and Participants Retrospective cohort study of all people 15 years and older shot due to interpersonal violence in Philadelphia, Pennsylvania, between January 1, 2015, and August 9, 2021. Exposures Geospatial access to care, defined as the predicted ground transport time to the nearest trauma center for each person shot, derived by geospatial network analysis. Main Outcomes and Measures Risk-adjusted mortality estimated using hierarchical logistic regression. The population attributable fraction was used to estimate the proportion of fatalities attributable to disparities in geospatial access to care. Results During the study period, 10 105 people (910 [9%] female and 9195 [91%] male; median [IQR] age, 26 [21-28] years; 8441 [84%] Black, 1596 [16%] White, and 68 other [<1%], including Asian and unknown, consolidated owing to small numbers) were shot due to interpersonal violence in Philadelphia. Of these, 1999 (20%) died. The median (IQR) predicted transport time was 5.6 (3.8-7.2) minutes. After risk adjustment, each additional minute of predicted ground transport time was associated with an increase in odds of mortality (odds ratio [OR], 1.03 per minute; 95% CI, 1.01-1.05). Calculation of the population attributable fraction using mortality rate ratios for incremental 1-minute increases in predicted ground transport time estimated that 23% of shooting fatalities could be attributed to differences in access to care, equivalent to 455 deaths over the study period. Conclusions and Relevance These findings indicate that geospatial access to care may be an important trauma system measure, improvements to which may result in reduced deaths from gun violence in US cities.
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Affiliation(s)
- James P. Byrne
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elinore Kaufman
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Dane Scantling
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Vicky Tam
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Niels Martin
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Shariq Raza
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jeremy W. Cannon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - C. William Schwab
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Patrick M. Reilly
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Mark J. Seamon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Change in outcomes for trauma patients over time: Two decades of a state trauma system. Injury 2022; 53:2915-2922. [PMID: 35752485 DOI: 10.1016/j.injury.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/26/2022] [Accepted: 06/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trauma center mortality rates are benchmarked to expected rates of death based on patient and injury characteristics. The expected mortality rate is recalculated from pooled outcomes across a trauma system each year, obscuring system-level change across years. We hypothesized that risk-adjusted mortality would decrease over time within a state-wide trauma system. METHODS We identified adult trauma patients presenting to Level I and II Pennsylvania trauma centers, 1999-2018, using the Pennsylvania Trauma Outcomes Study. Multivariable logistic regression generated risk-adjusted models for mortality in all patients, and in key subgroups: penetrating torso injury, blunt multisystem trauma, and patients presenting in shock. RESULTS Of 162,646 included patients, 123,518 (76.1%) were white and 108,936 (67.0%) were male. The median age was 49 (interquartile range [IQR] 29-70), median injury severity score was 16 (IQR 10-24), and 87.5% of injuries were blunt. Overall, 9.9% of patients died, and compared to 1999, no year had significantly higher adjusted odds of mortality. Overall mortality was significantly lower in 2007-2009 and 2011-2018. Of patients with blunt, multisystem injuries, 17.7% died, and adjusted mortality improved over time. Mortality rates were 24.9% for penetrating torso injury, and 56.9% for shock, with no significant change. Mortality improved for patients with ISS < 25, but not for the most severely injured. CONCLUSIONS Over 20 years, Pennsylvania trauma centers demonstrated improved risk-adjusted mortality rates overall, but improvement remains lacking in high-risk groups despite numerous innovations and practice changes in this time period. Identifying change over time can help guide focus to these critical gaps.
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An analysis of police transport in an Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients. J Trauma Acute Care Surg 2022; 93:265-272. [PMID: 35121705 DOI: 10.1097/ta.0000000000003563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Police transport (PT) of penetrating trauma patients in urban locations has become routine in certain metropolitan areas; however, whether it results in improved outcomes over prehospital Advanced life support (ALS) transport has not been determined in a multicenter study. We hypothesized that PT would not result in improved outcomes. METHODS This was a multicenter, prospective, observational study of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers. Police transport and ALS patients were allocated via nearest neighbor, propensity matching. Transport mode also examined by Cox regression. RESULTS Of 1,618 total patients, 294 (18.2%) had PT and 1,324 (81.8%) were by ALS. After matching, 588 (294/cohort) remained. The patients were primarily Black (n = 497, 84.5%), males (n = 525, 89.3%, injured by gunshot wound (n = 494, 84.0%) with 34.5% (n = 203) having Injury Severity Score of 16 or higher. Overall mortality by propensity matching was not different between cohorts (15.6% ALS vs. 15.0% PT, p = 0.82). In severely injured patients (Injury Severity Score ≥16), mortality did not differ between PT and ALS transport (38.8% vs. 36.0%, respectively; p = 0.68). Cox regression analysis controlled for relevant factors revealed no association with a mortality benefit in patients transported by ALS. CONCLUSION Police transport of penetrating trauma patients in urban locations results in similar outcomes compared with ALS. Immediate transport to definitive trauma care should be emphasized in this patient population. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level III.
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Smart G, Banstola A, Raut R, Ghimire K, Mytton J, Joshi E, Joshi S. Post-Crash First Response by Traffic Police in Nepal: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148481. [PMID: 35886332 PMCID: PMC9323792 DOI: 10.3390/ijerph19148481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 12/04/2022]
Abstract
Background: Road traffic injuries are a significant and increasing public health burden in Nepal, but there is no national coverage of regulated and standardized emergency medical service systems. Therefore, this study was designed to develop a first responder trauma training program for the Nepal traffic police and to evaluate the feasibility of its delivery and follow up. Methods: A training needs assessment with traffic-police officers in a single district of Nepal informed the development of a 3-day first-response course which was provided to officers in May 2019. Participants were supplied with a trauma-pack and asked to complete a report form when first-responder skills were used. Knowledge and confidence face-to-face surveys were used before and after training to assess learning, and were repeated at 6 months to assess retention of knowledge. The surveys at 6 months assessed the factors affecting application of first response skills. Results: Most (97%) participants believed giving first-aid was part of their responsibilities and 95% had experience of transporting road crash victims to hospital with a range of injuries. Low levels of first-aid training and variable course content were reported. Knowledge and confidence scores improved post-intervention but were reduced at 6-months. During attendance at 303 road crashes in the 6-months follow-up period, 44% of the participants self-reported using at least one skill from the course; applying them on 92 occasions. Incident report-forms were frequently not completed. Barriers to providing treatment included: the patient already en-route to hospital when police arrived at scene; resistance to providing care from relatives or bystanders; and competing police duties (e.g., traffic management). Conclusions: Delivering a first-response training program for traffic-police in Nepal is feasible. Knowledge was retained and used, and skills were in frequent demand. A study of effectiveness and cost-effectiveness appears warranted to determine if extending the training to other districts can improve outcomes in road traffic injury patients in the absence of formal emergency medical services.
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Affiliation(s)
- Gary Smart
- Faculty of Health and Applied Sciences, University of the West of England, Bristol BS16 1DD, UK;
- Correspondence:
| | - Amrit Banstola
- Division of Global Public Health, Department of Health Sciences, Brunel University London, London UB8 3PH, UK;
| | - Raju Raut
- Nepal Red Cross Society, First Aid Division, Kathmandu 44614, Nepal; (R.R.); (K.G.)
| | - Krishna Ghimire
- Nepal Red Cross Society, First Aid Division, Kathmandu 44614, Nepal; (R.R.); (K.G.)
| | - Julie Mytton
- Faculty of Health and Applied Sciences, University of the West of England, Bristol BS16 1DD, UK;
| | - Elisha Joshi
- Nepal Injury Research Centre, Kathmandu Medical College, Kathmandu University, Kathmandu 44600, Nepal; (E.J.); (S.J.)
| | - Sunil Joshi
- Nepal Injury Research Centre, Kathmandu Medical College, Kathmandu University, Kathmandu 44600, Nepal; (E.J.); (S.J.)
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Dauer E, Beard JH, Maher Z, Sjoholm L, Santora T, Pathak A, Anderson J, Goldberg A. Talk and Die: A Descriptive Analysis of Penetrating Trauma Patients. J Surg Res 2022; 278:1-6. [PMID: 35588570 DOI: 10.1016/j.jss.2022.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION "Talk and die" traditionally described occult presentations of fatal intracranial injuries, but we broaden its definition to victims of penetrating trauma. METHODS We conducted a descriptive analysis of patients with penetrating torso trauma who presented with a Glasgow Coma Scale verbal score ≥3 and died within 48 h of arrival from 2008 to 2018. RESULTS Sixty patients were identified. Eighteen (30.0%) required resuscitative thoracotomy with 7 (11.7%) dying in the trauma bay. Fifty-three (86.9%) patients went to the operating room, and 35 (66.0%) required multicavitary exploration. The most common injuries were hollow viscous (58.5%), intra-abdominal vascular (49.0%), liver (28.3%), pulmonary (26.4%), intrathoracic vascular (18.9%), and cardiac (15.75) injuries. Twenty-three (43.4%) patients survived their initial operation, but died in the first 48 h postoperatively. CONCLUSIONS Patients who "talk and die" most frequently have intra-abdominal vascular injures and require multicavitary exploration.
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Affiliation(s)
| | | | - Zoë Maher
- Temple University Hospital, Philadelphia, Pennsylvania
| | - Lars Sjoholm
- Temple University Hospital, Philadelphia, Pennsylvania
| | | | | | | | - Amy Goldberg
- Temple University Hospital, Philadelphia, Pennsylvania
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Abou Arbid SA, Bachir RH, El Sayed MJ. Association between Mode of Transportation and Survival in Adult Trauma Patients with Penetrating Injuries: Matched Cohort Study between Police and Ground Ambulance Transport. Prehosp Disaster Med 2022; 37:1-8. [PMID: 35256031 DOI: 10.1017/s1049023x22000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Police transport (PT) of penetrating trauma patients has the potential to improve survival rates. There are no well-established guidelines for PT of penetrating trauma patients. STUDY OBJECTIVE This study examines the association between survival rate to hospital discharge of adult penetrating trauma patients and mode of transport (PT versus ground ambulance [GA]). METHODS A retrospective, matched cohort study was conducted using the United States (US) National Trauma Data Bank (NTDB). All adult penetrating injury patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by GA for analysis. Descriptive analysis was carried out. The patients' demographic and clinical characteristics were tabulated and stratified by the transport mode. RESULTS Out of the 733 patients with penetrating injuries, ground Emergency Medical Services (EMS) transported 513 patients and police transported 220 patients. Most patients were 16-64 years of age with a male (95.6%) and Black/African American race (79.0%) predominance. Firearm-related injuries (68.8%) were the most common mechanism of injury with the majority of injuries involving the body extremities (62.9%). Open wounds were the most common nature of injury (75.7%). The overall survival rate to hospital discharge was similar for patients transported by GA and by police (94.5% versus 92.7%; P = .343). CONCLUSION In this study, patients with penetrating trauma transported by police had similar outcomes to those transported by GA. As such, PT in penetrating trauma appears to be effective. Detailed protocols should be developed to further improve resource utilization and outcomes.
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Affiliation(s)
- Samer A Abou Arbid
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana H Bachir
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen J El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon
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Nix J, Shjarback JA. Factors associated with police shooting mortality: A focus on race and a plea for more comprehensive data. PLoS One 2021; 16:e0259024. [PMID: 34758026 PMCID: PMC8580236 DOI: 10.1371/journal.pone.0259024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To quantify nonfatal injurious police shootings of people and examine the factors associated with victim mortality. METHODS We gathered victim-level data on fatal and nonfatal injurious police shootings from four states that have such information publicly available: Florida (2009-14), Colorado (2010-19), Texas (2015-19), and California (2016-19). For each state, we examined bivariate associations between mortality and race/ethnicity, gender, age, weapon, and access to trauma care. We also estimated logistic regression models predicting victim mortality in each state. RESULTS Forty-five percent of these police shooting victims (N = 1,322) did not die. Black-white disparities were more pronounced in nonfatal injurious police shootings than in fatal police shootings. Overall, Black victims were less likely than white victims to die from their wound(s). Younger victims were less likely to die from their wound(s), as well as those who were unarmed. CONCLUSIONS Racial and age disparities in police shootings are likely more pronounced than previous estimates suggest. POLICY IMPLICATIONS Other states should strongly consider compiling data like that which is currently being gathered in California. Absent data on nonfatal injurious police shootings-which account for a large share of deadly force incidents-researchers and analysts must be cautious about comparing and/or ranking jurisdictions in terms of their police-involved fatality rates.
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Affiliation(s)
- Justin Nix
- School of Criminology and Criminal Justice, University of Nebraska Omaha, Omaha, NE, United States of America
| | - John A. Shjarback
- Department of Law and Justice Studies, Rowan University, Glassboro, NJ, United States of America
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Bou Saba G, Bachir R, El Sayed M. Impact of Trauma Center Designation Level on the Survival of Trauma Patients Transported by Police in the United States. PREHOSP EMERG CARE 2021; 26:582-589. [PMID: 34550042 DOI: 10.1080/10903127.2021.1983092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Police involvement in trauma management and transport is increasing in the US. Little is known about prehospital triage criteria and transport patterns used by Police Officers. In this study, we examined the impact of trauma designation level on the survival of trauma patients transported to trauma centers by police.Methods: We used the National Trauma Data Bank (NTDB) 2017 dataset in this retrospective observational study. Adult trauma patients transported by Police to Level I, II and III trauma centers were included. We performed a univariate analysis followed by a bivariate analysis. Finally, we carried out a multivariable logistic regression analysis adjusting for confounders to assess the impact of trauma level designation on outcomes of patients transported by Police.Results: A total of 2,788 patients were included. The majority of the patients were males (84.6%) between the ages of 16 and 55 with half of them being African American. Most had a mild GCS (13-15) (89.5%) and only 17.4% were recorded to have severe traumatic injuries with ISS ≥ 16. The most common trauma type was blunt trauma (61.4%) followed by penetrating injuries (32.2%) and burns (1.5%). Around half of injuries were the result of assault (49.4%) and 43.0% were unintentional. Head and neck injuries were most common (40.8%) followed by extremities (27.4%) and torso injuries (25.0%). Approximately half of the patients were admitted to floor bed/observation unit/step-down unit (50.7%) while 18.9% and 19.8% went to the Operating Room or Intensive Care Unit respectively. Overall survival to hospital discharge was 93.2%. Survival was 91.6% in Level I, 98.2% in level II and 98.7% in Level III centers. After adjusting for significant confounders, survival to hospital discharge was similar for patients transported by police to level II and III trauma centers in comparison to those transported to level I (OR = 0.866 95%CI (0.321-2.333); p = 0.776).Conclusion: Transport of trauma patients by police to trauma centers of different designation levels was not associated with survival in this study. Survival was also similar to other trauma studies. As such, trauma patients may be safely transported by Police to closest trauma designated center without affecting outcomes.
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Affiliation(s)
- Ghassan Bou Saba
- Received June 9, 2021 from Faculty of Medicine, American University of Beirut, Beirut, Lebanon (GBS); Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon (RB, MES); Emergency Medical Services and Pre-hospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon (MES). Revised received September 14, 2021; accepted for publication September 15, 2021
| | - Rana Bachir
- Received June 9, 2021 from Faculty of Medicine, American University of Beirut, Beirut, Lebanon (GBS); Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon (RB, MES); Emergency Medical Services and Pre-hospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon (MES). Revised received September 14, 2021; accepted for publication September 15, 2021
| | - Mazen El Sayed
- Received June 9, 2021 from Faculty of Medicine, American University of Beirut, Beirut, Lebanon (GBS); Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon (RB, MES); Emergency Medical Services and Pre-hospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon (MES). Revised received September 14, 2021; accepted for publication September 15, 2021
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Scantling D, Orji W, Hatchimonji J, Kaufman E, Holena D. Firearm Violence, Access to Care, and Gentrification: A Moving Target for American Trauma Systems. Ann Surg 2021; 274:209-217. [PMID: 33605588 DOI: 10.1097/sla.0000000000004771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to determine whether gentrification predicts the movement of shooting victims over time and if this process has decreased access to care. BACKGROUND Trauma centers remain fixed in space, but the populations they serve do not. Nationally, gentrification has displaced disadvantaged communities most at risk for violent injury, potentially decreasing access to care. This process has not been studied, but an increase of only 1 mile from a trauma center increases shooting mortality up to 22%. METHODS We performed a cross-sectional study utilizing Philadelphia Police Department (PPD) and Pennsylvania trauma systems outcome (PTOS) data 2006-2018. Shootings were mapped and grouped into census tracts. They were then cross-mapped with gentrification data and hospital location. PPD and PTOS shooting data were compared to ensure patients requiring trauma care were captured. Census tracts with ≥500 residents with income and median home values in the bottom 40th percentile of the metropolitan area were eligible to gentrify. Tracts were gentrified if residents ≥25 with a bachelor's degree increased and home price increased to the top third in the metropolitan area. Change in distribution of shootings and its relation to gentrification was our primary outcome while proximity of shootings to a trauma center was our secondary outcome. RESULTS Thirty-two percent (123/379) of eligible tracts gentrified and 31,165 shootings were captured in the PPD database. 9090 (29.2%) patients meeting trauma criteria were captured in PTOS with an increasing proportion over time. The proportion of shootings within gentrifying tracts significantly dropped 2006-2018 (40%-35%, P < 0.001) and increased in non-gentrifying tracts (52%-57%, P < 0.001). In evaluation of shooting densities, a predictable redistribution occurred 2006-2018 with incident density decreasing in gentrified areas and increasing in non-gentrified areas. Shootings within 1 mile of a trauma center increased overall, but proportional access decreased in gentrified areas. CONCLUSIONS Shootings in Philadelphia predictably moved out of gentrified areas and concentrated in non-gentrified ones. In this case study of a national crisis, the pattern of change paradoxically resulted in an increased clustering of shootings around trauma centers in non-gentrified areas. Repetition of this work in other cities can guide future resource allocation and be used to improve access to trauma care.
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Affiliation(s)
- Dane Scantling
- The University of Pennsylvania Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, Pennsylvania
| | - Whitney Orji
- The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justin Hatchimonji
- The University of Pennsylvania Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, Pennsylvania
| | - Elinore Kaufman
- The University of Pennsylvania Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, Pennsylvania
| | - Daniel Holena
- The University of Pennsylvania Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, Pennsylvania
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Maher Z, Beard JH, Dauer E, Carroll M, Forman S, Topper GV, Pathak A, Santora TA, Sjoholm LO, Zhao H, Goldberg AJ. Police transport of firearm-injured patients-more often and more injured. J Trauma Acute Care Surg 2021; 91:164-170. [PMID: 34108420 DOI: 10.1097/ta.0000000000003225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Police transport (PT) of penetrating trauma patients decreases the time between injury and trauma center arrival. Our study objective was to characterize trends in the rate of PT and its impact on mortality. We hypothesized that PT is increasing and that these patients are more injured. METHODS We conducted a single-center, retrospective cohort study of adult (≥18 years) patients presenting with gunshot wounds (GSWs) to a level 1 center from 2012 to 2018. Patients transported by police or ambulance (emergency medical service [EMS]) were included. The association between mode of transport (PT vs. EMS) and mortality was evaluated using χ2, t tests, Mann-Whitney U tests, and logistic regression. RESULTS Of 2,007 patients, there were 1,357 PT patients and 650 EMS patients. Overall in-hospital mortality was 23.7%. The rate of GSW patients arriving by PT increased from 48.9% to 78.5% over the study period (p < 0.001). Compared with EMS patients, PT patients were sicker on presentation with lower initial systolic blood pressure (98 vs. 110, p < 0.001), higher Injury Severity Score (median [interquartile range], 10 [2-75] vs. 9 [1-17]; p < 0.001) and more bullet wounds (3.5 vs. 2.9, p < 0.001). Police-transported patients more frequently underwent resuscitative thoracotomy (19.2% vs. 10.0%, p < 0.001) and immediate surgical exploration (31.3% vs. 22.6%, p < 0.001). There was no difference in adjusted in-hospital mortality between transport groups. Of patients surviving to discharge, PT patients had higher Injury Severity Score (9.6 vs. 8.3, p = 0.004) and lower systolic blood pressure on arrival (126 vs. 130, p = 0.013) than EMS patients. CONCLUSION Police transport of GSW patients is increasing at our urban level 1 center. Compared with EMS patients, PT patients are more severely injured but have similar in-hospital mortality. Further study is necessary to understand the impact of PT on outcomes in specific subsets in penetrating trauma patients. LEVEL OF EVIDENCE Epidemiological, level III.
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Affiliation(s)
- Zoё Maher
- From the Division of Trauma and Critical Care, Department of Surgery, (Z.M., J.H.B., E.D., A.P., T.A.S., L.O.S., A.J.G.), Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Department of Surgery (M.C.), Yale School of Medicine, New Haven, Connecticut; Lewis Katz School of Medicine at Temple University (S.F., G.V.T.), Philadelphia, Pennsylvania, and Department of Clinical Sciences (H.Z.), Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Taghavi S, Maher Z, Goldberg AJ, Chang G, Mendiola M, Anderson C, Ninokawa S, Tatebe LC, Maluso P, Raza S, Keating JJ, Burruss S, Reeves M, Coleman LE, Shatz DV, Goldenberg-Sandau A, Bhupathi A, Spalding MC, LaRiccia A, Bird E, Noorbakhsh MR, Babowice J, Nelson MC, Jacobson LE, Williams J, Vella M, Dellonte K, Hayward TZ, Holler E, Lieser MJ, Berne JD, Mederos DR, Askari R, Okafor BU, Haut ER, Etchill EW, Fang R, Roche SL, Whittenburg L, Bernard AC, Haan JM, Lightwine KL, Norwood SH, Murry J, Gamber MA, Carrick MM, Bugaev N, Tatar A, Duchesne J, Tatum D. An Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients. J Trauma Acute Care Surg 2021; 91:130-140. [PMID: 33675330 PMCID: PMC8216597 DOI: 10.1097/ta.0000000000003151] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/01/2021] [Accepted: 03/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prehospital procedures (PHP) by emergency medical services (EMS) are performed regularly in penetrating trauma patients despite previous studies demonstrating no benefit. We sought to examine the influence of PHPs on outcomes in penetrating trauma patients in urban locations where transport to trauma center is not prolonged. We hypothesized that patients without PHPs would have better outcomes than those undergoing PHP. METHODS This was an Eastern Association for the Surgery of Trauma-sponsored, multicenter, prospective, observational trial of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers. The impact of PHPs and transport mechanism on in-hospital mortality were examined. RESULTS Of 2,284 patients included, 1,386 (60.7%) underwent PHP. The patients were primarily Black (n = 1,527, 66.9%) males (n = 1,986, 87.5%) injured by gunshot wound (n = 1,510, 66.0%) with 34.1% (n = 726) having New Injury Severity Score of ≥16. A total of 1,427 patients (62.5%) were transported by Advanced Life Support EMS, 17.2% (n = 392) by private vehicle, 13.7% (n = 312) by police, and 6.7% (n = 153) by Basic Life Support EMS. Of the PHP patients, 69.1% received PHP on scene, 59.9% received PHP in route, and 29.0% received PHP both on scene and in route. Initial scene vitals differed between groups, but initial emergency department vitals did not. Receipt of ≥1 PHP increased mortality odds (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.01-1.83; p = 0.04). Logistic regression showed increased mortality with each PHP, whether on scene or during transport. Subset analysis of specific PHP revealed that intubation (OR, 10.76; 95% CI, 4.02-28.78; p < 0.001), C-spine immobilization (OR, 5.80; 95% CI, 1.85-18.26; p < 0.01), and pleural decompression (OR, 3.70; 95% CI, 1.33-10.28; p = 0.01) had the highest odds of mortality after adjusting for multiple variables. CONCLUSION Prehospital procedures in penetrating trauma patients impart no survival advantage and may be harmful in urban settings, even when performed during transport. Therefore, PHP should be forgone in lieu of immediate transport to improve patient outcomes. LEVEL OF EVIDENCE Prognostic, level III.
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Association between Mode of Transportation and Survival in Adult Trauma Patients with Blunt Injuries: Matched Cohort Study between Police and Ground Ambulance Transport. Prehosp Disaster Med 2021; 36:431-439. [PMID: 34078515 DOI: 10.1017/s1049023x21000510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Early police transport (PT) of penetrating trauma patients has the potential to improve survival rates for trauma patients. There are no well-established guidelines for the transport of blunt trauma patients by PT currently. STUDY OBJECTIVE This study examines the association between the survival rate of blunt trauma patients and the transport modality (police versus ground ambulance). METHODS A retrospective, matched cohort study was conducted using the National Trauma Data Bank (NTDB). All blunt trauma patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by ground Emergency Medical Services (EMS) for analysis. Descriptive analysis was carried out. This was followed by comparing all patients' characteristics and their survival rates in terms of the mode of transportation. RESULTS Out of the 2,469 patients with blunt injuries, EMS transported 1,846 patients and police transported 623 patients. Most patients were 16-64 years of age (86.2%) with a male predominance (82.5%). Fall (38.4%) was the most common mechanism of injury with majority of injuries involving the head and neck body part (64.8%). Fractures were the most common nature of injury (62.1%). The overall survival rate of adult blunt trauma patients was similar for both methods of transportation (99.2%; P = 1.000). CONCLUSION In this study, adult blunt trauma patients transported by police had similar outcomes to those transported by EMS. As such, PT in trauma should be encouraged and protocolized to improve resource utilization and outcomes further.
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Maddry JK, Arana AA, Mora AG, Perez CA, Cutright JE, Kester BM, Ng PC, Schauer SG, Bebarta VS. Advancing Prehospital Combat Casualty Evacuation: Patients Amenable to Aeromedical Evacuation via Unmanned Aerial Vehicles. Mil Med 2021; 186:e366-e372. [PMID: 33200779 DOI: 10.1093/milmed/usaa438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The U.S. military currently utilizes unmanned aerial vehicles (UAVs) for reconnaissance and attack missions; however, as combat environment technology advances, there is the increasing likelihood of UAV utilization in prehospital aeromedical evacuation. Although some combat casualties require life-saving interventions (LSIs) during medical evacuation, many do not. Our objective was to describe patients transported from the point of injury to the first level of care and characterize differences between patients who received LSIs en route and those who did not. MATERIALS AND METHODS We conducted a retrospective review of the records of traumatically injured patients evacuated between January 2011 and March 2014. We compared patient characteristics, complications, and outcomes based on whether they had an LSI performed en route (LSI vs. No LSI). We also constructed logistic regression models to determine which characteristics predict uneventful flights (no en route LSI or complications). RESULTS We examined 1,267 patient records; 47% received an LSI en route. Most patients (72%) sustained a blast injury and injuries to the extremities and head. Over 78% experienced complications en route; the LSI group had higher rates of complications compared to the No LSI group. Logistic regression showed that having a blunt injury or the highest abbreviated injury scale (AIS) severity score in the head/neck region are significant predictors of having an uneventful flight. CONCLUSION Approximately half of casualties evaluated in our study did not receive an LSI during transport and may have been transported safely by UAV. Having a blunt injury or the highest AIS severity score in the head/neck region significantly predicted an uneventful flight.
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Affiliation(s)
- Joseph K Maddry
- United States Army Institute of Surgical Research, TX 78234, USA.,Department of Emergency Medicine, Brooke Army Medical Center, TX 78234, USA.,Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Allyson A Arana
- United States Air Force En Route Care Research Center/59th MDW/ST, TX 78236, USA
| | - Alejandra G Mora
- United States Air Force En Route Care Research Center/59th MDW/ST, TX 78236, USA
| | - Crystal A Perez
- United States Air Force En Route Care Research Center/59th MDW/ST, TX 78236, USA
| | - Julie E Cutright
- United States Air Force En Route Care Research Center/59th MDW/ST, TX 78236, USA
| | - Braden M Kester
- United States Army Institute of Surgical Research, TX 78234, USA
| | - Patrick C Ng
- United States Air Force En Route Care Research Center/59th MDW/ST, TX 78236, USA.,Department of Emergency Medicine, Brooke Army Medical Center, TX 78234, USA.,Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Steven G Schauer
- United States Army Institute of Surgical Research, TX 78234, USA.,Department of Emergency Medicine, Brooke Army Medical Center, TX 78234, USA.,Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Vikhyat S Bebarta
- United States Air Force En Route Care Research Center/59th MDW/ST, TX 78236, USA.,Center for COMBAT Research, University of Colorado, Aurora, CO 80045, USA.,Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
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Elkbuli A, Rowe S, Raslan S, Ali A, Boserup B, McKenney M. An Analysis of Patients Dead on Arrival in the American College of Surgeons Trauma Quality Program Participant Use File Data Set. Am Surg 2021; 88:2374-2379. [PMID: 33877943 DOI: 10.1177/00031348211011099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Trauma patient care begins on-scene as field triage and mode of transportation are determinants of patient outcomes. This study evaluates the US national patterns of dead on arrival (DOA) among the trauma population. METHODS A cross-sectional review of the American College of Surgeons (ACS) Trauma Quality Program Participant Use File (TQP-PUF) data set (2013-2017) was performed. Trauma patients reported as DOA were stratified by ISS into low (<15), intermediate (15-24), or high (≥25) severity. Each group was then subdivided by patient demographics, mechanism, type of injury, and mode of transportation. RESULTS Of the 4 336 816 injury cases in the TQP-PUF data set, 33 199 were DOA (.77%). 77.1% (25 604/33 199) of DOAs were male. In the low-ISS group, .36% (13 272/3 639 811) were DOA; in the intermediate-ISS group, 1.2% (4868/421 994) were DOA; and in the high-ISS group, 5.5% (15 059/275 011) were DOA. Motor vehicle collisions (MVCs) (11 262) and firearms (8894) were the most common injury types, equating to 60.7% of DOAs. Falls accounted for 9.1% of all DOAs. The most common DOA age-group was 18-64 years, followed by ≥65 years. CONCLUSION DOA trauma patients are predominately adult men suffering fatal blunt force injuries most frequently via MVC. DOAs are caused by all ranges of injury severity. We recommend further development of prevention programs thereby reducing the prevalence of common traumatic injuries, notably MVC, falls, and firearms to improve survival. Future studies should also investigate the access to and distribution of trauma centers and the role of helicopter, ground, and police transport modalities and transport time on and reducing DOAs and improving trauma patient outcomes.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Scott Rowe
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Shahm Raslan
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Aleeza Ali
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Brad Boserup
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
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Neeki M, DuMontier S, Toy J, Archambeau B, Goralnick E, Pennington T, Inaba K, Hammesfahr R, Wong D, Plurad DS. Prehospital Trauma Care in Disasters and Other Mass Casualty Incidents - A Proposal for Hospital-Based Special Medical Response Teams. Cureus 2021; 13:e13657. [PMID: 33824808 PMCID: PMC8016499 DOI: 10.7759/cureus.13657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/12/2022] Open
Abstract
Current mass casualty incident (MCI) response in the United States calls for rapid deployment of first responders, such as law enforcement, fire, and emergency medical services personnel, to the incident and simultaneous activation of trauma center disaster protocols. Past investigations demonstrated that the incorporation of advanced trauma-trained physicians and paramedics into prehospital teams resulted in improved mortality during routine emergency medical care in Europe and in the combat setting. To date, limited research exists on the incorporation of advanced trauma-trained physicians and paramedics into prehospital teams for civilian MCIs. We proposed the concept of Special Medical Response Teams, which would rapidly deploy advanced trauma-trained physicians and paramedics to deliver a higher level of medical and surgical care in the prehospital setting during civilian mass casualty incidents.
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Affiliation(s)
- Michael Neeki
- Emergency Medicine, California University of Science and Medicine, Colton, USA
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | | | - Jake Toy
- Emergency Medicine, Harbor University of California Los Angeles Medical Center, Torrance, USA
| | | | | | - Troy Pennington
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Kenji Inaba
- Surgery, University of Southern California, Los Angeles, USA
| | - Rick Hammesfahr
- Tactical Emergency Support Team, Marietta Police and Fire Department, Marietta, USA
| | - David Wong
- Surgery, Arrowhead Regional Medical Center, Colton, USA
- Surgery, California University of Science and Medicine, Colton, USA
| | - David S Plurad
- Department of Surgery, Riverside Community Hospital, Riverside, USA
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Friedman JK, Mytty E, Ninokawa S, Reza T, Kaufman E, Raza S, Horwitz B, Asher J, Taghavi S, Guidry C, Duchesne J. A Tale of Two Cities: What’s Driving the Firearm Mortality Difference in Two Large Urban Centers? Am Surg 2021; 87:1400-1405. [DOI: 10.1177/0003134820945258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Per police data, the case fatality rate (CFR) of firearm assault in New Orleans (NO) over the last several years ranged between 27% and 35%, compared with 18%-22% in Philadelphia. The reasons for this disparity are unknown, and potentially reflect important system differences with broader implications for the reduction of firearm mortality. Methods A retrospective analysis of police and city-specific trauma databases between 2012 and 2017 was performed. Victims of firearm assaults within city limits were included. Univariate analysis was performed using chi-square for categorical and t-test for continuous variables. Bivariate analysis was conducted using logistic regression. Results Per police data, the CFR of firearm assault was 31% in NO and 20% in Philadelphia. However, per trauma registry data, the CFR of firearm assault was 14% in NO and 25% in Philadelphia. Patients in Philadelphia were older, had higher injury severity score, and lower blood pressure. Patients in NO had higher rates of head injury. 51% of patients in Philadelphia arrived via police compared to <1% in NO. There was no mortality difference between police and emergency medical service (EMS) transport. Longer EMS prehospital times were associated with increased mortality in NO but not Philadelphia. A much larger percentage of patients died on-scene in NO than Philadelphia. Conclusions Our findings suggest that the major driver of increased mortality following firearm assault in NO compared with Philadelphia is death prior to the arrival of first responders. Interventions that shorten prehospital time will likely have the greatest impact on mortality in NO. This should include the consideration of police transport.
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Affiliation(s)
| | - Elizabeth Mytty
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | | | - Tara Reza
- Tulane School of Medicine, New Orleans, LA, USA
| | | | - Shariq Raza
- University of Pennsylvania, Philadelphia, PA, USA
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Rosen DL, Travers D. Emergency department visits among patients transported by law enforcement officers. PLoS One 2021; 16:e0244679. [PMID: 33439860 PMCID: PMC7806121 DOI: 10.1371/journal.pone.0244679] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022] Open
Abstract
Law enforcement officers frequently encounter people with health conditions. We sought to estimate the rates, diagnoses, and characteristics of emergency department (ED) visits among patients transported directly by law enforcement. We analyzed statewide North Carolina Emergency Department data for adults, aged 18+ years, from 2009 to 2016. We estimated transport rates using census data; categorized primary ED diagnoses into 13 major and 8 substituent categories; compared county transport rates by rurality; and examined patient characteristics. There were 136,240 patients transported by law enforcement; annual rates increased from 186.9 (per 100,000 adult residents) in 2009 to 279.2 in 2016. Among visits, 67.7% were among men, the median age was 37 years, and 20.4% resulted in a hospital admission. Most common primary diagnoses were Mental Health Diagnoses (43.1%)-including Schizophrenia and other Psychotic Disorders (7.6%), Mood Disorders (9.7%), and Alcohol and Substance Use (10.7%)-followed by Injury and Poisoning (12.4%) and Circulatory conditions (4.1%). Involuntary commitments constituted 22% of all visits. The median transport rate in rural counties, 291.1, was 2 times that of large metro counties, 145.1. The visit rate increased by nearly 50% during the study period, with the highest rates in rural counties. Many transports were for Mental Illness and involuntary commitments. The relatively common occurrence of law enforcement transports suggests the need for greater research to understand factors influencing law enforcement transport decisions, the impact of these transports on patient health and safety, and the repercussions on patient care of a growing officer presence in EDs.
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Affiliation(s)
- David L. Rosen
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Carrboro, North Carolina, United States of America
- * E-mail:
| | - Debbie Travers
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Shjarback JA, White MD, Bishopp SA. Can police shootings be reduced by requiring officers to document when they point firearms at citizens? Inj Prev 2021; 27:508-513. [PMID: 33397795 DOI: 10.1136/injuryprev-2020-043932] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/21/2020] [Accepted: 11/27/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the impact of a novel firearm 'pointing' policy that requires officers to document when they directly point their guns at citizens. METHODS Sixteen years (2003-2018) of narrative officer-involved shooting (OIS) reports from the Dallas Police Department were qualitatively coded to explore both the total frequency and specific characteristics of OIS before and after the policy change in 2013. RESULTS χ2 tests found that the firearm pointing policy was associated with a reduction in the proportion of 'threat perception failure' shootings (ie, those where an officer mistakes an item for a gun). Auto Regressive Integrated Moving Average analysis found that the policy change was associated with a gradual, permanent reduction in total OIS; however, that impact was not immediate. CONCLUSIONS Firearm pointing policies have the potential to alter organisational behaviour, particularly in highly discretionary shootings. It is unclear whether the specific mechanisms for the changes include more accountability through constrained discretion, reduced options to handle situations once officers' guns are drawn and pointed, or an effect on officers' timing and vision during ambiguous scenarios. POLICY IMPLICATIONS Although organisational change may be a long and complex process, reductions in OIS can prevent serious injuries and death. The policy change did not lead to an increase in the proportion of officers injured during OIS incidents.
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Affiliation(s)
- John A Shjarback
- Department of Law and Justice Studies, Rowan University, Glassboro, New Jersey, USA
| | - Michael D White
- School of Criminology and Criminal Justice, Arizona State University, Phoenix, Arizona, USA
| | - Stephen A Bishopp
- Dallas Police Department, University of Texas School of Public Health - Houston (Dallas campus), Dallas, Texas, USA
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Winter E, Hynes AM, Shultz K, Holena DN, Malhotra NR, Cannon JW. Association of Police Transport With Survival Among Patients With Penetrating Trauma in Philadelphia, Pennsylvania. JAMA Netw Open 2021; 4:e2034868. [PMID: 33492375 PMCID: PMC7835719 DOI: 10.1001/jamanetworkopen.2020.34868] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Police in Philadelphia, Pennsylvania, routinely transport patients with penetrating trauma to nearby trauma centers. During the past decade, this practice has gained increased acceptance, but outcomes resulting from police transport of these patients have not been recently evaluated. OBJECTIVE To assess mortality among patients with penetrating trauma who are transported to trauma centers by police vs by emergency medical services (EMS). DESIGN, SETTING, AND PARTICIPANTS This cohort study used the Pennsylvania Trauma Outcomes Study registry and included 3313 adult patients with penetrating trauma from January 1, 2014, to December 31, 2018. Outcomes were compared between patients transported by police (n = 1970) and patients transported by EMS (n = 1343) to adult level I and II trauma centers in Philadelphia. EXPOSURES Police vs EMS transport. MAIN OUTCOMES AND MEASURES The primary end point was 24-hour mortality. Secondary end points included death at multiple other time points. After whole-cohort regression analysis, coarsened exact matching was used to control for confounding differences between groups. Matching criteria included patient age, injury mechanism and location, Injury Severity Score (ISS), presenting systolic blood pressure, and Glasgow Coma Scale score. Subgroup analysis was performed among patients with low, moderate, or high ISS. RESULTS Of the 3313 patients (median age, 29 years [interquartile range, 23-40 years]) in the study, 3013 (90.9%) were men. During the course of the study, the number of police transports increased significantly (from 328 patients in 2014 to 489 patients in 2018; P = .04), while EMS transport remained unchanged (from 246 patients in 2014 to 281 patients in 2018; P = .44). On unadjusted analysis, compared with patients transported by EMS, patients transported by police were younger (median age, 27 years [interquartile range, 22-36 years] vs 32 years [interquartile range, 24-46 years]), more often injured by a firearm (1741 of 1970 [88.4%] vs 681 of 1343 [50.7%]), and had a higher median ISS (14 [interquartile range, 9-26] vs 10 [interquartile range, 5-17]). Patients transported by police had higher mortality at 24 hours than those transported by EMS (560 of 1970 [28.4%] vs 246 of 1343 [18.3%]; odds ratio, 1.86; 95% CI, 1.57-2.21; P < .001) and at all other time points. After coarsened exact matching (870 patients in each transport cohort), there was no difference in mortality at 24 hours (210 [24.1%] vs 212 [24.4%]; odds ratio, 0.95; 95% CI, 0.59-1.52; P = .91) or at any other time point. On subgroup analysis, patients with severe injuries transported by police were less likely to be dead on arrival compared with matched patients transported by EMS (64 of 194 [33.0%] vs 79 of 194 [40.7%]; odds ratio, 0.48; 95% CI, 0.24-0.94; P = .03). CONCLUSIONS AND RELEVANCE For patients with penetrating trauma in an urban setting, 24-hour mortality was not different for those transported by police vs EMS to a trauma center. Timely transport to definitive trauma care should be emphasized over medical capability in the prehospital management of patients with penetrating trauma.
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Affiliation(s)
- Eric Winter
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Allyson M. Hynes
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kaitlyn Shultz
- The West Chester Statistical Institute, Department of Mathematics, West Chester University, West Chester, Pennsylvania
- McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia
| | - Daniel N. Holena
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Neil R. Malhotra
- McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jeremy W. Cannon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Jacoby SF, Branas CC, Holena DN, Kaufman EJ. Beyond survival: the broader consequences of prehospital transport by police for penetrating trauma. Trauma Surg Acute Care Open 2020; 5:e000541. [PMID: 33305004 PMCID: PMC7692989 DOI: 10.1136/tsaco-2020-000541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/28/2020] [Accepted: 10/25/2020] [Indexed: 11/15/2022] Open
Abstract
Background Time to definitive hemorrhage control is a primary driver of survival after penetrating injury. For these injuries, mortality outcomes after prehospital transport by police and emergency medical service (EMS) providers are comparable. In this study we identify patient and geographic predictors of police transport relative to EMS transport and describe perceptions of police transport elicited from key stakeholders. Methods This mixed methods study was conducted in Philadelphia, Pennsylvania, which has the highest rate of police transport nationally. Patient data were drawn from Pennsylvania’s trauma registry and geographic data from the US Census and American Community Survey. For all 7500 adults who presented to Philadelphia trauma centers with penetrating injuries, 2006–2015, we compared how individual and geospatial characteristics predicted the odds of police versus EMS transport. Concurrently, we conducted qualitative interviews with patients, police officers and trauma clinicians to describe their perceptions of police transport in practice. Results Patients who were Black (OR 1.50; 1.20–1.88) and Hispanic (OR 1.38; 1.05–1.82), injured by a firearm (OR 1.58; 1.19–2.10) and at night (OR 1.48; 1.30–1.69) and who presented with decreased levels of consciousness (OR 1.18; 1.02–1.37) had higher odds of police transport. Neighborhood characteristics predicting police transport included: percent of Black population (OR 1.18; 1.05–1.32), vacant housing (OR 1.40; 1.20–1.64) and fire stations (OR 1.32; 1.20–1.44). All stakeholders perceived speed as police transport’s primary advantage. For patients, disadvantages included pain and insecurity while in transport. Police identified occupational health risks. Clinicians identified occupational safety risks and the potential for police transport to complicate the workflow. Conclusions Police transport may improve prompt access to trauma care but should be implemented with consideration of the equity of access and broad stakeholder perspectives in efforts to improve outcomes, safety, and efficiency. Level of evidence Epidemiological study, level III.
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Affiliation(s)
- Sara F Jacoby
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Charles C Branas
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Daniel N Holena
- Division of Trauma, Surgical Critical Care and Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Elinore J Kaufman
- Division of Trauma, Surgical Critical Care and Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Houghton AC, Friedman JK, Smith AA, Toraih EA, Flanagan MR, Schroll RW, Guidry C, McGrew PR, Fakhry SM, Duchesne JC. Zero Preventable Deaths by 2020: Analysis of Prehospital and Emergency Department Deaths Following Penetrating Trauma Stratified by Anatomic Location. Am Surg 2020; 87:784-789. [PMID: 33190520 DOI: 10.1177/0003134820945251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Preventable deaths following trauma are high and unchanged over the last two decades. The objective of this study was to describe the location of death in patients with penetrating trauma, stratified by anatomic location of injury, in order to better tailor our approach to reducing preventable deaths from trauma. METHODS This retrospective analysis of a prospectively maintained trauma registry included consecutive adult trauma activations with penetrating trauma at a level 1 trauma center between 07/2012 and 03/2018. Injuries were categorized as extremity, junctional, and torso. Head and neck injuries were excluded. Patients injured in >1 defined location were categorized as "multiple." Location of death was defined as on-scene, emergency department (ED), or hospital. Two-sided χ2 tests were used to compare groups. Multivariate analysis was performed using logistic regression. RESULTS A total of 1024 patients were included with an overall case fatality rate (CFR) of 7.8%. The CFR following extremity injury (3.0%) was significantly lower than all other injury sites (P = .02).There were no significant differences in CFR for junctional (10.4%), torso (8.3%), or multiple injuries (9.6%). Forty percent of fatalities following junctional injury occurred on-scene and an additional 20% occurred in the ED. DISCUSSION To our knowledge, this is the first study to describe location of death stratified by anatomic location of injury. There was no difference in the CFRs of junctional and torso injuries, and a large proportion of deaths occurred prior to reaching the hospital or in the trauma bay. These findings support reevaluating the classical algorithms and care pathways for patients with proximal penetrating trauma.
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Affiliation(s)
| | | | - Alison A Smith
- 5783 Tulane University School of Medicine, New Orleans, LA, USA
| | - Eman A Toraih
- 5783 Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | - Chrissy Guidry
- 5783 Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Samir M Fakhry
- Medical University of South Carolina, Charleston, SC, USA
| | - Juan C Duchesne
- 5783 Tulane University School of Medicine, New Orleans, LA, USA
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Factors Associated with Survival in Adult Trauma Patients Transported to US Trauma Centers by Police. Prehosp Disaster Med 2020; 36:58-66. [PMID: 33138881 DOI: 10.1017/s1049023x20001314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Police units often reach the trauma scene before Emergency Medical Services (EMS). Initiatives aiming at delivering early basic trauma care by non-medical providers including police personnel are on the rise. This study describes characteristics of trauma patients transported by police to US hospitals and identifies factors associated with survival in this patient population. METHODS Using the 2015 National Trauma Data Bank (NTDB), an observational study was conducted of adult trauma patients who were transported by police. After describing the study population, the factors associated with survival to hospital discharge were evaluated using a multivariate analysis. RESULTS A total of 2,394 patients were included in the study. Patients had a median age of 34.0 years (interquartile range [IQR]: 25-48) and most were males (84.5%). Blunt trauma mechanism (59.4%) was more common than penetrating trauma (29.4%). Factors associated with improved survival included: comorbidity (odds ratio [OR] = 2.92; 95% CI, 1.33-6.40); use of drugs (OR = 2.91; 95% CI, 1.07-7.92); cut/pierce (OR = 11.07; 95% CI, 2.10-58.43); motor vehicle traffic (MVT) mechanism (OR = 6.56; 95% CI, 1.60-26.98); trauma resulting in fractures (OR = 3.03; 95% CI, 1.38-6.64); and private/commercial insurance (OR = 3.41; 95% CI, 1.10-10.55). CONCLUSION In this study population, a relatively high survival rate was noted (93.5%). Police transport of patients with blunt trauma was unexpectedly more common. Factors associated with survival to hospital discharge were identified. These factors can be used to implement more standardized and protocol-driven risk stratification tools of trauma patients on scene to improve police involvement in trauma patient transport.
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Nasser AAH, Khouli Y. The Impact of Prehospital Transport Mode on Mortality of Penetrating Trauma Patients. Air Med J 2020; 39:502-505. [PMID: 33228903 DOI: 10.1016/j.amj.2020.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/10/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The optimal mode of transport of trauma patients from the scene to the hospital remains unknown. We aimed to study the impact of different prehospital modes of transport of penetrating trauma patients on hospital mortality. METHODS Using the Trauma Quality Improvement Program 2010 to 2016 database, we identified all adults with a penetrating injury. Univariate then multivariable logistic regression analyses were performed to study the correlation between the mode of transport and in-hospital mortality, adjusting for several covariates. RESULTS A total of 92,427 subjects were included. The overall mean transport time for patients transported by a ground ambulance, helicopter, fixed wing ambulance, and police/private vehicle were 32.2, 61.2, 68.9, and 28.2 minutes, respectively. Multivariable analyses revealed that compared with ground ambulance, helicopter transport was associated with a 34% decrease in the odds of mortality (odds ratio = 0.66, P < .0001), whereas police transport and private vehicle transport were associated with a 52% decrease in the odds of mortality (odds ratio = 0.48, P < .0001). CONCLUSION Helicopter, police, and private vehicle transports are associated with a decreased odds of mortality compared with ground ambulance. Further research should examine the variation in levels of care within different modes of prehospital transport.
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Affiliation(s)
- Ahmed A H Nasser
- Trauma and Orthopaedics Department, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, United Kingdom.
| | - Yousef Khouli
- General Surgery Department, Broomfield Hospital, Mid Essex Hospitals NHS Trust, Broomfield, United Kingdom
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Nasser AAH. Most of the Variation in Prehospital Scene Time Is Not Related to Patient Factors, Injury Characteristics, or Geography. Air Med J 2020; 39:374-379. [PMID: 33012475 DOI: 10.1016/j.amj.2020.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/09/2020] [Accepted: 05/25/2020] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The time spent on scene by emergency medical services remains highly variable. We sought to investigate how much of the prehospital scene time variation in penetrating trauma patients could be explained by prehospital factors. METHODS Using the 2010 to 2016 Trauma Quality and Improvement database, all adult penetrating trauma patients were included. The prehospital scene time was defined as the time from emergency medical service scene arrival to departure. Using all Trauma Quality and Improvement database variables including patient, injury (eg, Injury Severity Score), geography, and logistical (eg, transport mode) factors, multivariable linear regression models were created to predict the prehospital scene time. The prehospital scene time was treated as a continuous variable, and the degree to which the models could explain the variation in scene time was measured using the coefficient of determination (R). RESULTS A total of 45,560 patients were included. The median prehospital scene time was 6 minutes (interquartile range, 3-10 minutes). The R for factors in the multivariable regression model was 0.06, suggesting that 94% of the prehospital scene time variation cannot be explained by the wide range of prehospital factors. CONCLUSION Most of the variation in prehospital scene time cannot be explained by injury characteristics. The variation may be caused by logistical delays or system-related factors.
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Affiliation(s)
- Ahmed A H Nasser
- Trauma and Orthopaedics Department, West Middlesex University Hospital, Isleworth, UK.
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FAST Performance in a Stationary versus In-Motion Military Ambulance Utilizing Handheld Ultrasound: A Randomized Controlled Study. Prehosp Disaster Med 2020; 35:632-637. [PMID: 32843108 DOI: 10.1017/s1049023x20001028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE On-scene prehospital conditions and patient instability may warrant a during-transport ultrasound (US) exam. The objective of this study was to assess the effect of ambulance turbulence on the performance of the Focused Assessment with Sonography in Trauma (FAST) with a handheld US device. METHODS This was a randomized controlled trial in which participants were randomized to perform a FAST in either a stationary or an in-motion military ambulance. Participants were physicians and physician assistants (PAs) with previous FAST training. All exams were performed on an US phantom model. The primary outcome was FAST completion time, reported as a mean, in seconds. Secondary outcomes included image acquisition score (range of 0-24, reported as a mean), diagnostic accuracy (reported as sensitivity and specificity), and a post-participation survey with five-item Likert-type scales. RESULTS Twenty-seven participants performed 27 FASTs, 14 in the stationary ambulance and 13 in the in-motion ambulance. All participants obtained the four requisite views of the FAST. A significant difference was detected in image acquisition scores in favor of the stationary ambulance group (19.4 versus 16.7 [95% CI for difference, 0.9-4.4]; P <.01). Significant differences in survey items between groups were related to obtaining and maintaining US images and the exam conditions. There was not a difference in FAST completion time between groups (98.5 seconds versus 78.7 seconds [95% CI for difference, -13.5 seconds to 53.1 seconds]; P = .23). Sensitivity and specificity of FAST in the stationary ambulance was 85.7% (95% CI, 67.3%-96.0%) and 96.4% (95% CI, 81.7%-99.9%) versus 96.2% (95% CI, 80.4%-99.9%) and 100.0% (95% CI, 86.8%-100.0%) in the in-motion ambulance group (P = .21). CONCLUSION Vehicular motion did not affect FAST completion time and diagnostic accuracy; however, it did reduce FAST image acquisition scores. The results suggest timely and diagnostically accurate FASTs may be completed by experienced sonographers during moderate levels of ambulance turbulence. Further investigation assessing the utility and limitations of newer handheld US devices in various prehospital conditions is warranted.
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Nasser AAH, Nederpelt C, El Hechi M, Mendoza A, Saillant N, Fagenholz P, Velmahos G, Kaafarani HMA. Every minute counts: The impact of pre-hospital response time and scene time on mortality of penetrating trauma patients. Am J Surg 2020; 220:240-244. [PMID: 31761299 DOI: 10.1016/j.amjsurg.2019.11.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/02/2019] [Accepted: 11/11/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prompt surgical control of hemorrhage is crucial in penetrating trauma patients. We aimed to study the impact of prehospital response time (PreRespT) and scene time (SceneT) on hospital mortality. METHODS Using the Trauma Quality Improvement Program (TQIP) 2010-2016 database, we identified all adults with penetrating injury. We defined PreRespT as time from EMS dispatch to scene arrival, and SceneT as time spent on scene. Univariate then multivariable logistic regression analyses were performed to study the independent correlation between PreRespT and SceneT on hospital mortality, adjusting for several covariates. RESULTS Out of a total of 1,403,470 patients, 43,467 patients were included. Multivariable analyses suggested that: 1) every minute increase in PreRespT independently correlates with a 2% increase in mortality (OR 1.02, p < 0.0001), and 2) every minute increase in SceneT independently correlates with a 1% increase in mortality (OR 1.01, p = 0.001). CONCLUSION In the penetrating injury trauma patient, PreRespT and SceneT independently correlate with hospital mortality. This data suggests that a faster PreRespT and a "scoop and run" strategy may be more beneficial in this population.
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Affiliation(s)
- Ahmed A H Nasser
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Charlie Nederpelt
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Majed El Hechi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - April Mendoza
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Fagenholz
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Use of ShotSpotter detection technology decreases prehospital time for patients sustaining gunshot wounds. J Trauma Acute Care Surg 2020; 87:1253-1259. [PMID: 31425474 DOI: 10.1097/ta.0000000000002483] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Shorter prehospital time in patients sustaining penetrating trauma has been shown to be associated with improved survival. Literature has also demonstrated that police transport (vs. Emergency Medical Services [EMS]) shortens transport times to a trauma center. The purpose of this study was to determine if ShotSpotter, which triangulates the location of gunshots and alerts police, expedited dispatch and transport of injured victims to the trauma center. METHODS All shootings which occurred in Camden, NJ, from 2010 to 2018 were reviewed. Demographic, geographic, response time, transport time, and field intervention data were collected from medical and police records. We compared shootings where the ShotSpotter was activated versus shootings where ShotSpotter was not activated. Incidents, which did not occur in Camden or where complete data were not available, were excluded as were patients not transported by police or EMS. RESULTS There were 627 shootings during the study period which met inclusion criteria with 190 (30%) activating the ShotSpotter system. Victims involved in shootings with ShotSpotter activation were more severely injured, more likely to be transported by police, less likely to undergo trauma bay resuscitative measures, and more likely to receive blood products. Mortality, when adjusted for distance, Trauma, and Injury Severity Score, Injury Severity Score, and shock index, was not significantly different between ShotSpotter and non-ShotSpotter incidents. ShotSpotter activation significantly reduced both the response time as well as transport time for both police and EMS (all p < 0.05). CONCLUSION The activation of the ShotSpotter technology increased the likelihood of police transport of gunshot victims. Furthermore, the use of this technology resulted in shorter response times as well as transport times for both police and EMS. This technology may be beneficial in enhancing the care of victims of penetrating trauma. LEVEL OF EVIDENCE Therapeutic/Care management, level III.
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Comparison of the causes of death and wounding patterns in urban firearm-related violence and civilian public mass shooting events. J Trauma Acute Care Surg 2020; 88:310-313. [PMID: 31389914 DOI: 10.1097/ta.0000000000002470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are no reports comparing wounding pattern in urban and public mass shooting events (CPMS). Because CPMS receive greater media coverage, there is a connation that the nature of wounding is more grave than daily urban gun violence. We hypothesize that the mechanism of death following urban gunshot wounds (GSWs) is the same as has been reported following CPMS. METHODS Autopsy reports of all firearm-related deaths in Washington, DC were reviewed from January 1, 2016, to December 31, 2017. Demographic data, firearm type, number and anatomic location of GSWs, and organ(s) injured were abstracted. The organ injury resulting in death was noted. The results were compared with a previously published study of 19 CPMS events involving 213 victims. RESULTS One hundred eighty-six urban autopsy reports were reviewed. There were 171 (92%) homicides and 13 (7%) suicides. Handguns were implicated in 180 (97%) events. One hundred eight (59%) gunshots were to the chest/upper back, 85 (46%) to the head, 77 (42%) to an extremity, and 71 (38%) to the abdomen/lower back. The leading mechanisms of death in both urban firearm violence and CPMS were injury to the brain, lung parenchyma, and heart. Fatal brain injury was more common in CPMS events as compared with urban events involving a handgun. CONCLUSION There is little difference in wounding pattern between urban and CPMS firearm events. Based on the organs injured, rapid point of wounding care and transport to a trauma center remain the best options for mitigating death following all GSW events. LEVEL OF EVIDENCE Epidemiological, level IV.
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Frisby JC, Kim TWB, Schultz EM, Adeyemo A, Lo KW, Hazelton JP, Miller LS. Novel policing techniques decrease gun-violence and the cost to the healthcare system. Prev Med Rep 2019; 16:100995. [PMID: 31763160 PMCID: PMC6861592 DOI: 10.1016/j.pmedr.2019.100995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/23/2019] [Accepted: 09/19/2019] [Indexed: 11/16/2022] Open
Abstract
The objective was to investigate the effects of novel policing techniques on hospital-observed incidence, healthcare utilization, mortality and costs associated with gun violence, from the perspective of a level-1 trauma center. An eight-year retrospective review evaluating the clinical and financial effects of gunshot wound (GSW) encounters between January 1st, 2010 and December 31st, 2017. Individuals who presented to the emergency department (Level-1 trauma center in Camden, NJ) between January 1, 2010 and December 31, 2017 with GSW (995 encounters) were included; however, patients with incomplete financial or medical record data were excluded (55 encounters). Patients were subdivided into two cohorts: before and after changes in policing tactics (May 1st, 2013). 940 total firearm-related encounters were included in the study. Following the policing changes, the hospital-observed quarterly incidence of GSW encounters decreased by 22% post-policing changes, 44.3 to 34.6 (p = 0.038). Average quarterly days spent in-house for GSW treatment decreased 220.7 to 151.3 (31%) days. Hospital observed mortality increased from 13.5% of presentations to 17.3% of presentations (p = 0.106). Total cost savings associated with the policing change was roughly $254,000 per quarter (p = 0.023). In areas susceptible to high rates of gun violence, similar novel policing tactics could significantly decrease hospital-observed incidence, costs and healthcare utilization demanded by firearm-related injury.
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Affiliation(s)
- Justin C Frisby
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States.,Thomas Jefferson University, College of Population Health, 1020 Walnut St., Philadelphia, PA 19107, United States
| | - Tae Won B Kim
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States
| | - Emily M Schultz
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States
| | - Adeshina Adeyemo
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States.,Penn State Milton S. Hershey Medical Center, 500 University Drive, Hersey, PA 17033, United States
| | - Karina W Lo
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States.,Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, United States
| | - Joshua P Hazelton
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States
| | - Lawrence S Miller
- Cooper Bone & Joint Institute, Cooper University Hospital, 3 Cooper Plaza, Camden, NJ 08103, United States
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Lukumay GG, Outwater AH, Mkoka DA, Ndile ML, Saveman BI. Traffic police officers' experience of post-crash care to road traffic injury victims: a qualitative study in Tanzania". BMC Emerg Med 2019; 19:51. [PMID: 31601171 PMCID: PMC6788084 DOI: 10.1186/s12873-019-0274-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/30/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Recently, road traffic injuries (RTIs) have become a major health problem affecting health systems in many low- and middle-income countries. Regardless of whether an ambulance is available for evacuation, police officers have been shown to arrive at the crash scene first, becoming, in effect, the first responders to RTI victims. Therefore, the study aimed to explore the experiences of traffic police officers in regard to the provision of care to RTI victims in the prehospital environment, including the role of traffic police upon arriving at the crash scene, the challenges they face, and their opinions about how to improve care to RTI victims. METHOD The study used a qualitative approach in which data were obtained from 10 individual interviews and three focus group discussions. There were 41 participants, 27 of them were male and 14 were female. About half (48.7%) of the study participants were aged between 30 to 39 years. Qualitative content analysis was used to analyse all the materials. RESULTS Three themes emerged from the analysis. The theme "Maintain safety while saving injured victims' lives and facilitating access to a health facility" was comprised of safety, sorting, initial help, and assisting access to hospital care. "Overwhelmed working with limited resources and support" included limited care and transport resources, police fatigue, and little or no support. "Improving supportive system and empowering frontline personnel" included the need for an emergency care system, availability of resources and an emergency medical support system, and training for police and drivers regarding victims' first-aid care, and road safety. CONCLUSION The study findings characterize an environment in which the police first responders have no knowledge or skills and no equipment and supplies to provide care to RTI victims at the scene before rushing them to definitive care. The results suggest a favorable climate for training and equipping officers so that they can deliver competent postcrash care at the scene while emergency medical services are yet to be established. However, more research will be needed to determine the efficacy of such training and its acceptability in the Tanzanian context.
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Affiliation(s)
- Gift G Lukumay
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
| | - Anne H Outwater
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Dickson A Mkoka
- Department of Clinical Nursing, MUHAS, Dar es Salaam, Tanzania
| | - Menti L Ndile
- Department of Clinical Nursing, MUHAS, Dar es Salaam, Tanzania
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Wandling MW, Nathens AB, Shapiro MB, Haut ER. Association of Prehospital Mode of Transport With Mortality in Penetrating Trauma: A Trauma System-Level Assessment of Private Vehicle Transportation vs Ground Emergency Medical Services. JAMA Surg 2019; 153:107-113. [PMID: 28975247 DOI: 10.1001/jamasurg.2017.3601] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Time to definitive care following injury is important to the outcomes of trauma patients. Prehospital trauma care is provided based on policies developed by individual trauma systems and is an important component of the care of injured patients. Given a paucity of systems-level trauma research, considerable variability exists in prehospital care policies across trauma systems, potentially affecting patient outcomes. Objective To evaluate whether private vehicle prehospital transport confers a survival advantage vs ground emergency medical services (EMS) transport following penetrating injuries in urban trauma systems. Design, Setting, and Participants Retrospective cohort study of data included in the National Trauma Data Bank from January 1, 2010, through December 31, 2012, comprising 298 level 1 and level 2 trauma centers that contribute data to the National Trauma Data Bank that are located within the 100 most populous metropolitan areas in the United States. Of 2 329 446 patients assessed for eligibility, 103 029 were included in this study. All patients were 16 years or older, had a gunshot wound or stab wound, and were transported by ground EMS or private vehicle. Main Outcome and Measure In-hospital mortality. Results Of the 2 329 446 records assessed for eligibility, 103 029 individuals at 298 urban level 1 and level 2 trauma centers were included in the analysis. The study population was predominantly male (87.6%), with a mean age of 32.3 years. Among those included, 47.9% were black, 26.3% were white, and 18.4% were Hispanic. Following risk adjustment, individuals with penetrating injuries transported by private vehicle were less likely to die than patients transported by ground EMS (odds ratio [OR], 0.38; 95% CI, 0.31-0.47). This association remained statistically significant on stratified analysis of the gunshot wound (OR, 0.45; 95% CI, 0.36-0.56) and stab wound (OR, 0.32; 95% CI, 0.20-0.52) subgroups. Conclusions and Relevance Private vehicle transport is associated with a significantly lower likelihood of death when compared with ground EMS transport for individuals with gunshot wounds and stab wounds in urban US trauma systems. System-level evidence such as this can be a valuable tool for those responsible for developing and implementing policies at the trauma system level.
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Affiliation(s)
- Michael W Wandling
- Division of Trauma and Critical Care, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Surgical Outcomes and Quality Improvement Center, Department of Surgery, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois
| | - Avery B Nathens
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.,Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael B Shapiro
- Division of Trauma and Critical Care, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elliott R Haut
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Emergency Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.,The Johns Hopkins University School of Public Health, Baltimore, Maryland
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Circo GM. Distance to trauma centres among gunshot wound victims: identifying trauma ‘deserts’ and ‘oases’ in Detroit. Inj Prev 2019; 25:i39-i43. [DOI: 10.1136/injuryprev-2019-043180] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 11/03/2022]
Abstract
IntroductionAmong the factors related to survival among individuals with gun shot wounds (GSW) is distance to trauma care. Relatively little is known about neighbourhood-level patterns of GSW mortality and distance to hospitals with trauma centres. This study focuses on distance to the nearest trauma centre as a correlate of survival among GSW victims.MethodsFatal and non-fatal shooting incident data for 9,205 victimisation in Detroit, Michigan between 2011 and 2017 were collected. A Bayesian conditional autoregressive model was utilised to estimate block-group levels of GSW mortality. Clustering techniques were used to identify spatially proximate neighbourhoods with higher or lower than expected rates of GSW mortality.ResultsDistance to the nearest trauma centre was associated with a 22% increase in fatal outcomes, per-mile (OR 1.22, 95% CI, 1.06 to 1.40) after adjusting for block-group level covariates. A Getis-Ord Gi* analysis identified 91 block groups with lower than expected rates of GSW mortality and 12 block-groups with higher than expected rates.ConclusionDistance to the nearest trauma centre is associated with GSW victim survival. Clusters of block-groups with below-average GSW mortality were observed within close proximity of major trauma centres in Detroit. Improving speed and access to trauma care may play a role in reducing GSW mortality.
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Affiliation(s)
- Elizabeth Dauer
- Department of Surgery, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Zone C, 4th Floor, Philadelphia, PA 19140, USA.
| | - Amy Goldberg
- Department of Surgery, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Zone C, 4th Floor, Philadelphia, PA 19140, USA
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A review of the landscape: Challenges and gaps in trauma response to civilian high threat mass casualty incidents. J Trauma Acute Care Surg 2019; 84:S21-S27. [PMID: 29370053 DOI: 10.1097/ta.0000000000001811] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The ultimate goal of the emergency response and trauma system is to reduce potentially preventable death from trauma. Tremendous advances in trauma care emerged from the past 15 years of United States' combat engagements around the globe. Unfortunately, combat and insurgency tactics have also metastasized to the civilian world, resulting in increasingly complex and dynamic acts of intentional mass violence. These high threat active violent incidents (AVIs) pose significant preparedness, response, and clinical care challenges to the civilian healthcare systems. Currently, there are several operational and policy gaps that limit the successful preparedness and response to AVIs and dynamic MCIs in the United States.
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Lukumay GG, Ndile ML, Outwater AH, Mkoka DA, Padyab M, Saveman BI, Backteman-Erlanson S. Provision of post-crash first aid by traffic police in Dar es Salaam, Tanzania: a cross-sectional survey. BMC Emerg Med 2018; 18:45. [PMID: 30458715 PMCID: PMC6247529 DOI: 10.1186/s12873-018-0199-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/08/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The availability of prehospital trauma care is an important means of reducing serious injuries and fatalities associated with road traffic injuries (RTIs). Lay responders such as traffic police play an important role in the provision of prehospital trauma care to RTI victims, especially where there is no established prehospital care system. Therefore, the objective of the present study was to investigate knowledge, self-reported practice, and attitudes toward post-crash first aid among traffic police officers in Tanzania. METHOD A cross-sectional survey was conducted in Dar es Salaam, Tanzania between July-September 2017 to investigate knowledge, self-reported practice and attitude among traffic police officers during provision of post-crash care. We used simple random technique to recruit 340 traffic police officers, self -administered questionnaires were used to collect data. The researchers used descriptive statistics and Pearson's chi-square tests to analyze the data. RESULTS A total of 340 traffic police officers were surveyed. Nearly two thirds (65.3%) reported having had post-crash first aid on-the job training; a slightly larger proportion (70.9%) reported that they had cared for RTI victims in the previous year. The survey responses showed that, generally, traffic police officers' level of knowledge about post-crash first aid to RTI victims was low-about 3% of the surveyed officers possessed knowledge at a level considered good. Also, there was a statistically significant correlation between higher educational attainment and greater knowledgeability (p = 0.015). Almost all of the officers (96%) had a positive attitude toward providing post-crash first aid to RTI victims. CONCLUSIONS Improved training of Tanzania traffic police officers, by means of an updated post-crash first aid curriculum and updated resources is recommended. Also, user-friendly post-crash first aid leaflets should be provided to traffic police for their reference.
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Affiliation(s)
- Gift G. Lukumay
- Department of Community Health Nursing, Muhimbili University of Heath and Allied Sciences, Dar es Salaam, Tanzania
| | - Menti L. Ndile
- Department of Community Health Nursing, Muhimbili University of Heath and Allied Sciences, Dar es Salaam, Tanzania
| | - Anne H. Outwater
- Department of Community Health Nursing, Muhimbili University of Heath and Allied Sciences, Dar es Salaam, Tanzania
| | - Dickson A. Mkoka
- Department of Community Health Nursing, Muhimbili University of Heath and Allied Sciences, Dar es Salaam, Tanzania
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Möller A, Hunter L, Kurland L, Lahri S, van Hoving DJ. The association between hospital arrival time, transport method, prehospital time intervals, and in-hospital mortality in trauma patients presenting to Khayelitsha Hospital, Cape Town. Afr J Emerg Med 2018; 8:89-94. [PMID: 30456155 PMCID: PMC6223589 DOI: 10.1016/j.afjem.2018.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/22/2017] [Accepted: 01/21/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Trauma is a leading cause of unnatural death and disability in South Africa. The aim of the study was to determine whether method of transport, hospital arrival time or prehospital transport time intervals were associated with in-hospital mortality among trauma patients presenting to Khayelitsha Hospital, a district-level hospital on the outskirts of Cape Town, South Africa. METHODS The Khayelitsha Hospital Emergency Centre database was retrospectively analysed for trauma-related patients presenting to the resuscitation area between 1 November 2014 and 30 April 2015. Missing data and additional variables were collected by means of a chart review. Eligible patients' folders were scrutinised for hospital arrival time, transport time intervals, transport method and in-hospital mortality. Descriptive statistics were presented for all variables. Categorical data were analysed using the Fisher's Exact test and Chi-square, continuous data by logistic regression and the Mann Whitney test. A confidence interval of 95% was used to describe variance and a p-value of <0.05 was deemed significant. RESULTS The majority of patients were 19-44 year old males (n = 427, 80.3%) and penetrating trauma the most frequent mechanism of injury (n = 343, 64.5%). In total, 258 (48.5%) patients arrived with their own transport, 254 (47.7%) by ambulance and 20 (3.8%) by the police service. The arrival of trauma patients peaked during the weekend, and was especially noticeable between midnight and six a.m. In-hospital mortality (n = 18, 3.4%) was not significantly affected by transport method (p = 0.26), hospital arrival time (p = 0.22) or prehospital transport time intervals (all p-values >0.09). DISCUSSION Method of transport, hospital arrival time and prehospital transport time intervals did not have a substantially measurable effect on in-hospital mortality. More studies with larger samples are suggested due to the small event rate.
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Affiliation(s)
- Anders Möller
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden
| | - Luke Hunter
- Khayelitsha Hospital, Private Bag X6, Khayelitsha, 7784 Cape Town, South Africa
| | - Lisa Kurland
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden
- Department of Medical Sciences, Örebro University, School of Medical Sciences, Campus USÖ, S-701 82 Örebro, Sweden
- Department of Emergency Medicine, Örebro University Hospital, School of Medical Sciences, Campus USÖ, S-701 82 Örebro, Sweden
| | - Sa'ad Lahri
- Khayelitsha Hospital, Private Bag X6, Khayelitsha, 7784 Cape Town, South Africa
| | - Daniël J. van Hoving
- Division of Emergency Medicine, Stellenbosch University, Private Bag X1, Matieland, 7602 Stellenbosch, Cape Town, South Africa
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Ruelas OS, Tschautscher CF, Lohse CM, Sztajnkrycer MD. Analysis of Prehospital Scene Times and Interventions on Mortality Outcomes in a National Cohort of Penetrating and Blunt Trauma Patients. PREHOSP EMERG CARE 2018; 22:691-697. [PMID: 29617208 DOI: 10.1080/10903127.2018.1448494] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Recent studies have suggested improved outcomes in victims of penetrating trauma managed with shorter prehospital times and limited interventions. The purpose of the current study was to perform an outcome analysis of patients transported following penetrating and blunt traumatic injuries. METHODS We performed a descriptive retrospective analysis of the 2014 National Emergency Medical Services Information System (NEMSIS) public release research data set for patients presenting after acute traumatic injury. RESULTS A total of 2,018,141 patient encounters met criteria, of which 3.9% were penetrating trauma. Prehospital cardiac arrest occurred in 0.5% blunt and 4.2% penetrating trauma patients. Emergency department (ED) mortality was higher in penetrating than blunt trauma patients (4.1% vs. 0.8%). Scene times were 18.1 ± 36.5 minutes for blunt and 16.0 ± 45.3 minutes for penetrating trauma. Mean scene time for blunt trauma patients who died in the ED was 24.9 ± 58.0 minutes compared with 18.8 ± 38.5 minutes for those admitted; for penetrating trauma, scene times were 17.9 ± 23.5 and 13.4 ± 11.6 minutes, respectively. Mean number of procedures performed for blunt trauma patients who died in the ED was 6.5 ± 4.3 compared with 3.1 ± 2.3 for those who survived until admission; for penetrating trauma, the numbers of procedures performed were 5.7 ± 3.4 and 2.6 ± 2.0, respectively. CONCLUSIONS Although less frequent than blunt trauma, penetrating trauma is associated with significantly higher prehospital and ED mortality. Increased scene time and number of procedures was associated with greater mortality for both blunt and penetrating trauma. Further study is required to better understand any causal relationships between prehospital times and interventions and patient outcomes.
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Bores SA, Pajerowski W, Carr BG, Holena D, Meisel ZF, Mechem CC, Band RA. The Association of Prehospital Intravenous Fluids and Mortality in Patients with Penetrating Trauma. J Emerg Med 2018; 54:487-499.e6. [PMID: 29501219 DOI: 10.1016/j.jemermed.2017.12.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 11/27/2017] [Accepted: 12/17/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND The optimal approach to prehospital care of trauma patients is controversial, and thought to require balancing advanced field interventions with rapid transport to definitive care. OBJECTIVE We sought principally to examine any association between the amount of prehospital IV fluid (IVF) administered and mortality. METHODS We conducted a retrospective cohort analysis of trauma registry data patients who sustained penetrating trauma between January 2008 and February 2011, as identified in the Pennsylvania Trauma Systems Foundation registry with corresponding prehospital records from the Philadelphia Fire Department. Analyses were conducted with logistic regression models and instrumental variable analysis, adjusted for injury severity using scene vital signs before the intervention was delivered. RESULTS There were 1966 patients identified. Overall mortality was 22.60%. Approximately two-thirds received fluids and one-third did not. Both cohorts had similar Trauma and Injury Severity Score-predicted mortality. Mortality was similar in those who received IVF (23.43%) and those who did not (21.30%) (p = 0.212). Patients who received IVF had longer mean scene times (10.82 min) than those who did not (9.18 min) (p < 0.0001), although call times were similar in those who received IVF (24.14 min) and those who did not (23.83 min) (p = 0.637). Adjusted analysis of 1722 patients demonstrated no benefit or harm associated with prehospital fluid (odds ratio [OR] 0.905, 95% confidence interval [CI] 0.47-1.75). Instrumental variable analysis utilizing variations in use of IVF across different Emergency Medical Services (EMS) units also found no association between the unit's percentage of patients that were provided fluids and mortality (OR 1.02, 95% CI 0.96-1.08). CONCLUSIONS We found no significant difference in mortality or EMS call time between patients who did or did not receive prehospital IVF after penetrating trauma.
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Affiliation(s)
- Sam A Bores
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - William Pajerowski
- Wharton School of Business, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brendan G Carr
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel Holena
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zachary F Meisel
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - C Crawford Mechem
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Philadelphia Fire Department, Philadelphia, Pennsylvania
| | - Roger A Band
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
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