Hold the phone: An ambulance might lower your chances of surviving some injuries

September 20, 2017, Johns Hopkins University School of Medicine
A new study finds that victims of gunshots and stabbings are significantly less likely to die if they're taken to the trauma center by a private vehicle than ground emergency medical services (EMS). Credit: Johns Hopkins Medicine

Victims of gunshots and stabbings are significantly less likely to die if they're taken to the trauma center by a private vehicle than ground emergency medical services (EMS), according to results of a new analysis.

A report on the study's findings, published Sept. 20 in JAMA Surgery, highlights the importance of studying the effects of transport, EMS services and other prehospital interventions by specific injury type.

"Time is truly of the essence when it comes to certain kinds of injuries and our analysis suggests that, for penetrating injuries such as knife and gun wounds, it might be better to just get to a trauma center as soon as possible in whatever way possible," says Elliott Haut, M.D., Ph.D., an associate professor of surgery and emergency medicine at the Johns Hopkins University School of Medicine and the paper's senior author.

While Haut acknowledges that more research needs to be conducted before declaring one type of transport superior to another, he says, "For certain types of injury, it might be best to call the police, Uber or a cab—however you can get to the trauma center fastest."

Typically, policies and protocols for prehospital interventions are established at a regional or statewide trauma system level, which allows first responders such as EMTs and paramedics to determine what, if any, medical procedures should be performed prior to and during transport to the hospital, says Haut. But research studies have rarely, if ever, evaluated or compared all of the effects of system-driven prehospitalization policies, leaving ideal prehospital care strategies undefined, Haut adds.

In what the researchers believe is the first effort of its kind to do that evaluation for ambulance versus private transportation, they elected to analyze the relationship between transport mode and in-hospital mortality (death in the emergency department and prior to discharge) on a city-by-city, trauma system level.

For the study, Haut and colleagues examined data from the American College of Surgeons National Trauma Data Bank, the largest available collection of United States trauma registry data. Specifically, the team examined information already gathered on 103,029 patients at least 16 years old who entered a U.S. trauma center between Jan. 1, 2010, and Dec. 31, 2012, for a gunshot or stab wound and were transported to the by ground EMS (ambulance) or private vehicle. The data were gathered from 298 level I and level II trauma centers within the 100 most populous U.S. metro areas.

Approximately 16.4 percent of all patients were transported by private vehicle. The analysis found an overall 2.2 percent mortality rate for patients transported via private vehicle, compared to 11.6 percent for ground EMS.

Gunshot victims transported by private vehicle saw a lower mortality rate (4.5 percent versus 19.3 percent), as did stab victims (0.2 percent versus 2.9 percent). When adjusting for differences in severity, patients with penetrating injuries were 62 percent less likely to die when transported by private vehicle compared to EMS.

"Unlike CPR and defibrillation for heart attacks, the type of damage done in penetrating often can't be reversed in a prehospital setting. This study supports other studies that prehospital interventions can actually result in less favorable outcomes for certain types of injuries," says Michael W. Wandling, M.D, M.S., an American College of Surgeons (ACS) Clinical Scholar in Residence, general surgery resident at the Northwestern University Feinberg School of Medicine and the study's first author.

Explore further: Spike in serious road injuries among cyclists

Related Stories

Spike in serious road injuries among cyclists

September 11, 2017
The number of Victorian cyclists being admitted to hospital with serious trauma from road crashes has more than doubled in the past nine years, according to a Monash University study.

Children injured in motor vehicle crashes fare better at level I pediatric trauma centers

May 19, 2016
Children and adolescents injured in motor vehicle accidents have better outcomes when treated at a stand-alone Level I pediatric trauma center (PTC) than at general adult trauma centers (ATC) or adult trauma centers with ...

Survival rates similar for gunshot/stabbing victims whether brought to the hospital by police or EMS

January 2, 2014
A new study from the Perelman School of Medicine at the University of Pennsylvania has found no significant difference in adjusted overall survival rates between gunshot and stabbing (so-called penetrating trauma injuries) ...

New guidance for administering hemorrhage prevention treatment

August 16, 2016
Tranexamic acid (TXA) is currently being administered to injured patients by many prehospital air and ground systems, despite a lack of evidence supporting or refuting its efficacy in preventing hemorrhage. Several studies ...

Children with suspected child abuse present to hospital late

April 26, 2017
(HealthDay)—Children with suspected child abuse (SCA) present late to the hospital, and most arrive at hospitals that are not designated pediatric-capable major trauma centers, according to a study published online April ...

Recommended for you

Cold open water plunge provides instant pain relief

February 12, 2018
A short, sharp, cold water swim may offer an alternative to strong painkillers and physiotherapy to relieve severe persistent pain after surgery, suggest doctors in the journal BMJ Case Reports.

Study spotlights risks in anesthesiologist handoffs

February 9, 2018
Most patients are totally unaware that the anesthesiologist who put them under for surgery might not be the same one who brings them out even though that 'handoff' between the two doctors has been linked to a series of negative ...

One in five older adults experience brain network weakening following knee replacement surgery

February 7, 2018
A new University of Florida study finds that 23 percent of adults age 60 and older who underwent a total knee replacement experienced a decline in activity in at least one region of the brain responsible for specific cognitive ...

New algorithm decodes spine oncology treatment

February 6, 2018
Every kind of cancer can spread to the spine, yet two physician-scientists who treat these patients describe a paucity of guidance for effectively providing care and minimizing pain.

Patients and doctors often disagree in evaluation of surgical scarring

February 1, 2018
When it comes to the physical scars surgery leaves behind, a new study shows patients and doctors often don't assess their severity the same way. Researchers from the Perelman School of Medicine at the University of Pennsylvania ...

Boosting a key protein to help bones that won't heal

February 1, 2018
When a patient breaks a bone, there's a possibility the fracture won't heal properly or quickly—even with the aid of pins, plates or a cast.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.