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Factors Associated with Survival in Adult Trauma Patients Transported to US Trauma Centers by Police

Published online by Cambridge University Press:  03 November 2020

Jure M. Colnaric
Affiliation:
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon University of Ljubljana, Ljubljana, Slovenia
Rana H. Bachir
Affiliation:
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Mazen J. El Sayed*
Affiliation:
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
*
Correspondence: Mazen J. El Sayed, MD, MPH, FAAEM, FAEMS, Associate Professor of Clinical Emergency Medicine, Director of EMS & Prehospital Care, Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box - 11-0236 Riad El Solh, Beirut1107 2020Lebanon, E-mail: melsayed@aub.edu.lb

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.

Type
Original Research
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

World Health Organization. The Global Burden of Disease 2004. https://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf. Accessed April 1, 2020.Google Scholar
Rui, P, Kang, K, Ashman, JJ. National Hospital Ambulatory Medical Care Survey: 2016 emergency department summary tables. https://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2016_ed_web_tables.pdf. Accessed April 1, 2020.Google Scholar
The American Association for the Surgery of Trauma. Trauma Facts 2008. https://www.aast.org/trauma-facts. Accessed April 1, 2020.Google Scholar
Branas, CC, Sing, RF, Davidson, SJ. Urban trauma transport of assaulted patients using nonmedical personnel. Acad Emerg Med. 1995;2(6):486-493.CrossRefGoogle ScholarPubMed
Cornwell, EE 3rd, Belzberg, H, Hennigan, K, et al. Emergency Medical Services (EMS) vs non-EMS transport of critically injured patients: a prospective evaluation. Arch Surg. 2000;135(3):315-319.CrossRefGoogle ScholarPubMed
Jacobs, LM Jr. Joint committee to create a national policy to enhance survivability from intentional mass-casualty and active shooter events. The Hartford Consensus III: implementation of bleeding control—if you see something, do something. Bull Am Coll Surg. 2015;100(1 Suppl):40-46.Google Scholar
Band, RA, Salhi, RA, Holena, DN, Powell, E, Branas, CC, Carr, BG. Severity-adjusted mortality in trauma patients transported by police. Ann Emerg Med. 2014;63(5):608-614.CrossRefGoogle ScholarPubMed
Band, RA, Pryor, JP, Gaieski, DF, Dickinson, ET, Cummings, D, Carr, BG. Injury-adjusted mortality of patients transported by police following penetrating trauma. Acad Emerg Med. 2011;18(1):32-37.10.1111/j.1553-2712.2010.00948.xCrossRefGoogle ScholarPubMed
Wandling, MW, Nathens, AB, Shapiro, MB, Haut, ER. Police transport versus ground EMS: a trauma system-level evaluation of prehospital care policies and their effect on clinical outcomes. J Trauma Acute Care Surg. 2016;81(5):931-935.CrossRefGoogle ScholarPubMed
American College of Surgeons. Inspiring Quality: Highest Standards, Better Outcomes. Annual Call for Data: National Trauma Data Bank (NTDB). https://www.facs.org/quality-programs/trauma/tqp/center-programs/ntdb. Accessed January 20, 2020.Google Scholar
Maher, Z, Goldberg, AJ, Lewis, K. Welcoming the Philadelphia immediate transport in penetrating trauma trial! https://tashq.org/wp-content/uploads/ 2016/11/Oct2016ZMaherEditorial.pdf. Published 2016. Accessed April 5, 2020.Google Scholar
Taylor, BN, Rasnake, N, McNutt, K, Mcknight, CL, Daley, BJ. Rapid ground transport of trauma patients: a moderate distance from trauma center improves survival. J Surg Res. 2018;232:318-324.CrossRefGoogle ScholarPubMed
Zafar, SN, Haider, AH, Stevens, KA, et al. Increased mortality associated with EMS transport of gunshot wound victims when compared to private vehicle transport. Injury. 2014;45(9):1320-1326.CrossRefGoogle ScholarPubMed
Kaufman, EJ, Jacoby, SF, Sharoky, CE, et al. Patient characteristics and temporal trends in police transport of blunt trauma patients: a multicenter retrospective cohort study. Prehosp Emerg Care. 2017;21(6):715-721.CrossRefGoogle ScholarPubMed
Philadelphia Police Department. Directive 3.14. https://www.phillypolice.com/assets/directives/D3.14-HospitalCases.pdf. Issued: 1996. Updated: 2001. Accessed April 1, 2020.Google Scholar
Chicago Police Department. Squadrol Operating Procedures. http://directives.chicagopolice.org/directives/data/a7a57be2-12b53b0f-33812-b53e-d78b693bdacbb396.html. Published 2017. Accessed April 1, 2020.Google Scholar
Seattle Police Department Manual. 16.130 - Providing Medical Aid. https://www.seattle.gov/police-manual/title-16---patrol-operations/16130---providing-medical-aid. Published 2020. Accessed April 5, 2020.Google Scholar
Sasser, SM, Hunt, RC, Faul, M, et al. Centers for Disease Control and Prevention (CDC) Guidelines for field triage of injured patients: recommendations of the national expert panel on field triage, 2011. MMWR Recomm Rep. 2012;61(RR-1):1-20.Google Scholar
Wardle, TD. Co-morbid factors in trauma patients. Br Med Bull. 1999;55(4):744-756.CrossRefGoogle ScholarPubMed
Morris, JA Jr, MacKenzie, EJ, Damiano, AM, Bass, SM. Mortality in trauma patients: the interaction between host factors and severity. J Trauma. 1990;30 (12):1476-1482.CrossRefGoogle ScholarPubMed
Wutzler, S, Maegele, M, Marzi, I, Spanholtz, T, Wafaisade, A, Lefering, R. Association of pre-existing medical conditions with in-hospital mortality in multiple- trauma patients. J Am Coll Surg. 2009;209(1):75-81.CrossRefGoogle Scholar
Melton, LJ 3rd, Achenbach, SJ, Atkinson, EJ, Therneau, TM, Amin, S. Long-term mortality following fractures at different skeletal sites: a population-based cohort study. Osteoporos Int. 2013;24(5):1689-1696.CrossRefGoogle ScholarPubMed
Browner, WS, Pressman, AR, Nevitt, MC, Cummings, SR. Mortality following fractures in older women. The study of osteoporotic fractures. Arch Intern Med. 1996;156(14):1521-1525.CrossRefGoogle Scholar
Tran, T, Bliuc, D, Hansen, L, et al. Persistence of excess mortality following individual non-hip fractures: a relative survival analysis. J Clin Endocrinol Metab. 2018;103(9):3205-3214.CrossRefGoogle Scholar
Salim, A, Ottochian, M, DuBose, J, et al. Does insurance status matter at a public, Level I trauma center? J Trauma. 2010;68(1):211-216.Google Scholar
Taghavi, S, Srivastav, S, Tatum, D, et al. Did the affordable care act reach penetrating trauma patients? J Surg Res. 2020;250:112-118.CrossRefGoogle ScholarPubMed
Institute of Medicine (US) Committee on the Consequences of Uninsurance I. Care without Coverage: Too Little, Too Late. Washington, DC USA: National Academy Press; 2002.Google Scholar