Philadelphia Police Begin Transporting Trauma Victims

New directive has police taking patients with penetrating injuries to nearest trauma center.


 
 

ALLISON STEELE, The Philadelphia Inquirer | | Monday, June 4, 2012


Dominique Seward heard the shots, three loud pops coming from behind as she walked toward her West Philadelphia home. Seward was six months pregnant on the night of May 24, 2011, and as she started to run, hands holding her belly, she felt a wave of fatigue, then searing pain.

The bullet ripped through her back under her shoulder blade, and lodged near her heart. When police arrived at the scene at 60th Street near Lansdowne, officers said there was no time to wait for an ambulance. With Seward bleeding heavily in the backseat of the cruiser, officers ran all the lights until they reached the Hospital of the University of Pennsylvania.

Police estimate that Seward arrived at the ER in four minutes. She was in shock and nearly unconscious.

Three surgeries, two blood transfusions, and three days later, she awoke with tubes in her chest, surrounded by family. Her son, delivered at 32 weeks by C-section, was alive.

When Seward opened her eyes, she wondered whether she was dreaming. "I thought I was dead," she said.

The race against time that officers made with Seward is commonplace for police in Philadelphia. Officers at times must make a life-or-death choice when they come across shooting victims who are rapidly losing blood: Risk watching them bleed to death in a matter of minutes, or put them in the car and drive.

Philadelphia is one of a few cities that use police transports, sometimes called "scoop and runs" by officers, or "cop drops" by doctors.

The department does not keep numbers on it, but some patrol officers estimate that they take as many as a third of the city's shooting victims to hospitals. Police in high-crime neighborhoods often arrive at scenes several minutes ahead of an ambulance. And since Philadelphia's EMS and ambulance system has long been described as overworked and stretched thin, police commanders say a police transport is an efficient choice when a shooting victim is near death.

Police also believe that without transports, the city's murder rate would be higher.

Deputy Police Commissioner Kevin Bethel has championed the policy. Besides getting some patients to hospitals faster, he said, getting victims off the street can defuse tension and lessen the chance of a retaliatory shooting.

"Is it perfect?" Bethel said. "No. Obviously, there are some times when officers don't take someone, or they wait too long. But the bottom line is that it saves lives."

Of the 674 people who were shot in Philadelphia last year, Seward's case is seen as one of the most remarkable. ER doctors don't often see shooting victims in late stages of pregnancy. The doctors who treated Seward believe the officers likely saved her life.

She was struck by a stray bullet when gunfire erupted in a neighborhood that police said has been rife with drugs and crime. For a split second after she was hit, Seward was unaware that she was hurt. She remembers feeling wetness under her fingers as she ran from the sound of gunfire, but it wasn't until she saw blood covering her hands that the pain hit her.

"You know how you put your foot in hot water all of a sudden, then take it right out because it hurts?" asked Seward. "I wanted to take my foot out of that water so bad."

On the way to the hospital, her head resting in her boyfriend's lap, Seward felt certain she was dying.

"She was very unstable when they brought her in," said Patrick Kim, director of the Trauma Program at Penn, who treated Seward. "She had a high likelihood of dying immediately."

The concept behind police transports is what doctors call "the golden hour": the period after a traumatic injury when medical care matters most. In terms of shooting injuries, it means the window in which doctors must treat the patient before brain damage or other irreversible injury occurs.

"When you're losing blood, time is short," said Brendan G. Carr, a Penn ER physician. "And time is medicine."

City police have been transporting shooting victims for more than 20 years. The practice has taken place in other cities, including Chicago and New York City, but Philadelphia may be the only city that has formalized it by including it in the guidelines for officers.

According to the directive, police must take people with serious penetrating injuries - meaning gunshot or stab wounds - to the nearest trauma center, and they are instructed not to wait for Fire Department paramedics.

So far, what research there is on transports supports the policy. Carr and Roger A. Band, both assistant professors of emergency medicine at Penn, published a 2010 paper that found that, after comparing only patients with the most serious injuries, there was no difference in the survival rate of people taken to the hospital by police vs. ambulance.

"We can show it's safe," Carr said. "Is it better? We don't know. But it's safe."

In a perfect world, an ambulance would appear at the scene of every shooting within a minute or two, Band and Carr said. But that isn't possible in Philadelphia, where there are 250,000 calls each year for emergency service.

Philadelphia's EMS system has been labeled overwhelmed and understaffed, and paramedics have repeatedly called for reform. The city has about 50 ambulances, a number that drops at night. In a 2011 audit analyzing Fire Department data, experts estimated it would take 70 ambulances to adequately cover the city. That audit also found that a third of city residents who call for ambulances wait longer than nine minutes, the widely accepted response time.

Band defined the benchmark for a good ambulance response time as between eight and 10 minutes. If officers at the scene of a bad shooting are six minutes away from the nearest trauma center, they can dramatically cut the time it will take to get a victim to the hospital - or they can wait several minutes for EMTs, who can provide lifesaving procedures as soon as they arrive.

"The debate becomes, scoop-and-run vs. stay-and-stabilize," Carr said. "How do you best spend that pre-hospital time: by providing support, or minimizing the time it takes to get the person to the hospital?"

The answer, Carr said, can be a moving target. It depends largely on how close the victim is to the nearest trauma center.

One major reason the practice is successful in Philadelphia, Band said, is that the city is dense with such facilities and that many of them - Penn, Temple, Jefferson, Hahnemann, and Einstein - are near high-crime areas. Since officers regularly patrol those areas, they often get to a scene in seconds.

"Sometimes, the math is simple," Carr said. "If it takes close to 10 minutes for an ambulance to get to the scene from the hospital, and 10 minutes back, and a police officer knows he can get there in half that time, that's an easy choice."

Officers and doctors say police transports should not be seen as a judgment of the care provided by city medics. Transports are used as a last resort, Band said, and only in specific situations. People injured in car accidents or by blunt-force trauma, for example, are not candidates for police transport because they could be injured further.

Philadelphia Regional EMS medical director C. Crawford Mechem also supports the policy. "Among at least some trauma patients, police transport is associated with as good as, if not better, outcomes than ambulance transport."

Police officers don't need a study to tell them the process works. Lt. Thomas McLean, who works out of North Philadelphia's 22d District, said an officer could get to Temple in less than six minutes.

"We're not going to let someone die on the street while we wait," McLean said. "When you're losing a serious amount of blood, it's a matter of minutes."

Officers receive little training to prepare for transports. There are no hard rules, and officers are expected to use their judgment. Usually, McLean said, an officer calls a supervisor, who then decides.

"If you're doing it for the first time, you might get hyped up," he said. "But once you experience it a few times, it becomes more routine."

Officers put on latex gloves and either urge the victim to get into the car or have someone help them get in. Victims must agree to the process, which can be a challenge with those who are going in and out of consciousness, McLean said. Victims are sometimes belligerent or distrustful if their shooting stemmed from involvement with drugs or other illegal activities.

Deputy Police Commissioner Bethel acknowledged that some officers might not be thrilled with rescuing the same people they might be arresting on another night.

"We try to stress to officers, 'It's a life, it's a human being,' " Bethel said. "We can't get caught up in thinking that they're a criminal."

Besides, whether officers like it or not, there is another obvious benefit to police transports: Each person saved is one fewer person in the year-end homicide count.

After Dominique Seward was hit by a stray bullet last year, she spent 23 days in the hospital. About a month later, she suffered a brain aneurysm related to her injuries, but she recovered. A bullet remains in her chest, too close to her heart for it to be removed safely, and she has regular checkups to monitor it.

Her son, Harish, who turned a year old last month, is an energetic, happy baby.

No one has been charged in Seward's shooting. The Overbrook section is a drug hot spot, and many people see gunfire as a part of life. On April 3, as Seward began to put the shooting behind her, she found herself reliving it. Tyrone White, the father of her son, who had been with Seward all through her recovery, was shot in the stomach less than two blocks from where Seward nearly died almost a year earlier.

White said he didn't know who shot him, but he and Seward acknowledged that he knows dealers and lives in an area overrun with violence.

White said he didn't know if he was the target that day. He heard the shots, then saw people on the street scream and run as he fell.

"A couple of my boys yelled, 'We can't leave him like this!' and they ran up to me," White said. "Everybody got in my face, they were saying, 'You gotta stay alive.' "

When police arrived, his friends knew what to do: They lifted him into the backseat of the cruiser. By the time White arrived at Penn's ER, he was unconscious and going into shock.

Doctors took White to surgery, where, over the course of four hours, they removed his spleen, a kidney, and part of his pancreas. White pulled through. A little more than a week after the shooting, he was sitting up in bed, surrounded by shiny Mylar balloons, and enjoying cherry water ice with Seward and their son at his side.

"When I woke up, all I knew is the doctors told me I was lucky," he said. "If it had been a few more minutes, I'd have died."



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