Columns, Major Incidents, Patient Care

Should Trauma Patients Be Transported by Police Officers?

Issue 2 and Volume 42.

The Research

Wandling MW, Nathens AB, Shapiro MB, et al. 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.

The Science

Data was drawn from the National Trauma Data Bank (NTDB) for adult patients with gunshot and stab wounds transported to a Level 1 or 2 trauma center in the 100 most populous U.S. cities from 2010–2012. The death rate was calculated for those who arrived by police transport compared to those transported by ground EMS.

Researchers identified 88,564 patients, of which 86,097 (97.2%) were transported by EMS and 2,467 (2.8%) by police. Unadjusted mortality was 17.7% for police transport and 11.6% for ground EMS.

After risk adjustment, patients transported by police were no more likely to die than those transported by EMS (OR = 1.00, 95% CI: 0.69–1.45). Three urban cities (Philadelphia, Detroit and Sacramento) represented 87% of the police transports.

It was concluded that the mortality rate was no worse for patients transported by law enforcement as compared to traditional EMS. Furthermore, the three urban centers identified should be considered for future study and analysis of this subject.

Medic Wesley Comments

I think this study makes the point that rapid transport with BLS vs. on-scene ALS care doesn’t worsen the survivability of penetrating trauma patients in urban areas. The authors state that it’s a feasible option to have law enforcement transport these patients as they found no significant difference in survival with EMS “load and go” and law enforcement “scoop and run.”

My concerns address the duties of law enforcement, and the scene safety issues for EMS. Law enforcement is a “protect and serve” agency.

Stories of police providing emergency care and saving lives occur every day. They’re there, on scene, when things happen. They rush in with bullets flying to neutralize the threat. Although it’s “feasible” for the police to grab the injured and run, wouldn’t that put others in greater danger as a result of decreasing the number of officers on the scene?

EMS scene times in these types of calls will traditionally be longer because of scene safety issues and patient access. Although some say EMS providers should rush into harm’s way, it’s my belief that EMS providers deserve to be provided with safety measures, even if it means delaying patient transport.

Making law enforcement a routine method of transport for trauma patients is disregarding the job they perform every day. I think they already have their hands full.

There are many things that can be done. However, it doesn’t mean they should.

Doc Wesley Comments

I’m afraid I must disagree with Medic Wesley.Events such as last year’s Orlando nightclub shooting and the ambush of the Dallas law enforcement officers has shown that rapid transport of the wounded away from the hot zone immediately to the nearest trauma center saves lives. Definitive care for penetrating trauma is to stop the bleeding and step on the accelerator.

In such events, which are often in areas with a high crime rate, EMS will stage until the scene is safe. There’s nothing wrong with that. As Medic Wesley stated, they must remain safely away from the hot zone until the perimeter is secured. Unfortunately, that takes time that could be used to access and transport the most badly injured.

The study’s authors noted that the victims transported by police had significantly greater injuries. It goes without saying that rapid transport benefits those victims the most.

My only criticism of the study was that the researchers failed to document the time from injury to arrival in the ED. It’s assumed by the authors, but not proven by their data, that police transport took less time compared to EMS.

However, it must be recognized that the clear majority of data the authors base their conclusion on came from only three urban centers. Why is that? Probably because most cities, large and small, may not condone police officer transport of trauma victims. The liability is potentially greater when surviving family members claim that their loved one would have survived had they been treated by conventional EMS care.

As the authors correctly stated, Philadelphia has permitted police transport for more than 25 years. It would seem they’ve addressed the myriad issues of liability, officer resources at the scene, delivery of BLS care during transport and many more than I can imagine. Perhaps they will share with us their “best practice” and we can try to duplicate in other large cities across the nation.