In the comments to Injury-adjusted Mortality of Patients Transported by Police Following Penetrating Trauma is the following from Anonymous –
I have been a medic for the phila fire dept for 13 years at a medic unit doing 8000 runs a year. There are many things that are not factored into this study.
1. Zero care being done during the transport in police vehicle
No formal policy outlines how care should be provided to injured patients transported by police, and in practice (based on our observations) individuals transported by police are typically rendered no care, including even direct pressure on bleeding extremity wounds.[1]
Clearly, the authors of the study did take this into account.
This would only make outcomes worse for patients transported by police. You are only making EMS look worse.
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2.police have no bsi issued and use none during transport of bloody pt
That would not affect the outcome for patients. Most police I know do carry gloves.
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3.delay of dispatch of EMS and lack of direct communication between police and EMS
Many of the problems with the way that EMS and police are handled at the political level and are not within the control of the authors. Assuming that the politicians do not change these policies, there is no reason to expect that the results would change.
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4.it is frequent practice for police to pull around an arriving medic unit
I prefer to have the police between me and the scene of a shooting/stabbing. Are you claiming that the police transport patients when EMS is already on scene?
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5. Police do get more OT transporting a trauma pt
How would that affect the patients’ outcomes?
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6. Transport of pt’s that should be left DOA to preserve a crime scene
This also not a good thing, but –
This would only make the outcomes look worse for those patients transported by police.
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7. Unsafe,reckless driving by police often leaves the pt wedged between the seats of the car upon arrival at the ED.
The same as above – this would only worsen the outcome for patients transported by police.
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8. ED staff being exposed due to trying extricate a bleeding mess that is wedged in the rear of a patrol car. ( the police aren’t getting the pt out once at the ED)
Once more, this is not good, but would only lead to worse outcomes for those transported by police.
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9. Delay of care and lack of treatment while trying to remove the pt from a patrol car
Ditto.
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10.Improper sanitation of the transporting police vehicle after the bloody transport
This is not good, but should not affect outcomes either way.
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Medic units are often times available with good response times and the practice is still being done.
When 911 dispatches EMS is not within the control of the the authors of the study.
Is 911 avoiding dispatching EMS?
Is there a way to obtain documentation of this delay of dispatch?
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It is a poor, unsafe standard of care and should be stopped.
One alternative for systems that are short of paramedics (such as paramedics) might be a tiered system.
There are implications for dispatch policy, as well, in that proximity of the prehospital provider to the injury scene should outweigh the level of training when making decisions about dispatch for penetrating injury.[1]
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Believe me we do get our fair share of penetrating trauma but allowing this in any fashion is an insult to our profession.
I don’t care about insults to our profession.
A much bigger problem is people who harm out patients.
I don’t see how any of the information you provide points out any flaws in the study.
There are plenty of flaws in the system, but the point of this was to suggest an alternative for systems that are flawed.
We believe that these findings suggest that implementation of police transport for this patient population is safe and may help to decompress overwhelmed EMS systems or those without any significant EMS structure either in rural areas or in resource-poor countries.[1]
The flaws are flaws with the system, rather than flaws with the study.
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Footnotes:
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[1] Injury-adjusted Mortality of Patients Transported by Police Following Penetrating Trauma.
Band RA, Pryor JP, Gaieski DF, Dickinson ET, Cummings D, Carr BG.
Acad Emerg Med. 2010 Dec 16. doi: 10.1111/j.1553-2712.2010.00948.x. [Epub ahead of print]
PMID: 21166730 [PubMed – as supplied by publisher]
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What are you saying new here? The police transporting ANY medical/trauma patient is WRONG regardless of what one near cited study says. Oh, and yes I’ve witnessed police disregard there own rules and drive around medics on scene. I respect the authors as doctors I interact with daily.
Rouge, these are the same police that by allowing them to transport trauma are now taking pediatric codes. What are your thoughts on them scooping your child out of your arms, and providing no care en route to the wrong hospital?
One limitation to the study was that all the patients arrived at U-Penn. Do the Philadelphia police know which hospitals are Level-1 trauma centers and which are not? I suspect the outcomes of patients transported by PD to Methodist or Graduate may be different.
That said, patient shot and stabbed need a trauma center as safely, then as fast as possible. They definitely don’t need a backboarded, which this study helps confirm.
Instead of criticizing a study like this, I wish that Phila Fire Medics would look for ways improve the outcomes of penetrating trauma patients. All of the legitimate business people shot in Philadelphia would benefit from some healthy competition between the police and fire departments.
There are several trauma centers in Philadelphia an several other non- trauma. I’ve noted or been apart of an IFT when police transported to non- trauma hospitals. Not that these hospitals don’t have good staff but it overwhelms them and obviously creates a secondary incident for us. Street medics can’t make the city add units and that is one way to get faster response times. But like I said I’ve had under 4 min response times and the patient was already gone. You literally have to be involved in the shooting or have multiple shot if there is any hope of EMS getting a patient.