13 October 2017

Trauma Center Transport

Welcome back. Earlier this year, I blogged about Gun Research. I mentioned a Boston University study that found nearly every American is likely to know a gun violence victim in their social network during their lifetime. That result alone, never mind stabbing victims, underlines the importance of a recent study that assessed the best mode of transporting penetrating injury victims to a trauma care center.

What is the best way to transport
gunshot and stab wound victims
to the trauma center? (photo
from multiple websites)
Wait! Best mode? Am I suggesting that transport by emergency medical services (EMS) ambulance may not offer the best chance for survival? Here’s the story.

Ground EMS vs. Private Vehicle Transport
Collaborating medical specialists from Northwestern University, American College of Surgeons, University of Toronto and Johns Hopkins analyzed information available from the National Trauma Data Bank for the years 2010 through 2012.

From over 2.3 million patient records, they selected 103,029 at 298 hospitals for study. Those were the gunshot or stab wound patients age 16 or older, who were transported by ground EMS or private vehicle to a level 1 or level 2 trauma center in the 100 most populous metropolitan areas. (Level 1 and 2 centers have the most comprehensive resources and admit the most patients.)

Patients in the study sample were predominantly male (88%), average age 32, 48% black, 26% white and 18% Hispanic. Black and Hispanic patients were over 4 times more likely to have been transported by private vehicle than by ground EMS; white patients were over 6 times more likely to have been transported by ground EMS.

Risk-adjusted mortality was assessed and evaluated after stratifying by injury severity. Variables included presenting heart rate, presenting systolic blood pressure, presenting Glasgow Coma Scale Motor Score (describes level of consciousness after traumatic brain injury), Injury Severity Score (assesses trauma severity), age, sex, race/ethnicity, insurance status and year of admission.

The average Injury Severity Score for patients transported by private vehicle (5.5) was about half that of patients transported by ground EMS (10.1); both averages were below moderate/severe (15), which is considered major trauma.

Lowest Mortality Transport
The researchers found that, after risk adjustment, the odds of penetrating injury patients dying when transported by private vehicle were on the order of 38% lower than when transported by ground EMS. This broke down to about 45% lower for gunshot wound patients and about 32% lower for stab wound patients.

Does that say forget about calling for an ambulance for your next heart attack or injury? Absolutely not. The study was limited to gunshot and stab wound victims because penetrating injury victims are least likely to benefit significantly from prehospital interventions and most likely to benefit from timely surgical intervention.  

Gunshot and stab wound victims
need timely surgical intervention
more than prehospital
interventions. (photo from
multiple websites)
Although data were not available to compare EMS “stay and stabilize” policy with EMS “scoop and run” policy, the results suggest the latter might be more beneficial for gunshot and stabbing wound patients.

Wrap Up
I felt urged to review this study when I saw that the State of Wisconsin, where I currently reside, will probably join a dozen other states and allow permitless carry (aka constitutional carry) of concealed guns. As I understand it, none of these states requires the gun buyer to receive any safety training.

Whatever my views on gun rights and gun control, I am a realist. I expect the number of gunshot wounds to increase with permitless concealed carry, and thus, I see the need to alert the public that private vehicle transport might be the way to go, at least if you’re in range of a level 1 or 2 trauma center. (While nearly all Wisconsin hospitals participate in the trauma system, only 9% are level 1 or 2.)

I hope I’m wrong. Thanks for stopping by.

Study of penetrating injury transport to trauma center in JAMA Surgery: jamanetwork.com/journals/jamasurgery/fullarticle/2654239
Article on study on ScienceDaily website: www.sciencedaily.com/releases/2017/09/170920131648.htm
American College of Surgeons National Trauma Data Bank: www.facs.org/quality-programs/trauma/ntdb
American Trauma Society - Trauma Center Levels: www.amtrauma.org/?page=traumalevels
Injury Severity Score: dphhs.mt.gov/Portals/85/publichealth/documents/EMSTS/trauma/coordinator/ISSHandoutTC.pdf
Example articles on Wisconsin permitless concealed carry law:

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