By Matthew Konya
There is an episode of the television show “COPS” filmed in the early 1990s. In it, Philadelphia police officers respond to an apartment to find one male unresponsive from several gunshot wounds. Trying to save the man’s life, police officers place him on a makeshift litter, request a patrol wagon, place him inside the van by himself and speed away to the nearest hospital.
This is a classic example of the Philadelphia scoop and run; a policy that allows Philadelphia police officers, without waiting for EMS, to transport patients to the hospital. Alternative transport policies do not have to be limited to police departments, but can include transportation of patients by any means other than ambulance (public busses, medic chase units, fire engines, etc.). Studies have been mixed on patient outcomes when not transported by ambulance.
A 2014 University of Pennsylvania study revealed that overall, patients who were transported by Philadelphia police officers were more likely to die than patients who were transported by ambulance. However, when the data was adjusted to only include patients with severe injuries (an Injury Severity Score greater than 15), gunshot wounds or stab wounds, transport by police slightly increased patients’ survival rate. And rapid transport of patients by police without coordination with EMS can lead to confusion on scene and at nearby facilities. The focus of this study was patients who are seriously injured and require immediate transportation to the hospital. Therefore, transport by Uber or other ride sharing platforms was not discussed.
On May 12, 2015, Amtrak Train 188 derailed in the Port Richmond section of Philadelphia. Within minutes of the accident, Philadelphia police officers started transporting injured patients to local hospitals. When fire officials arrived on scene, they found it almost impossible to get ambulances and medics to the scene, due to the large number of police vehicles clogging surrounding streets.
In fact, of the 43 passengers who were considered seriously injured, only three were transported by ambulance. In the NTSB’s final report, investigators noted; “as a result of victims being transported to hospitals without coordination, some hospitals were over-utilized while others were significantly under-utilized during the response to the derailment.” The NTSB recommended that the Philadelphia Fire Department, Police Department and Office of Emergency Management work together to revise policies regarding transport of patients during mass casualty incidents.
If your agency is considering a policy to allow transport of seriously injured patients by means other than ambulance, there are three simple guidelines your agency should keep in mind.
1. Know the areas a non-ambulance transport policy would benefit
Creating a policy that allows or even encourages agencies to transport patients without waiting for EMS only makes sense in areas where a hospital is close by. Urban areas would likely be best suited for alternative transport policies. In suburban and rural areas, extended transport times would make alternative transport policies infeasible.
The theory behind such policies is that the rapid transport of patients to the hospital will increase patients’ likelihood of survival. When creating an alternative transport policy, it is vital to not only be familiar with your coverage area, but also the resources available in your area. Having hospitals too far away or not enough resources to transport patients will make such a policy infeasible.
2. Create a non-ambulance transport policy with input from other agencies
Alternative transport policies cannot be created in a vacuum. The nature of such policies will require your agency to work with other agencies to create a policy that works for everyone. The policy will be used by members of another agency to determine when it would be appropriate to transport patients without waiting for EMS.
This cooperation will not stop after the policy is created. Keep in mind, those who are transporting the patients may have little-to-no medical training. Your agency will need to continually work with the other agencies to ensure the policy is being implemented correctly.
3. Have clear non-ambulance transport transport guidelines
If you find that an alternative transport policy is right for your agency and your community, make sure that policy is clearly defined. One take-away from the derailment of Amtrak Train 188 and the University of Pennsylvania study is that most often, transport by EMS is preferred.
You will want to create a policy that limits transporting of patients by means other than ambulance to very specific situations – such as when ambulances are not available or there are inadequate qualified EMS practitioners available.
Also, the policy should deter alternative transport methods in situations where organized transport of patients is key, such as mass casualty incidents, to ensure adequate coordination with hospital resources. Make sure the policy is clear and can be easily applied in an emergency.
The policy should be written in such a way that even individuals with little-to-no medical experience can easily determine if the patient they are assisting would benefit from rapid non-ambulance transportation. Even with clear guidelines, it is important to keep in mind that alternative transport policies should only be used in very limited circumstances.
Alternative transport policies are only meant for the limited situations when police or other agencies, arrive on scene before EMS and there is a critical need to immediately transport a patient to the hospital.
Alternative treatment policies should never be used as a substitute for patient refusal policies. Once EMS makes patient contact, EMS practitioners should follow their agency’s patient refusal policy. Creating an alternative transport policy that allows EMS practitioners to release patients to police for transport to a hospital, without first following patient refusal policies, can open an agency up to liability. All agencies involved should be clear that once EMS makes patient contact, the patient should not be transported by means other than ambulance, barring a patient refusal or some extenuating circumstance.
Finally, as with any policy, it is important to keep patient care as an overriding priority. Alternative transport policies should only be established if those policies can improve patient outcomes in your community.
