Study: Ambulances lower survival rates for gunshot, stabbing victims
The study suggested that dispatchers begin asking callers if they have a car and can take victims to the nearest trauma center
By Meredith Cohn
The Baltimore Sun
BALTIMORE — Driving shooting and stabbing victims to a hospital trauma center, rather than waiting for an ambulance, gives them a better chance to survive.
That’s the conclusion of research led by John Hopkins Medicine, where an emergency physician involved in the study now advises people to get in their own cars, Ubers or police vehicles and just go.
“If I’m in the Inner Harbor and I get mugged and shot, or I’m at Camden Yards, I tell my family to get me to Shock Trauma now,” said Dr. Elliott Haut, an associate professor of surgery and emergency medicine at the Johns Hopkins University School of Medicine.
Haut isn’t the first to find a higher rate of survival in patients driven directly to a trauma center, but he said people in many cities haven’t heard about the difference in survival rates and might be more apt to wait for paramedics.
Eventually he’d like emergency dispatchers to begin asking callers if they have a car and can take victims to the nearest trauma center.
The state’s emergency policy makers, however, say not so fast. Call 911, insisted Dr. Richard Alcorta, EMS medical director for the Maryland Institute for Emergency Medical Services.
While he said research like Haut’s is valuable for policy makers, who face different circumstances in their own regions, he doesn’t believe Maryland should make changes.
Without guidance, people won’t necessarily know how to apply life-saving pressure or a tourniquet, Alcorta said. They also won’t be able to aid a person who may be alone in the back of their car. Drivers may have trouble navigating busy city streets.
And most importantly, he said, few people know which are the trauma hospitals, as regular emergency rooms are not equipped to handle such penetrating wounds.
Further, patients likely wouldn’t make it to the hospital at all if they have an obstructed airway or other problem that a layperson could not address on the scene or in a car, Alcorta said.
“With a study like this that is speaking to a statistical evaluation of private vehicles versus EMS, they are able to show we are fighting time,” Alcorta said. “We agree. But if people are not given proper care immediately or if the rapid transit doesn’t get them to a trauma center, the outcome could be worse… These people need to be in the operating room of a trauma hospital.”
Haut said patients already do arrive at Hopkins in private and even police cars, though in his professional experience many more do in other cities such as Philadelphia. He said there could be an educational campaign, similar to ones that got people comfortable offering CPR or using defibrillator so people know what to do and where to go.
For now, he knows few people likely know the four trauma hospitals in Baltimore: Johns Hopkins Hospital, Maryland Shock Trauma Center, Sinai Hospital and Johns Hopkins Bayview Medical Center. He also doesn’t want people to misunderstand and show up at an unprepared emergency room, where time would be lost stabilizing and transferring patients.
Still, he said, he’d like to see the conversation begin with the study, done in conjunction with researchers from Northwestern University’s Feinberg School of Medicine and the American College of Surgeons, which maintains the nation’s largest trauma databank.
The study, published in JAMA Surgery this month, examined more than 100,000 shooting and stabbing patients at nearly 300 U.S. trauma centers from 2010 through 2012 in urban settings. About 16.4 percent of all patients came by private vehicle. The analysis found 2.2 percent of those who arrive in a private vehicle died, while 11.6 percent of those who came via ambulance died.
For gunshot victims, about 4.5 percent who came in a private car died, compared with 19.3 percent who came by ambulance. For stabbing victims, about 0.2 percent who came via private car died, versus 2.9 percent of those arriving in an ambulance.
When adjusted for difference in injury severity, shooting and stabbing victims were 62 percent less likely to die when they came in a car.
“Time is truly of the essence when it comes to certain kinds of injuries,” Haut said. “Our analysis suggests that, for penetrating injuries such as knife and gun wounds, it might be better to just get to a trauma center as soon as possible in whatever way possible.”
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