Transport decisions: 3 factors to consider in injured Detroit police officer controversy
The selection of one trauma center over another should not be the basis for making operational changes
The controversy about how and where an injured Detroit police officer was transported to last week provides a couple of lessons about the intricacies and politics of EMS.
In summary, a commercial ambulance provider, contracted to Detroit to provide EMS services, transported the critically wounded police officer to a Level II trauma center that, at least geographically, was farther from scene than a Level I trauma center, as well as another Level II.
This transport decision has caused a bit of a ruckus within Detroit's public safety services, with the Detroit fire union president making demands to the fire commissioner that only the municipal-based Detroit EMS transport injured firefighters.
EMS1 readers have weighed in with their opinions, with some suggesting waiting for more details before assigning blame, while others suggesting travel time to the farther hospital was less than the closer facilities. While I tend to agree with the "wait and see" approach, the transport decision did trigger three questions beyond ease of access.
1. Is there a destination protocol for critical trauma patients?
The Michigan System Protocols for Ault/Pediatric Triage simply suggests that adult trauma patients meeting physiologic or anatomic criteria should be transported to the closest appropriate Level I or Level II trauma center if transport time is less than 45 minutes.
2. What was the operating environment at the time?
A report of an officer down brings an unusually heavy response from law enforcement, with rapid closures of streets and neighborhoods. It's possible, but unknown, if access to the geographically closer facilities was obstructed.
3. Was the EMS crew familiar with travel routes to major facilities?
An often-overlooked aspect of an EMS provider's responsibilities is knowing how to get to receiving facilities safely and with little delay. While many of us carry personal or professional GPS equipment, the technology cannot reliably predict traffic, road conditions, hazards or other changes that happen in real time.
Focus on how the transport decision was made
As for the politics of private versus public EMS, they need to be set aside when providing care and transport of critically injured patients. When time is of the essence, the need to deliver the major trauma patient into the hands of a surgical trauma team outweighs the politics of the moment.
The lettering on the side of the ambulance matters little to the victim who has suffered a major trauma mechanism. While the destination decision might be questioned, it should not serve as the basis for making operational changes in protocol that could end up being more harmful.
Systems are designed to provide the most optimal coverage possible given the local resources and political climate. Abrupt changes without considering the consequences can cause wide-ranging ripple effects that can put the system at risk of unforeseen catastrophic failure.
For now, the focus should be on how the decision was made. If 20/20 hindsight can bring to light a mistake in judgment, that should be handled through internal processes designed for such situations, and not through the local news media.