Research review: Gunshot victims transport, anaphylaxis recognition, interfacility transfers

Philadelphia police "scoop and run" policy may get shooting victims to the hospital faster which may explain increased survival rates of seriously injured patients


Updated January 29, 2018 

Two-thirds of gunshot victims taken to Philadelphia-area trauma centers by police between 2003 and 2007 survived - the same rate as those taken by EMS, finds a study by University of Pennsylvania researchers published in the January issue of Annals of Emergency Medicine.

About 29.5 percent of patients transported by police died, compared to 26.5 percent of those taken by ambulance. Yet shooting victims transported by police tended to have more serious injuries. When researchers took into account injury severity, patients transported to trauma centers by police actually were slightly more likely to survive.

The study included 4,122 patients who had been shot or stabbed, of whom 2,961 were transported by ambulance and 1,161 by police car to eight trauma centers. The overall mortality rate was 27 to 33 percent of those with gunshot wounds and 8 percent with stab wounds.

According to a university news release, more than 25 years ago, the Philadelphia Police Department began a policy known as “scoop and run,” in which police officers, if they arrived on scene first, were allowed to transport victims of penetrating trauma to trauma centers.

Typically, patients transported by police don’t receive any care on scene or en route, although the police department has recently issued tourniquets to every police officer in the city.

Researchers speculate that the reason patients transported by police fare better than those transported by the EMS division of the fire department is because the police, by nature of being out on patrol, have shorter response times.

INTERFACILITY TRANSFERS LESS LIKELY FOR UNINSURED PATIENTS

Uninsured patients are less likely to be transferred from one hospital to another, a finding that surprised researchers from the University of Pittsburgh. They had hypothesized that the uninsured would be more likely to be transferred because hospitals are eager to get rid of patients who are unable to pay.

The study included data from 316,000 patients aged 18 to 64 from more than 1,050 hospitals included in the 2010 Nationwide Inpatient Sample, the largest all-payer in-patient care database in the United States. Researchers analyzed the relationship between insurance status and interfacility transfers for five common medical diagnoses: biliary tract disease, chest pain, pneumonia, sepsis and skin infection.

Uninsured patients were 20 to 40 percent less likely to be transferred to another hospital for four of the five diagnoses compared to patients with private insurance, even after adjusting for demographic factors and illness severity. Women were 35 to 40 percent less likely than men to be transferred for all five diagnoses. The transfer rate for all patients ranged from 2 to 5 percent.

“If we presume that transfer between hospitals results in greater access to advanced treatments, then it’s evident that the uninsured and women face a serious health care disparity,” noted lead study author Janel Hanmer, M.D., Ph.D., assistant professor of medicine at Pitt’s School of Medicine, in a university news release. “Alternatively, privately insured patients and men may be at risk of greater exposure to more costly procedures and excessive treatments.”

The findings were published Jan. 20 in Annals of Internal Medicine.

PARENTS AND EMS PROVIDERS TOO OFTEN FAIL TO GIVE EPI FOR ANAPHYLAXIS

A review of 218 cases of children experiencing anaphylaxis found that only 41 percent were given epinephrine, which can halt the life-threatening systemic allergic reaction if administered soon enough. Anaphylaxis occurs after contact with an allergy-causing substance such as food, bee stings or medication.

In the study, about 87 percent of reactions occurred at home, while 12 percent occurred at school. About 69 percent of the 26 kids who reacted at school received epinephrine from the school nurse. But among the 117 children who had known allergies and who had their reaction at home, only 41 percent received epinephrine.

Even when EMS was called, only one in three children (36%) who met the criteria for anaphylaxis were given epinephrine. Researchers from Yale University School of Medicine called for more education about anaphylaxis to boost usage of epinephrine and potentially save lives. The study is in the January–March issue of Prehospital Emergency Care.

HOMELESS CANADIANS ARE FREQUENT ED USERS

A study that followed 1,200 homeless adults in Toronto for four years found they used more healthcare resources and went to the ED more often than other low-income patients matched for age and gender. A further analysis found that the higher rates of ED usage is driven by a small subset of homeless individuals who are extremely high-intensity users of EDs and hospitals.

The study found 77 percent of homeless, single adults visited the ED at least once in the prior year. Yet a subset of homeless frequent users was responsible for the majority of visits, averaging more than 12 a year. Though these frequent users represented only 10 percent of the homeless people studied, they accounted for more than 60 percent of visits.

The findings, by researchers at the Centre for Research on Inner City Health at St. Michael’s Hospital in Toronto, were published in October 2013 in a special issue of the American Journal of Public Health on homelessness.

Canada has universal, government-funded health insurance and comprehensive databases that capture all doctor, ED and hospital visits, researchers note. Similar research would be difficult to do in the United States, where many homeless people have no insurance and there is no comprehensive database.

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