Ambulance Transport Lowers Penetrating Trauma Survival Rates

A new study suggests that gunshot and stabbing victims are more likely to die if they are transported to the trauma center by ambulance.

Researchers at Johns Hopkins Medicine (Baltimore, MD, USA), Northwestern University (NU; Chicago, IL, USA), and other institutions collected data from the American College of Surgeons (ACS) data bank on 103,029 patients who entered one of 298 level I and level II trauma centers in 100 United States metro areas following a gunshot or stab wound. The data, gathered from 2010 to 2012, were then examined for mode of transport – ambulance triage by ground emergency medical services (EMS) or by private vehicle.

The study population was predominantly male (87.6%), with a mean age of 32.3 years, of whom 47.9% were black, 26.3% were white, and 18.4% were Hispanic; about 16.4% of the victims were transported by private vehicle. Analysis found an overall 2.2% mortality rate for patients transported via private vehicle, compared to 11.6% for ground EMS, a 62% reduction. The lower mortality rate remained significant following stratified analysis of gunshot wound and stab wound subgroups. The study was published on September 20, 2017, in JAMA Surgery.

“Time is truly of the essence when it comes to certain kinds of injuries and 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,” said senior author Elliott Haut, MD, PhD. “For certain types of injury, it might be best to call the police, Uber, or a cab -- however you can get to the trauma center fastest.”

“Unlike CPR and defibrillation for heart attacks, the type of damage done in penetrating trauma often can't be reversed in a prehospital setting,” said lead author Michael Wandling, MD, a general surgery resident at the Northwestern University. “The ‘scoop and run’ approach – getting the victim into any vehicle, fast – is far better.”

Related Links:
Johns Hopkins Medicine
Northwestern University