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Ambulances may lower survival chance for gunshot, stabbing victims, study says

Posted at 5:33 PM, Sep 20, 2017

In a critical situation where minutes determine life or death, you may think emergency medical services offer your best chance of survival. However, a Johns Hopkins trauma surgeon doesn't think that's always the case.

“If it were me, and I know a lot about trauma, drive me to the trauma center as fast as you can,” said Dr. Elliott Haut, associate professor of surgery and emergency medicine at the Johns Hopkins University School of Medicine and senior author of a new study that evaluates emergency transport for shooting and stabbing victims.

Haut and colleagues examined data from trauma centers within the 100 most populous U.S. metro areas and compared ambulance versus private vehicle transportation and the relationship between transport-mode and in-hospital mortality. 

He was not surprised by what he saw.

“Patients who are injured with penetrating trauma — so stab wounds and gunshot wounds, in urban settings, so these are in the City — have improved outcomes and improved mortality if they're brought to the trauma center by private vehicle compared to emergency medical services, EMS,” Haut said.

The keyword is trauma center; not all hospitals are equipped to handle walk-in patients with these kinds of injuries. And they are injuries that require immediate surgery. The study does not cover cardiac arrest where the most important thing is CPR and a defibrillator.

“When we control for all those things, the rapid transport of patients by private vehicle makes a big difference,” Haut said.

According to the study, 62 percent of patients are less likely to die when transported by private vehicle compared to EMS.

Dr. Gabe Kelen has seen many of these walk-in patients at the Johns Hopkins Hospital emergency department.

“You're waiting, waiting, waiting, the ambulance people get there, they do certain things, very skilled, it's all being done out there. Then they load you up, drive through traffic, they get here, that can take twice as long. It sometimes really is better to get you here, let us start doing our more definitive thing that we can do only in the emergency department,” said Kelen, director of the emergency department.

He agrees time is of the essence, but also cautions that this is one study.

“If you get multiple people being dropped off at one of the smaller hospitals, they may not have the staff to do everything that a place like ours can do so let the system work,” Kelen said.

The current standard of care in Maryland is to wait for EMS to arrive. Dr. Richard Alcorta, acting co-executive director of the Maryland Institute for Emergency Medical Services System (MIEMSS), does not support changing the standard.

He says not everyone knows where a trauma center is located and EMS can perform certain life-saving procedures that may be crucial before transport. 

A spokeswoman with the Baltimore Police Department said they do not have a position on the study’s findings and that “preservation of life is paramount." She added that a victim's decision to leave a crime scene "has little if any bearing on the outcome of the investigation. Thanks to video surveillance, CCTV cameras and our crime scene technicians it all seems to work out in the end.” 

For more information on the study, click here.