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I've previously discussed police transport for penetrating trauma in #Philadelphia ( @stemlyns post here: https://www.stemlynsblog.org/to-protect-and-serveand-drop-off-st-emlyns/)
While it may improve survival, what are the broader implications for patients, cops, & hospitals?
A great new paper in @TSACO_AAST tackles this
1/x
While it may improve survival, what are the broader implications for patients, cops, & hospitals?
A great new paper in @TSACO_AAST tackles this
1/x
2/x
Here's a link to the full paper (open access): https://tsaco.bmj.com/content/tsaco/5/1/e000541.full.pdf
Authors @SaraFredricka @ElinoreJKaufman @Daniel_Holena and Branas used 10 years of registry data to determine the influence
of geography, sociodemography & crime incidence on prehospital transport
Here's a link to the full paper (open access): https://tsaco.bmj.com/content/tsaco/5/1/e000541.full.pdf
Authors @SaraFredricka @ElinoreJKaufman @Daniel_Holena and Branas used 10 years of registry data to determine the influence
of geography, sociodemography & crime incidence on prehospital transport
3/
They then combined this with qualitative interviews of patients, police, & hospital personnel to identify perceived advantages/disadvantages of police transport
Neighborhood crime stats & sociodemographic
characteristics such as race & unemployment were reviewed
They then combined this with qualitative interviews of patients, police, & hospital personnel to identify perceived advantages/disadvantages of police transport
Neighborhood crime stats & sociodemographic
characteristics such as race & unemployment were reviewed
4/
Of 9438 penetrating trauma patients, 2813 (29.8%) were police transports, increasing over time.
Median number of penetrating injuries per zip code=97
Median number of police transports=28
Of 9438 penetrating trauma patients, 2813 (29.8%) were police transports, increasing over time.
Median number of penetrating injuries per zip code=97
Median number of police transports=28
5/
Of police transports:
80% of patients were #Black
Median 92.7% were male
Median age was 25 years
Median ISS was 14
Primary mechanism was #gunshot wound
Median 28.1% died
% of vacant housing & #Black population/neighborhood (but not crime rates) ↑ the odds of police transport
Of police transports:
80% of patients were #Black
Median 92.7% were male
Median age was 25 years
Median ISS was 14
Primary mechanism was #gunshot wound
Median 28.1% died
% of vacant housing & #Black population/neighborhood (but not crime rates) ↑ the odds of police transport
6/
The qualitative aspect involved interviews w/ patients, cops, & surgeons/nurses at 1 L1TC (& is a very interesting read)
All 3 groups shared a perception of the benefit of speed.
Patients felt they were valued. Police felt they were doing a real service to society.
The qualitative aspect involved interviews w/ patients, cops, & surgeons/nurses at 1 L1TC (& is a very interesting read)
All 3 groups shared a perception of the benefit of speed.
Patients felt they were valued. Police felt they were doing a real service to society.
7/
The perceived negatives are important to understand.
For patients:
-fear & pain from being unsecured in the back of the cop car
-worry that no medical treatment was being provided en-route to hospital
The perceived negatives are important to understand.
For patients:
-fear & pain from being unsecured in the back of the cop car
-worry that no medical treatment was being provided en-route to hospital
8/
Negatives for cops:
-occupational risk from body fluid exposure
-perceived lack of medical training beyond basic first aid, especially regarding transport urgency in some situations
-challenges in moving some patients quickly into (and out of) their vehicles
Negatives for cops:
-occupational risk from body fluid exposure
-perceived lack of medical training beyond basic first aid, especially regarding transport urgency in some situations
-challenges in moving some patients quickly into (and out of) their vehicles
9/
Negatives for #HCWs
-very short notification times, sometimes leading to unintended breakdown of organized trauma resuscitation
-potential risk to police/patients due to high-speed transports
-risk of weapons being brought into the hospital
-challenging vehicle extrication
Negatives for #HCWs
-very short notification times, sometimes leading to unintended breakdown of organized trauma resuscitation
-potential risk to police/patients due to high-speed transports
-risk of weapons being brought into the hospital
-challenging vehicle extrication
10/
What does this paper tell us?
-the expedience of police transport is broadly appreciated
-public/police perception is of "doing some good"
-patients are more likely to be #Black, male, & sustaining GSWs
-police transport appears to be unevenly distributed in the city
What does this paper tell us?
-the expedience of police transport is broadly appreciated
-public/police perception is of "doing some good"
-patients are more likely to be #Black, male, & sustaining GSWs
-police transport appears to be unevenly distributed in the city
11/
-this raises the concern for structural disparities in care distribution/access inequity
-there are several opportunities for improvement, including safety of patients/police during transport; limiting body fluid exposure risks; improving communication w/ trauma centers
-this raises the concern for structural disparities in care distribution/access inequity
-there are several opportunities for improvement, including safety of patients/police during transport; limiting body fluid exposure risks; improving communication w/ trauma centers
12/
All interventions have an opportunity cost.
Kudos to these authors for looking (for the 1st time) at this aspect for police transports
Both quantitative & qualitative aspects should be reviewed by others thinking of implementing police transport in their region
/end
All interventions have an opportunity cost.
Kudos to these authors for looking (for the 1st time) at this aspect for police transports
Both quantitative & qualitative aspects should be reviewed by others thinking of implementing police transport in their region
/end
cc: @TacTrauma @ATMA_Tactical @PoliceMedics @Obidoc @ATACCFaculty @CommitteeTECC @NoobieMatt @TotalResus @WestCorkRR @ClairePark01 @SpecOpsMedics @PolCasCPD @AleBaezMD @BenZabar @FLTDOC1
