The world of emergency medicine has long held the view of the “Golden Hour” when it comes to patients with traumatic injuries. That is, the sooner a patient receives definitive care in a hospital following trauma, the more likely they are to survive [1]. Traumatic injuries such as stabbings, gunshot wounds (GSWs), or amputations disrupt perfusion in some manner and usually require resuscitation with oxygenation and fluid replacement. Intuitively, an hour is far too long to delay definitive care; a patient’s condition could deteriorate in a matter of minutes. While advanced life support from ambulances is the standard of care in the U.S. for traumatic injuries, in some urban areas, police officers are transporting injured patients themselves before ambulances arrive.
In 2010, a 20-year-old Philadelphia man was found by a police unit less than a minute after being shot in the chest. Luckily for him, Philadelphia has a long history of the “scoop and run”, where victims of penetrating trauma are regularly taken to one of the city’s five Level 1 trauma centers in the backseat of police units [2]. A trauma surgeon on the case stated that had his arrival been delayed another minute, the patient surely would have died. Philadelphia police are backed in this undertaking by more than a collection of anecdotes. A retrospective study in 1995 compared ambulance and police transports for trauma victims in the early years of Philadelphia’s “scoop and run”, finding no significant difference between the groups [3].
Two decades after the initial study, Band and coauthors at the University of Pennsylvania studied four years of penetrating trauma victims in the city of Philadelphia. Crude data suggested that patients transported by police units were more likely to die from their injuries than those transported by ambulance. However, they noted that victims transported by police were more severely injured, and more likely to have been shot rather than stabbed [4]. After adjusting for injury severity, there was no significant difference between the two groups. Given the evidence that police transport can be beneficial to trauma patients, Band et al. suggested that a randomized controlled trial be conducted. A similar study in 2016 looking at police medical transports in urban centers across the country found no difference in mortality between ambulance and police transport groups [5].
The Philadelphia Immediate Transport in Penetrating Trauma Trial (PIPT) is the RCT prescribed by the Band study. Victims of penetrating trauma will be randomly assigned to basic life support (BLS) or advanced life support (ALS). The designers of this trial hope to examine IV catheterization and intubation as the key differences between ALS and BLS [6]. If paramedics are given the assignment of BLS for a patient, they will likely have a faster transport time but will give fewer prehospital interventions. To prospectively include all adults in Philadelphia, the study was approved through the city council and includes all trauma centers. Residents choosing to opt out of the study and automatically receive the ALS standard of care in the case of penetrating trauma can wear a wristband [7]. Originally slated to begin in 2016, the study will instead begin in July of 2019 and is expected to take five years [8].
A groundbreaking study in 2018 delved further into the issue of police medical transports by looking at the larger “private vehicle transport”. This includes any vehicle not specified as a ground emergency medical services vehicle, such as police units, personal vehicles, or rideshares. Wandling and coauthors found that GSW victims taken by ambulances in an urban setting were twice as likely to die than those taken by private vehicles. For stabbing victims, mortality was reduced by three times for those taken by private vehicles [9]. The shocking results of this study provide further evidence that every second counts when transporting a trauma victim to definitive care. Does this mean that all stabbing victims should call an Uber? Only if it will significantly reduce the time to get to a hospital, and any nearby police officer or friend may be the better transport option.
Since urban police officers are often the first on the scene of a violent trauma, their role in emergent medical transports may increase soon. Police medical transport is codified in departmental policy for the Philadelphia Police Department, providing institutional support to what has become a strong part of their culture. Other urban police departments have similar policies, such as Chicago, Cleveland, and Detroit [10]. However, no city has nearly as many medical transports by police as Philadelphia. This difference highlights the importance of policy versus practice. If a police department is to transport more stabbing and GSW victims, both policy and police officers’ attitudes would have to change. Unsurprisingly, medical transports are uncommon in police departments without specific policies on the issue. Prominent urban areas such as Phoenix, Baltimore, and New York City have limited data on police transports and do not appear to have considered this option. Time, research, and more anecdotal success stories may ultimately generate momentum towards a national trend of police medical transports.
- Eisele, C. The Golden Hour. JEMS. Published August 31, 2008. https://www.jems.com/articles/2008/08/golden-hour.html.
- Van Brocklin, E. Where Cop Cars Double as Ambulances. PoliceOne. Published November 15, 2018. https://www.policeone.com/police-training/articles/482088006-Where-cop-cars-double-as-ambulances/.
- Branas CC, Sing RF, Davidson SJ. Urban trauma transport of assaulted patients using nonmedical personnel. Acad Emerg Med. 1995;2(6):486-493.
- Band RA, Salhi RA, Holena DN, Powell E, Branas CC, Carr BG. Severity-adjusted mortality in trauma patients transported by police. Ann Emerg Med. 2014;63(5):608-614.e3.
- Wandling MW, Nathens AB, Shapiro MB, Haut ER. Association of prehospital mode of transport with mortality in penetrating trauma a trauma system-level assessment of private vehicle transportation vs ground emergency medical services. JAMA Surg. 2018;153(2):107-113.
- Temple University Department of Surgery. Philadelphia Immediate Transport in Penetrating Trauma Trial (PIPT). Accessed January 1, 2019. https://medicine.temple.edu/departments-centers/clinical-departments/surgery/research-programs/philadelphia-immediate-transport.
- Moselle, A. Will a Study Save Victims of Violence, Or Gamble With Their Lives? NPR. Published October 20, 2016. https://www.npr.org/sections/health-shots/2016/10/20/496828573/will-a-study-save-victims-of-violence-or-gamble-with-their-lives.
- NIH Clinical Trials. Philadelphia Immediate Transport in Penetrating Trauma Trial (PIPT). Updated August 1, 2018. https://clinicaltrials.gov/ct2/show/NCT02821364.
- Wandling MW, Nathens AB, Shapiro MB, Haut ER. Police transport versus ground EMS: A trauma system-level evaluation of prehospital care policies and their effect on clinical outcomes. J Trauma Acute Care Surg. 2016;81(5):931-935.
- Van Brocklin, E. “Scoop and Run” Can Save Lives. Why Don’t More Police Departments Try It? The Trace. Published November 19, 2018. https://www.thetrace.org/2018/11/scoop-and-run-gunshot-victim-police-transport/.
Luke Wohlford is a medical student in the University of Arizona College of Medicine - Phoenix, Class of 2022. He graduated from the University of Arizona in 2018 with a Bachelor of Science in physiology. Luke plans to go into emergency medicine has special interests in public health and EMS. He spends most of his free time hanging out with his dogs Kanye and Kelso or feeling guilty about not exercising.