An analysis of 24-hour survival based on arrival by atypical ground transport versus ground emergency medical services.

Abstract

Objectives: Studies comparing police, privately owned vehicle (POV), and ground Emergency Medical Services (GEMS) trauma transports reveal mixed results. It remains unclear whether using non-standard transport methods may be beneficial in the setting of certain injuries. We sought to determine 24-hour survival after transport by police or POV when compared to GEMS.

Methods: We analyzed data from the Trauma Quality Improvement Program datasets from 2020 to 2022 for patients arriving from scene by POV, police, or GEMS. The primary outcome was 24-hour survival. Multivariable logistic regression models were used to adjust for confounders. Further stratification was performed by mechanism. We used abbreviated Injury Severity Score (ISS) by body region to assess those with and without penetrating torso trauma.

Results: Patients arriving by POV had a lower median age than those arriving by GEMS and a higher proportion of pediatric patients. This group exhibited a lower incidence of blunt trauma but a higher incidence of penetrating trauma, along with fewer serious injuries across all body regions (Table 1). Across all adjusted models, arrival by POV was associated with higher odds of 24-hour survival, except for cases of penetrating torso trauma among pediatric patients (Table 2). Patients arriving by police also had a lower median age but a reduced proportion of pediatric patients. This group showed a higher proportion of penetrating trauma and serious injuries to the thorax and abdomen. Police arrivals with blunt trauma had higher odds of 24-hour survival, while those with penetrating trauma had lower odds of 24-hour survival, a pattern consistent when stratifying by ISS greater than 15.

Conclusions: This study highlights a survival advantage for trauma patients transported by POV compared to GEMS. Limitations include a lack of prehospital transport time and intervention data. While police transport showed improved survival for blunt trauma, it was associated with worse outcomes for penetrating trauma. These findings suggest that non-traditional transport methods may be beneficial in certain scenarios. Future research should aim to refine transport protocols, investigate the impact of non-traditional methods on transport time, and better understand the impact of prehospital interventions on patient outcomes.