BALTIMORE — It’s a harrowing choice in an adrenaline filled situation: someone you’re with has just been shot — do you put them in your car and drive, or wait for an ambulance to arrive?
While it should not be taken as medical advice, a recent study out of Johns Hopkins shows significantly higher survival rates for victims of gunshots or stabbings taken to a trauma center by private vehicle, rather than an ambulance or other ground emergency medical service (EMS) vehicle.
“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,” says the paper’s senior author Dr. Elliott Haut in a press release.
And while most medical professionals seem to agree that time is the biggest factor in such situations, many warn of other considerations, such as the type of hospital a victim is taken to.
In a recent Baltimore Sun article, Dr. Richard Alcorta, EMS medical director for the Maryland Institute for Emergency Medical Services, says it could be disastrous if a patient is taken to a hospital that doesn’t have the proper facilities.
“With a study like this that is speaking to a statistical evaluation of private vehicles versus EMS, they are able to show we are fighting time,” Alcorta says in the article. “We agree. But if people are not given proper care immediately or if the rapid transit doesn’t get them to a trauma center, the outcome could be worse… These people need to be in the operating room of a trauma hospital.”
With this in mind, Haut suggests public information campaigns so that people know what hospitals in their cities are equipped to handle trauma victims.
An associate professor of surgery and emergency medicine at the Johns Hopkins University School of Medicine, Haut, alongside several colleagues, examined the largest collection of trauma registry data in the United States. Looking at information on 103,029 gunshot or stabbing victims from the country’s 100 most populated metro areas, their analysis showed startlingly significant differences in survival.
Out of the examined cases, 16.4 percent of the victims were transported by private vehicle. After adjusting for differences in injury severity, the researchers found these penetrating injury victims were 62 percent less likely to die than patients transported by EMS.
“Unlike CPR and defibrillation for heart attacks, the type of damage done in penetrating trauma often can’t be reversed in a prehospital setting. This study supports other studies that prehospital interventions can actually result in less favorable outcomes for certain types of injuries,” says Dr. Michael Wandling, who conducted the research with Haut.
Such other studies include one from 1996 that also found that “patients with severe trauma transported by private means in (an urban setting) have better survival than those transported via the EMS system.”
Another 2013 study drew similar conclusions, noting “transport of injured patients by EMS was associated with higher mortality than private vehicle transport.”
Despite such studies, experts warn that there are always many factors to consider in emergency situations. Indeed, other research has confirmed the importance of helicopters in saving some victims. And, as in the case of Haut’s study, many of the studies on private transportation are focused on dense urban areas.
The findings were reported in a paper published Sept. 20 in JAMA Surgery.