Jacoby Sara F, Branas Charles C, Holena Daniel N, Kaufman Elinore J
Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.
Trauma Surg Acute Care Open. 2020 Nov 26;5(1):e000541. doi: 10.1136/tsaco-2020-000541. eCollection 2020.
Time to definitive hemorrhage control is a primary driver of survival after penetrating injury. For these injuries, mortality outcomes after prehospital transport by police and emergency medical service (EMS) providers are comparable. In this study we identify patient and geographic predictors of police transport relative to EMS transport and describe perceptions of police transport elicited from key stakeholders.
This mixed methods study was conducted in Philadelphia, Pennsylvania, which has the highest rate of police transport nationally. Patient data were drawn from Pennsylvania's trauma registry and geographic data from the US Census and American Community Survey. For all 7500 adults who presented to Philadelphia trauma centers with penetrating injuries, 2006-2015, we compared how individual and geospatial characteristics predicted the odds of police versus EMS transport. Concurrently, we conducted qualitative interviews with patients, police officers and trauma clinicians to describe their perceptions of police transport in practice.
Patients who were Black (OR 1.50; 1.20-1.88) and Hispanic (OR 1.38; 1.05-1.82), injured by a firearm (OR 1.58; 1.19-2.10) and at night (OR 1.48; 1.30-1.69) and who presented with decreased levels of consciousness (OR 1.18; 1.02-1.37) had higher odds of police transport. Neighborhood characteristics predicting police transport included: percent of Black population (OR 1.18; 1.05-1.32), vacant housing (OR 1.40; 1.20-1.64) and fire stations (OR 1.32; 1.20-1.44). All stakeholders perceived speed as police transport's primary advantage. For patients, disadvantages included pain and insecurity while in transport. Police identified occupational health risks. Clinicians identified occupational safety risks and the potential for police transport to complicate the workflow.
Police transport may improve prompt access to trauma care but should be implemented with consideration of the equity of access and broad stakeholder perspectives in efforts to improve outcomes, safety, and efficiency.
Epidemiological study, level III.
实现确定性出血控制的时间是穿透伤后生存的主要驱动因素。对于此类损伤，警察和紧急医疗服务（EMS）人员进行院前转运后的死亡率结果相当。在本研究中，我们确定相对于EMS转运而言警察转运的患者和地理预测因素，并描述关键利益相关者对警察转运的看法。
这项混合方法研究在宾夕法尼亚州费城进行，该市警察转运率在全国最高。患者数据来自宾夕法尼亚州的创伤登记处，地理数据来自美国人口普查和美国社区调查。对于2006年至2015年期间前往费城创伤中心就诊的所有7500名成年穿透伤患者，我们比较了个体和地理空间特征如何预测警察转运与EMS转运的几率。同时，我们对患者、警察和创伤临床医生进行了定性访谈，以描述他们在实际中对警察转运的看法。
黑人（比值比[OR]1.50；95%置信区间[CI]1.20 - 1.88）、西班牙裔（OR 1.38；95%CI 1.05 - 1.82）、因枪支受伤（OR 1.58；95%CI 1.19 - 2.10）、在夜间受伤（OR 1.48；95%CI 1.30 - 1.69）以及意识水平下降（OR 1.18；95%CI 1.02 - 1.37）的患者被警察转运的几率更高。预测警察转运的社区特征包括：黑人人口百分比（OR 1.18；95%CI 1.05 - 1.32）、空置房屋（OR 1.40；95%CI 1.20 - 1.64）和消防站（OR 1.32；95%CI 1.20 - 1.44）。所有利益相关者都认为速度是警察转运的主要优势。对患者来说，劣势包括转运过程中的疼痛和不安全感。警察指出了职业健康风险。临床医生指出了职业安全风险以及警察转运可能使工作流程复杂化的问题。
警察转运可能会改善创伤护理的及时可及性，但在实施时应考虑到可及性的公平性以及广泛利益相关者的观点，以努力改善结果、安全性和效率。
流行病学研究，III级。
