Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business?
Abstract Introduction Sweden is facing a surge of gun violence that mandates optimized prehospital transport approaches, and a survey of current practice is fundamental for such optimization. Management of severe, penetrating trauma is time sensitive, and there may be a survival benefit in limiting...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-09-01
|
| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13049-023-01112-x |
| _version_ | 1797556881791647744 |
|---|---|
| author | Mattias Renberg Martin Dahlberg Mikael Gellerfors Amir Rostami Mattias Günther Elham Rostami |
| author_facet | Mattias Renberg Martin Dahlberg Mikael Gellerfors Amir Rostami Mattias Günther Elham Rostami |
| author_sort | Mattias Renberg |
| collection | DOAJ |
| description | Abstract Introduction Sweden is facing a surge of gun violence that mandates optimized prehospital transport approaches, and a survey of current practice is fundamental for such optimization. Management of severe, penetrating trauma is time sensitive, and there may be a survival benefit in limiting prehospital interventions. An important aspect is unregulated transportation by police or private vehicles to the hospital, which may decrease time but may also be associated with adverse outcomes. It is not known whether transport of patients with penetrating trauma occurs outside the emergency medical services (EMS) in Sweden and whether it affects outcome. Method This was a retrospective, descriptive nationwide study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 registered in the Swedish national trauma registry (SweTrau) between June 13, 2011, and December 31, 2019. We hypothesized that transport by police and private vehicles occurred and that it affected mortality. Result A total of 657 patients were included. EMS transported 612 patients (93.2%), police 10 patients (1.5%), and private vehicles 27 patients (4.1%). Gunshot wounds (GSWs) were more common in police transport, 80% (n = 8), compared with private vehicles, 59% (n = 16), and EMS, 32% (n = 198). The Glasgow coma scale score (GCS) in the emergency department (ED) was lower for patients transported by police, 11.5 (interquartile range [IQR] 3, 15), in relation to EMS, 15 (IQR 14, 15) and private vehicles 15 (IQR 12.5, 15). The 30-day mortality for EMS was 30% (n = 184), 50% (n = 5) for police transport, and 22% (n = 6) for private vehicles. Transport by private vehicle, odds ratio (OR) 0.65, (confidence interval [CI] 0.24, 1.55, p = 0.4) and police OR 2.28 (CI 0.63, 8.3, p = 0.2) were not associated with increased mortality in relation to EMS. Conclusion Non-EMS transports did occur, however with a low incidence and did not affect mortality. GSWs were more common in police transport, and victims had lower GCS scorescores when arriving at the ED, which warrants further investigations of the operational management of shooting victims in Sweden. |
| first_indexed | 2024-03-10T17:09:21Z |
| format | Article |
| id | doaj.art-cc0403c3841f49989b8272253d3ebf98 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-03-10T17:09:21Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-cc0403c3841f49989b8272253d3ebf982023-11-20T10:43:26ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412023-09-013111810.1186/s13049-023-01112-xPrehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business?Mattias Renberg0Martin Dahlberg1Mikael Gellerfors2Amir Rostami3Mattias Günther4Elham Rostami5Department of Anesthesiology and Intensive Care, SödersjukhusetDepartment of Surgery, Södersjukhuset, Karolinska InstitutetDepartment of Perioperative Medicine and Intensive Care, Karolinska University HospitalDepartment for Social Work and Criminology, University of GävleDepartment of Anesthesiology and Intensive Care, SödersjukhusetExperimental Traumatology Unit, Department of Neuroscience, Karolinska InstitutetAbstract Introduction Sweden is facing a surge of gun violence that mandates optimized prehospital transport approaches, and a survey of current practice is fundamental for such optimization. Management of severe, penetrating trauma is time sensitive, and there may be a survival benefit in limiting prehospital interventions. An important aspect is unregulated transportation by police or private vehicles to the hospital, which may decrease time but may also be associated with adverse outcomes. It is not known whether transport of patients with penetrating trauma occurs outside the emergency medical services (EMS) in Sweden and whether it affects outcome. Method This was a retrospective, descriptive nationwide study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 registered in the Swedish national trauma registry (SweTrau) between June 13, 2011, and December 31, 2019. We hypothesized that transport by police and private vehicles occurred and that it affected mortality. Result A total of 657 patients were included. EMS transported 612 patients (93.2%), police 10 patients (1.5%), and private vehicles 27 patients (4.1%). Gunshot wounds (GSWs) were more common in police transport, 80% (n = 8), compared with private vehicles, 59% (n = 16), and EMS, 32% (n = 198). The Glasgow coma scale score (GCS) in the emergency department (ED) was lower for patients transported by police, 11.5 (interquartile range [IQR] 3, 15), in relation to EMS, 15 (IQR 14, 15) and private vehicles 15 (IQR 12.5, 15). The 30-day mortality for EMS was 30% (n = 184), 50% (n = 5) for police transport, and 22% (n = 6) for private vehicles. Transport by private vehicle, odds ratio (OR) 0.65, (confidence interval [CI] 0.24, 1.55, p = 0.4) and police OR 2.28 (CI 0.63, 8.3, p = 0.2) were not associated with increased mortality in relation to EMS. Conclusion Non-EMS transports did occur, however with a low incidence and did not affect mortality. GSWs were more common in police transport, and victims had lower GCS scorescores when arriving at the ED, which warrants further investigations of the operational management of shooting victims in Sweden.https://doi.org/10.1186/s13049-023-01112-xPenetrating traumaTraumaPolicePrehospitalPrivate vehicle |
| spellingShingle | Mattias Renberg Martin Dahlberg Mikael Gellerfors Amir Rostami Mattias Günther Elham Rostami Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business? Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Penetrating trauma Trauma Police Prehospital Private vehicle |
| title | Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business? |
| title_full | Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business? |
| title_fullStr | Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business? |
| title_full_unstemmed | Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business? |
| title_short | Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business? |
| title_sort | prehospital transportation of severe penetrating trauma victims in sweden during the past decade a police business |
| topic | Penetrating trauma Trauma Police Prehospital Private vehicle |
| url | https://doi.org/10.1186/s13049-023-01112-x |
| work_keys_str_mv | AT mattiasrenberg prehospitaltransportationofseverepenetratingtraumavictimsinswedenduringthepastdecadeapolicebusiness AT martindahlberg prehospitaltransportationofseverepenetratingtraumavictimsinswedenduringthepastdecadeapolicebusiness AT mikaelgellerfors prehospitaltransportationofseverepenetratingtraumavictimsinswedenduringthepastdecadeapolicebusiness AT amirrostami prehospitaltransportationofseverepenetratingtraumavictimsinswedenduringthepastdecadeapolicebusiness AT mattiasgunther prehospitaltransportationofseverepenetratingtraumavictimsinswedenduringthepastdecadeapolicebusiness AT elhamrostami prehospitaltransportationofseverepenetratingtraumavictimsinswedenduringthepastdecadeapolicebusiness |