Amid air raids, it’s wise to “keep calm and carry on.” When ablaze, certainly “stop, drop, and roll.” And in the case of a stabbing or shooting, it may be best to “scoop and run.” At least, that’s the takeaway from a new study in JAMA Surgery.
A mad dash to the hospital in a private ride—the scoop and run—may be better for survival than waiting for emergency responders, Johns Hopkins researchers report. In fact, stabbing and gunshot victims who caught their own lift to the hospital were 62 percent less likely to die than those who called for an ambulance.
The finding fits with the obvious fact that time is vital to trauma victims. But slicing deeper, it suggests that for those with such “penetrating injuries,” sophisticated prehospital interventions are of limited value. It may just be all about timing. Thus, healthcare systems may better serve their communities by adopting “scoop and run” over “stay and stabilize”-type policies for these trauma patients.
“Private vehicle transportation to a trauma center represents perhaps the most basic form of prehospital care, where no intervention is performed and only transportation is provided,” the authors write. “In essence, private vehicle transport is a pure example of the ‘scoop and run’ approach to prehospital trauma care.”
For the study, the Hopkins researchers compared transport methods within urban trauma systems to see if there was a perk to a private ride. From more than 2 million national trauma patient records, the researchers picked out a little more than 100,000 that involved gunshot and stabbing wounds between 2010 and 2012. Altogether, those patients were treated at 298 hospital systems that are within the 100 most populous urban centers in the US.
The researchers looked at survival rates prior to hospital discharge for each patient and came up with a model of the data. They accounted for a variety of factors, most importantly injury severity, as well as heart rate, blood pressure, age, sex, race/ethnicity, and insurance status.
The patients in the study sample were 87 percent male. Black and Hispanic patients were more likely to arrive at a trauma center in a private vehicle, while whites were more likely to show up in an ambulance. Patients with stab wounds were more like to take a private vehicle than those with gunshot wounds.
With the data adjusted for death risks, the researchers found that trauma victims who arrived in a private vehicle were 62 percent less likely to die than similarly injured patients who arrived in an ambulance. Splitting the injury types, those with gunshot wounds were 55 percent less likely to die, and those with stab wounds were 68 percent less likely to die if they arrived in a private vehicle. The association held up for all but the most minor injuries
The study has limitations. For one thing, the records don’t include transit time for those arriving by private vehicle. So it’s impossible to compare transit speeds directly and determine if it’s the sole or largest factor accounting for the difference in survival. That said, the authors argue that private rides are “unlikely” to take any longer than using emergency medical services, which involves waiting for responders to arrive and receiving prehospital care.
And of course, the data is only for these severe types of trauma: gunshot and stab wounds. Survival rates for other conditions and types of trauma may not benefit from private rides. Those include conditions that could benefit from prehospital treatments, such as CPR or defibrillation.
But in all, the researchers conclude that there is a clear link between catching a lift to the hospital and a lowered risk of death from gunshot and stab wounds. They call for more research into whether all health systems should adopt “scoop and run” policies for these patients.
“The goal of trauma systems is to deliver optimal care to injured patients,” they conclude. An important part of accomplishing this is determining what constitutes optimal care in each trauma system because it may be different.”
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