Urban trauma transport of assaulted patients using nonmedical personnel.

Abstract

To describe one urban trauma transport system to clarify the impact of transport by nonmedical personnel on patient outcome. Retrospective data were assembled over a six-year period through the use of the state trauma registry for an urban county served by seven state-accredited trauma centers. A subset of 4,767 consecutive assaulted patients was analyzed using the TRISS method to estimate survival probability. An unexpected death index (UDI), calculated as the difference between expected (TRISS method) and observed death rates, also was determined. Outcomes for patients transported by fire medics (FMs) vs nonmedical, police personnel (NPs) were compared. FMs transported 2,108 (44%) and NPs transported 1,356 (29%) of the injured assault victims. The FM-transported patients had a lower expected probability of survival than had the NP-transported patients (p < 0.001). This also was true within the penetrating-injury subgroup (p < 0.001), but not the blunt-injury subgroup. The observed death rate was higher for all the FM-transported patients than it was for the NP-transported patients (15% vs 11%; p < 0.01). The UDIs were not different overall, although the NP-transported patients who had blunt trauma had a significantly lower UDI (p < 0.01). NP transport of assaulted patients is generally associated with equivalent outcomes in comparison with FM transport in this urban environment. However, these data also provide evidence of an on-scene implicit triage with more severely injured patients generally transported by FMs.