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Program

WSU Medical School

Training Level

Medical Student

Institution

Wayne State University

Abstract

Introduction: Current data suggest trauma patients arriving via private vehicle transport (PVT) have improved outcomes forpenetrating trauma compared to patients arriving via EMS. These studies suggest patients that utilize EMS overprivate vehicle transport (PVT) have worse outcomes and are described as older, hypotensive, higher injury severityscore (ISS) and lower GCS. While previous studies focus on national data, regional behaviors likely play a role in selection of PVT. This study tests the hypothesis that these findings will also be reflected on a regional level in Detroit. Methods: This study was conducted at an academic, regional, Level 1 Trauma Center in Detroit from 2013-2017. Inclusion criteria were trauma patients presenting to the hospital utilizing PVT that were admitted, died in the emergencydepartment, or transferred out of hospital. Exclusion criteria includes patients transferred from outside hospitals,burn patients and pediatric patients defined as age less than 15 years old. Patients with the same inclusion and exclusion criteria utilizing EMS were the comparison group (N=4568, PVT n=1498). The data were obtained from a trauma registry and chart review. To describe statistical significance (p<0.01), chi-square tests were utilized for nominal data, and independent samples t-tests were utilized for continuous data. Results: 32.8% of trauma patients arrived via PVT. Of the 16% with penetrating injuries, 39.5% arrived via PVT. Patients arriving via PVT were found to have a significantly higher GCS and lower injury severity, intubation rate, activation level, poly-trauma rate, injury to critical anatomic locations, length of stay, ICU admissions and deaths. Significant differences were also observed with anticoagulation use, self-pay patients, and cognitively impaired patients. Race,age, gender, preexisting comorbidities, intoxication status, vital signs on arrival, and disposition to operating roomor general admission were not different between groups. Conclusions: Findings suggest patients arriving by PVT are in less critical condition with improved outcomes than those arriving by EMS as evidenced by higher GCS, lower intubation rates, lower activation levels, fewer admissions to ICU and lower mortality rates. Though this may suggest a survival benefit, the observation may be because patients arechoosing to call EMS because they recognize a more critical condition. These findings are similar to studies conducted on a national level, however, the rate of utilization of PVT is significantly higher in Detroit suggesting the role of regional factors in PVT utilization.

Publication Date

5-2019

Who Skips the Ambulance? A Study Examining Which Patients Choose Private Vehicle Transport Over EMS in Trauma

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