Background
Hemorrhage control is a primary determinant of survival after penetrating trauma.1–3 Accordingly, a key goal of trauma system improvement is to minimize prehospital time.4–6 In urban areas near trauma centers, at-scene prehospital interventions may delay transport with little benefit. This is supported by evidence demonstrating that patients transported in private vehicles have better survival outcomes when compared with those transported by emergency medical services (EMS).7 This is likely because, unlike EMS, bystanders are not delayed by the need for notification, dispatch, and travel. Police on patrol are often first to arrive at the scene of an injury. Direct hospital transport by police has demonstrated its potential to improve survival outcomes after penetrating injuries.8–10 However, little is known about the broader impact of police transport on patients, police officers, and trauma centers.11
Philadelphia, Pennsylvania, was the first US municipality to codify a ‘scoop and run’ policy in 1987.12 13 This policy authorizes non-medical police personnel to transport patients to the nearest trauma center without waiting for EMS in cases of ‘a serious penetrating wound, eg, gunshot, stab wound, and similar injuries of the head, neck, chest, abdomen’.14 By 2015, over 50% of patients with penetrating injuries arrived to one of the city’s eight trauma centers in a police vehicle.8 15 Philadelphia has the highest police transport rate for any US city,16 17 followed by Sacramento and Detroit,18 and more than 60% of all US police hospital transports occur in Philadelphia. Other cities are beginning to adopt police transport policies to meet the emergency medical needs of their residents.16
Police transport upends many of the usual expectations for prehospital patient care and understanding its full effects can inform trauma systems seeking new strategies to reduce the impact of penetrating injuries. In Philadelphia, for example, patients with penetrating injuries are predominately young Black men who may be at higher risk for mortality after trauma and postacute morbidities like depression and post-traumatic stress disorder.19–22 Qualitative evidence has illustrated how some injured Black men associate police transport and their interactions with law enforcement prior to reaching a trauma center with additional pain and feelings of dehumanization.23 24 Police transport may also pose underappreciated hazards to officers who provide injury first response with minimal medical training and equipment. Lastly, no studies have assessed variations in police transport and access to trauma care across a municipality or the effect on trauma care processes at a receiving center. To our knowledge, no study has evaluated police transport beyond hospital survival and length of stay.
In this study, we examine the practice, context, and social perception of police transport in Philadelphia, as a case study of the municipality with the longest and most prevalent use of police transport as a prehospital strategy. To do so, we combined a quantitative analysis of retrospective trauma registry data with a prospective exploratory qualitative analysis to achieve two distinct but complementary aims. The quantitative arm of this study aimed to identify the influence of geography, neighborhood sociodemography and crime incidence on prehospital transportation for victims of penetrating injuries over 10 years in Philadelphia. We hypothesized that the distribution of police versus EMS transport would differ by neighborhoods of the city and would be associated with the sociodemographic features and crime incidence of those neighborhoods.4 In the qualitative arm of this study we used qualitative interviews to develop an in-depth description the perceived advantages and disadvantages of ‘scoop and run’ as it is interpreted by injured people, police, and trauma clinicians working in the city’s trauma center emergency departments (EDs).25 26 This approach allows us to identify the perceived trade-offs of police transport in practice that we might not have expected a priori and serves to generate hypotheses for future testing.