Calling 911 May Not Be the Quickest Route to Hospital After a Gunshot Wound
After being shot or stabbed, new research shows that sometimes people are better off dragging themselves into the back seat of a friend’s Ford Taurus and telling him to book it to the nearest hospital than calling 911 and waiting for an ambulance.
A study published in the Journal of the American Medical Association from the National Injury Databank looked at 103,029 penetrating injuries – specifically stab wounds and gunshot wounds – in American urban areas. Among these cases, collected from 2010 to 2012, 9.4 percent were fatal. After adjusting for the severity of injuries and other factors, patients who arrived at the hospital by car were 60 percent less likely to die than those who arrived by ambulance, said Michael W. Wandling, MD, lead author of the study.
Wondling, a clinical scientist at the American College of Surgeons, says he could not “broadly recommend” a friend to take you to an ambulance instead of waiting for an emergency doctor a few minutes after a penetrating injury, but “in some circumstances, that’s something to think about. “
The study did not look at the response time of an ambulance, but Wandling says speed is likely a key factor in saving someone who has been stabbed or wounded. Outpatient transportation includes calling the dispatcher, the connection of this dispatcher with the ambulance team and the travel time of this brigade to the scene. It takes much less time to get into a friend’s car and apologize for the blood stains.
The study suggests that even with early intervention in the form of a tourniquet and the ability of ambulances to navigate normal traffic with lights and sirens on, the likelihood of survival is reduced by waiting for these first steps in the process.
But Scott Moore, a Massachusetts attorney who advises outpatient services, doesn’t think skipping an ambulance is good advice. He says non-medical professionals should not be involved in transportation in a medical emergency. “What if something happens along the way?” he asked.
Rob Lawrence, chief operating officer of the Richmond, VA, Ambulance Administration, says he is skeptical about the study because it lacks information on response times to ambulance calls. He says minority communities sometimes do not use the emergency services due to mistrust of the authorities or police interference. Some study participants may have organized their own trip to the emergency room, “although an ambulance could be right around the corner.”
The study population does include a disproportionately large number of minorities, of whom 47.9% were black, 26.3% white, and 18.4% Hispanic. This reflects the population that ends up in urban trauma centers with these injuries. For the same reason, the patients studied were predominantly male (87.6 percent of them) and had an average age younger than the population average: 32.3 years. Wondling says that in calculating numbers, he controlled race as a factor.
While Lawrence says more research is needed to improve ambulance response times in some areas, he believes that a layperson should not take an injured person to a hospital. “Since there is no professional in the car, your friend could bleed and die, and the consequences could be catastrophic,” he says.
Wandling, author of the study, says the study should be used as an opportunity to look at the entire emergency response system and find ways to reduce response times.
In the meantime, if you’re going to go alone, Wandling has a few tips.
“It’s important to transport [the victim] safely,” he says. “It won’t do anyone any good if you run through a red light and have an accident.” Also use GPS: “Getting lost won’t help.”
Finally, you might want to google “trauma center near me”. Not all emergency departments are capable of removing a bullet from someone’s chest 20 minutes after they walk through the door. If someone is nearby, “find a hospital with trauma or neurosurgeons, or a hospital that can call within minutes,” Wandling says.
He adds that penetrating wounds are unique and should not be applied to other medical emergencies. In the event of a heart attack, CPR and defibrillation may be the best first response to treatment. Some gunshot and stab wounds are associated with life-threatening blood loss that can only be stopped with prompt intervention by a surgeon. “These injuries are associated with isolated injuries to large blood vessels,” says Wandling. “They need to be treated surgically in a very short time.”