Waiting for an Ambulance Could Be Hazardous to Your Health

When adjusting for differences in injury severity, patients with gunshot or stabbing injuries were 62% less likely to die when transported by private vehicle compared to EMS.

Gunshot and stabbing victims’ odds for survival improve significantly if they’re taken to a trauma center by a private car instead of waiting for an ambulance, a new study shows.

The report, published today in JAMA Surgery, highlights the importance of studying the effects of transport, EMS services and other prehospital interventions by specific injury type.

“Time is truly of the essence when it comes to certain kinds of injuries and our analysis suggests that, for penetrating injuries such as knife and gun wounds, it might be better to just get to a trauma center as soon as possible in whatever way possible,” says Elliott Haut, MD, an associate professor of surgery and emergency medicine at the Johns Hopkins University School of Medicine and the paper’s senior author.

“For certain types of injury, it might be best to call the police, Uber or a cab — however you can get to the trauma center fastest,” he said.

Haut and colleagues examined American College of Surgeons data on 103,029 patients at least 16 years old who entered a trauma center between 2010 and 2012 for a gunshot or stab wound and were transported to the trauma center by ground ambulance or private vehicle. The data were gathered from 298 level I and level II trauma centers within the 100 most populous metro areas.

Approximately 16.4% of all patients were transported by private vehicle. The analysis found an overall 2.2% mortality rate for patients transported via private vehicle, compared to 11.6% for ground EMS.

Gunshot victims transported by private vehicle saw a lower mortality rate (4.5% versus 19.3%), as did stab victims (0.2% versus 2.9%). When adjusting for differences in injury severity, patients with penetrating injuries were 62% less likely to die when transported by private vehicle compared to EMS.

“Unlike CPR and defibrillation for heart attacks, the type of damage done in penetrating trauma often can’t be reversed in a prehospital setting. This study supports other studies that prehospital interventions can actually result in less favorable outcomes for certain types of injuries,” says Michael W. Wandling, MD, an American College of Surgeons Clinical Scholar in Residence, general surgery resident at the Northwestern University Feinberg School of Medicine and the study’s first author.