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Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business?

INTRODUCTION: Sweden is facing a surge of gun violence that mandates optimized prehospital transport approaches, and a survey of current practice is fundamental for such optimization. Management of severe, penetrating trauma is time sensitive, and there may be a survival benefit in limiting prehospi...

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Autores principales: Renberg, Mattias, Dahlberg, Martin, Gellerfors, Mikael, Rostami, Amir, Günther, Mattias, Rostami, Elham
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492387/
https://www.ncbi.nlm.nih.gov/pubmed/37684674
http://dx.doi.org/10.1186/s13049-023-01112-x
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author Renberg, Mattias
Dahlberg, Martin
Gellerfors, Mikael
Rostami, Amir
Günther, Mattias
Rostami, Elham
author_facet Renberg, Mattias
Dahlberg, Martin
Gellerfors, Mikael
Rostami, Amir
Günther, Mattias
Rostami, Elham
author_sort Renberg, Mattias
collection PubMed
description INTRODUCTION: Sweden is facing a surge of gun violence that mandates optimized prehospital transport approaches, and a survey of current practice is fundamental for such optimization. Management of severe, penetrating trauma is time sensitive, and there may be a survival benefit in limiting prehospital interventions. An important aspect is unregulated transportation by police or private vehicles to the hospital, which may decrease time but may also be associated with adverse outcomes. It is not known whether transport of patients with penetrating trauma occurs outside the emergency medical services (EMS) in Sweden and whether it affects outcome. METHOD: This was a retrospective, descriptive nationwide study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 registered in the Swedish national trauma registry (SweTrau) between June 13, 2011, and December 31, 2019. We hypothesized that transport by police and private vehicles occurred and that it affected mortality. RESULT: A total of 657 patients were included. EMS transported 612 patients (93.2%), police 10 patients (1.5%), and private vehicles 27 patients (4.1%). Gunshot wounds (GSWs) were more common in police transport, 80% (n = 8), compared with private vehicles, 59% (n = 16), and EMS, 32% (n = 198). The Glasgow coma scale score (GCS) in the emergency department (ED) was lower for patients transported by police, 11.5 (interquartile range [IQR] 3, 15), in relation to EMS, 15 (IQR 14, 15) and private vehicles 15 (IQR 12.5, 15). The 30-day mortality for EMS was 30% (n = 184), 50% (n = 5) for police transport, and 22% (n = 6) for private vehicles. Transport by private vehicle, odds ratio (OR) 0.65, (confidence interval [CI] 0.24, 1.55, p = 0.4) and police OR 2.28 (CI 0.63, 8.3, p = 0.2) were not associated with increased mortality in relation to EMS. CONCLUSION: Non-EMS transports did occur, however with a low incidence and did not affect mortality. GSWs were more common in police transport, and victims had lower GCS scorescores when arriving at the ED, which warrants further investigations of the operational management of shooting victims in Sweden.
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spelling pubmed-104923872023-09-10 Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business? Renberg, Mattias Dahlberg, Martin Gellerfors, Mikael Rostami, Amir Günther, Mattias Rostami, Elham Scand J Trauma Resusc Emerg Med Original Research INTRODUCTION: Sweden is facing a surge of gun violence that mandates optimized prehospital transport approaches, and a survey of current practice is fundamental for such optimization. Management of severe, penetrating trauma is time sensitive, and there may be a survival benefit in limiting prehospital interventions. An important aspect is unregulated transportation by police or private vehicles to the hospital, which may decrease time but may also be associated with adverse outcomes. It is not known whether transport of patients with penetrating trauma occurs outside the emergency medical services (EMS) in Sweden and whether it affects outcome. METHOD: This was a retrospective, descriptive nationwide study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 registered in the Swedish national trauma registry (SweTrau) between June 13, 2011, and December 31, 2019. We hypothesized that transport by police and private vehicles occurred and that it affected mortality. RESULT: A total of 657 patients were included. EMS transported 612 patients (93.2%), police 10 patients (1.5%), and private vehicles 27 patients (4.1%). Gunshot wounds (GSWs) were more common in police transport, 80% (n = 8), compared with private vehicles, 59% (n = 16), and EMS, 32% (n = 198). The Glasgow coma scale score (GCS) in the emergency department (ED) was lower for patients transported by police, 11.5 (interquartile range [IQR] 3, 15), in relation to EMS, 15 (IQR 14, 15) and private vehicles 15 (IQR 12.5, 15). The 30-day mortality for EMS was 30% (n = 184), 50% (n = 5) for police transport, and 22% (n = 6) for private vehicles. Transport by private vehicle, odds ratio (OR) 0.65, (confidence interval [CI] 0.24, 1.55, p = 0.4) and police OR 2.28 (CI 0.63, 8.3, p = 0.2) were not associated with increased mortality in relation to EMS. CONCLUSION: Non-EMS transports did occur, however with a low incidence and did not affect mortality. GSWs were more common in police transport, and victims had lower GCS scorescores when arriving at the ED, which warrants further investigations of the operational management of shooting victims in Sweden. BioMed Central 2023-09-08 /pmc/articles/PMC10492387/ /pubmed/37684674 http://dx.doi.org/10.1186/s13049-023-01112-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Original Research
Renberg, Mattias
Dahlberg, Martin
Gellerfors, Mikael
Rostami, Amir
Günther, Mattias
Rostami, Elham
Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business?
title Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business?
title_full Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business?
title_fullStr Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business?
title_full_unstemmed Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business?
title_short Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business?
title_sort prehospital transportation of severe penetrating trauma victims in sweden during the past decade: a police business?
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492387/
https://www.ncbi.nlm.nih.gov/pubmed/37684674
http://dx.doi.org/10.1186/s13049-023-01112-x
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