"Cop Drops"

[PotatoMedic]

Philadelphia Police Begin Transporting Trauma Victims

"According to the directive, police must take people with serious penetrating injuries - meaning gunshot or stab wounds - to the nearest trauma center, and they are instructed not to wait for Fire Department paramedics."


What do you guys think of this? Interesting read and the first time I have heard of a policy regarding it.

 

[ffemt8978]

Saw it on a episode of COPS about 15 years ago. They transported a shooting victim in the back of their paddy wagon.

 

[Meursault]

This sounds like a great idea, provided they call ahead. I don't have the study comparing outcomes for patients transported by homeboy ambulance vs. EMS handy, but it was interesting.

 

[STXmedic]

Our Tac Medic trained PD guys are being told to do this. Most the area trauma surgeons are on board with it, too.

 

[MMiz]

From what I understand it's not uncommon in some cities with an extended EMS response time. If I was an officer that suffered a GSW I'd want my partner to throw me in the back and get me to the hospital.

 

[Handsome Robb]

We had a pair cops transport a girl with an arterial bleed a couple years back.

Outlying area, they came on scene first, recognized the severity of the situation, tossed a TQ on, put her in the back with one of the cops while the other one hauled *** to the trauma center. They were at the ER faster than the ambulance would have been on scene.

It's definitely appropriate under the right circumstances.

 

[WTEngel]

All things being equal, if both units (paramedic and police) were on scene at the same time, I would say go with the ambulance.

As long as the cops are trained in basic procedures to control bleeding it all seems well and good. I wonder if these are two man units, so one cop can attend to the patient and control bleeding, while the other drives, or if the patient is in the back alone.

The first person who bleeds out in the back of a cop car en route to the hospital and arrives without a pulse will probably cause quite an issue. At least if you bleed out and lose pulses in the back of an ambulance, they can begin resuscitation, not matter how in vain the situation may seem. CPR quality is crap enough in the back of an ambulance, I can't imagine what it is in the back of a cop car.

I am on the fence on this issue. I think dramatic delays in trauma transport are obviously bad, but it is hard for me to picture where the risk and benefit curves cross in this situation to justify which course of action to take. I am definitely interested in seeing the forthcoming data.

Do you think they can use this as a way to justify paramedics arresting potential criminals in certain cases where the police might be delayed?

 

[Handsome Robb]

All things being equal, if both units (paramedic and police) were on scene at the same time, I would say go with the ambulance.

As long as the cops are trained in basic procedures to control bleeding it all seems well and good. I wonder if these are two man units, so one cop can attend to the patient and control bleeding, while the other drives, or if the patient is in the back alone.

The first person who bleeds out in the back of a cop car en route to the hospital and arrives without a pulse will probably cause quite an issue. At least if you bleed out and lose pulses in the back of an ambulance, they can begin resuscitation, not matter how in vain the situation may seem. CPR quality is crap enough in the back of an ambulance, I can't imagine what it is in the back of a cop car.

I am on the fence on this issue. I think dramatic delays in trauma transport are obviously bad, but it is hard for me to picture where the risk and benefit curves cross in this situation to justify which course of action to take. I am definitely interested in seeing the forthcoming data.

Do you think they can use this as a way to justify paramedics arresting potential criminals in certain cases where the police might be delayed?

You bring up a very valid point. In the case here there were two officers, one in back with the girl and one driving but most cops are single man units in my area, usually two man units are an FTO and a Trainee, I'm not sure how other departments do it.

 

[medicsb]

All things being equal, if both units (paramedic and police) were on scene at the same time, I would say go with the ambulance.

As long as the cops are trained in basic procedures to control bleeding it all seems well and good. I wonder if these are two man units, so one cop can attend to the patient and control bleeding, while the other drives, or if the patient is in the back alone.

The first person who bleeds out in the back of a cop car en route to the hospital and arrives without a pulse will probably cause quite an issue. At least if you bleed out and lose pulses in the back of an ambulance, they can begin resuscitation, not matter how in vain the situation may seem. CPR quality is crap enough in the back of an ambulance, I can't imagine what it is in the back of a cop car.

I am on the fence on this issue. I think dramatic delays in trauma transport are obviously bad, but it is hard for me to picture where the risk and benefit curves cross in this situation to justify which course of action to take. I am definitely interested in seeing the forthcoming data.

Do you think they can use this as a way to justify paramedics arresting potential criminals in certain cases where the police might be delayed?

I have personally helped pull victims from PD cars in Philly and the policy couldn't get anymore "load and go". They literally just put the person in the back seat and haul-*** to the hospital (no one is in the back with the victim). A good number of the victims are dead by the time they arrive. Who knows if they died enroute or not. I doubt PD routinely checks for a pulse.

However, the time is on their side considering that PD can be on scene of a shooting in 2-4 minutes on average and then be to a trauma center in 3-5 on average. PFD EMS has an average response time of 7-8 minutes and that's not counting chute time (PFD only measures dispatch to arrival, not call to arrival). So if the patient dies in the back of the cop car, chances are they would have died in the street waiting for EMS.

I don't know the exact policies of the hospitals, but they do pronounce quite a few from the start, but they also crack a lot of chests. One study found that you had double the chances of surviving an ED thoracotomy if you arrived via police car. The other study (not limited to ED thoracotomies) showed no difference in survival after adjusting for confounders.

So, despite no airway protection, no O2, no IV, and no restraints in the back seat of the police car, they are no worse than if brought by ambulance and may actually have a survival advantage.

What isn't mentioned in the article is that PPD sometimes takes the patient to a non-trauma center (personally seen it) and they sometimes take patients who are not victims of penetrating trauma. I've seen them bring in seizing kids, and a coworker of mine saw them bring in a guy from a motorcycle accident (yep). Fortunately the cases of them bringing in blunt trauma is pretty rare, as far as I know.

Overall, I think its a good policy, but I think that the medical community (EMS, actually) needs to have better oversight and at least provide the PPD with some education on who to transport and who not to transport. Right now, its rather haphazard.

[Also, just so there's no confusion - I do not work for PFD nor have I ever.]

 

[Tigger]

I suppose it might be nice if they put some sort of "blowout kit" in each cruiser and provided some rudimentary training in its use. Even a few 5x9s and a TK could make a fairly big difference if someone is bleeding that badly. I can't say I'm much for the idea of throwing them in back and just driving, but if it's increasing survival rates then what can you say?

Also are the hospitals notified of the police's arrival or do they just show up? Seems like notification of the trauma team is important here.

 

[AnthonyM83]

In my area, I would definitely want to be transported by police vehicle. Even if I were shot on-scene.

My partners all know that unless I have an unmanageable airway or some other extreme circumstance, to drive me straight to the trauma center...by cop car or front seat of ambulance. I'll do the same for them if they'd like, even if it means losing a license or jail time.

A local study showed that patients had a higher survival rate if they went to hospital on their own, PROVIDED that they arrived at a trauma center.

Going 80 to 140 MPH with superior maneuvering and braking without fear of being too rough on ambulance crew in the back will get you to the ER much faster than a heavy ambulance with long stopping/braking/stopping/braking times going only a few miles over the speed limit. Cops are also on the road and are sometimes on-scene before the call even gets forwarded to EMS.

I've been on many scenes with crews spending eons stripping, backboarding, trying to start a line over and over, carrying backboard to gurney, rolling gurney to ambulance, safely driving the bulky ambulance, calling the hospital, etc etc etc.

There are potential downsides, such as arriving to a hospital that is on diversion...


Trying to think of things that might kill me in the backseat that could be reversed by EMS, only tension pneumo comes to mind...In my area trauma centers aren't too far...if it was a 10+ minute trip, though, I might feel differently...

 

[silver]

Injury-adjusted mortality of patients transported by police following penetrating trauma.

http://www.ncbi.nlm.nih.gov/pubmed/21166730

enjoy

 

[Tigger]

The only other concern I have with this is how fast the officers are likely to be driving. Are cops better trained at high speed driving than we are? Generally yes, but if fear and adrenaline take over and the cop is hitting 100 in an urban area weaving in out of traffic, that is also not a good scenario.

 

[AnthonyM83]

The only other concern I have with this is how fast the officers are likely to be driving. Are cops better trained at high speed driving than we are? Generally yes, but if fear and adrenaline take over and the cop is hitting 100 in an urban area weaving in out of traffic, that is also not a good scenario.

Many times better than EMS at high speeds. At least in California, they give very detailed driving instruction by officers who teach that specific driving course over and over and know all kinds of driving theory. They've not only been to driving school, but to school on becoming a driving instructor. Versus what we get locally...a few cones in a large parking lot. Pass the maze and you're done. One day.

Also, I doubt most cops are going to be going too crazy. The 100+ would probably be on freeways and when transporting their own. But also remember cops don't have the do the full stop and go at each light (though they should) because they can't do a hard stop or maneuver around people who just stop in the middle of the road. Ambulances lose a lot of time on acceleration/deceleration and slow maneuvering around stopped cars. Not necessarily the max speed (cops aren't going to be maxing out for every patient...they've also probably seen more shootings than we have...for each one shooting I have, here's six to ten cops or so...)

 

[CANDawg]

I'm curious about how the law would handle situations like this. It seems there would need to be a loophole built in.

Cops aren't medical professionals, which means they don't have a scope of practice. (Other than if they're registered and up-to-date EMRs, which I doubt is 100% of all cops.)

That would mean they would be covered under good Samaritan laws AFAIK, which only covers you with basic first aid, and not under gross misconduct. I suspect that if you had c-spine injuries and a member of the public threw you in the back of their car and sped to the hospital, you would probably have a case to sue them if you ended up paralyzed. Would the cops be any different?

I may be totally off base, but its something to consider.

 

[usalsfyre]

I suspect the chances of c-spine injures for penetrating injuries are d@mn near nil...

 

[Aidey]

Quick, where is that study showing that you harm way more patients using backboards in penetrating trauma then you help?

 

[CANDawg]

Ahhh, I missed the 'penetrating injuries' part, and assumed this was regarding all trauma. MVA's and the like.

Makes more sense now. :lol:

EDIT: That said, my point still has merit.... to a point. Especially with the litigious environment the US has, I suspect that law enforcement would want to do some significant research into their legal liabilities if they are going to encourage their officers to do this.

 

[usalsfyre]

Legal protection from liability of government entities, especially when they're not receiving remuneration for the service, is pretty broad usually.

 

[325Medic]

We as in the tac medics for the MIRT / warrant squad are training the officers to stop bleeding / place T.Q.'s and pack wounds with Q.C. in the possibility that the P.D. transport themselves in our area. We are in the burbs of Philly but in a realitive bad area of the burbs and our medical director produced plenty of info regarding bleeding and how it kills fast, as we all know including the officer, I think it was in S.C. that bleed to death from a thigh wound during transport. It has worked out well for the officers and now are teaching it to all officers on the dept. The P.D. here have transported a few seizing kids and a couple penetrating traumas but we have a "medic" or 3 in every township at one time.

325.