title: Prehospital management of gunshot patients at major trauma care centers: exploring the gaps in patient care.
abstract: BACKGROUND
  Prehospital management of gunshot-wounded (GW) patients influences injury-induced morbidity and mortality.
  
  
  OBJECTIVE
  To evaluate prehospital management to GW patients emphasizing the protocol of patient transfer to appropriate centers.
  
  
  METHODS
  This prospective study, included all GW patients referred to four major, level-I hospitals in Mashhad, Iran. We evaluated demographic data, triage, transport vehicles of patients, hospitalization time and the outcome.
  
  
  RESULTS
  There were 66 GW patients. The most affected body parts were extremities (60.6%, n = 40); 59% of cases (n = 39) were transferred to the hospitals with vehicles other than an ambulance. Furthermore, 77.3% of patients came to the hospitals directly from the site of event, and 22.7% of patients were referred from other medical centers. EMS action intervals from dispatchers to scene departure was not significantly different from established standards; however, arrival to hospital took longer than optimal standards. Additionally, time spent at emergency wards to stabilize vital signs was significantly less in patients who were transported by EMS ambulances (P = 0.01), but not with private ambulances (P = 0.47). However, ambulance pre-hospital care was not associated with a shorter hospital stay. Injury Severity was the only determinant of hospital stay duration (β = 0.36, P = 0.01) in multivariate analysis.
  
  
  CONCLUSIONS
  GW was more frequent in extremities and the most patients were directly transferred from the accident site. EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance. Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay. This showed that upgrade of ambulance equipment and training of private ambulance personnel may be needed.
authors.affiliation: Department of Epidemiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, IR Iran ; Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Norouzpour
authors.affiliation: Department of Epidemiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, IR Iran.
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Khoshdel
authors.affiliation: Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Mohammad-Hadi
authors.initials: MH
authors.lastname: Modaghegh
authors.affiliation: Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Gholam-Hossein
authors.initials: GH
authors.lastname: Kazemzadeh
keywords: Emergency Medical Services; Iran; Triage; Wounds and Injuries; Wounds, Gunshot