title: Increased mortality associated with EMS transport of gunshot wound victims when compared to private vehicle transport.
abstract: BACKGROUND
  Recent studies suggest that mode of transport affects survival in penetrating trauma patients. We hypothesised that there is wide variation in transport mode for patients with gunshot wounds (GSW) and there may be a mortality difference for GSW patients transported by emergency medical services (EMS) vs. private vehicle (PV).
  
  
  METHODS
  We studied adult (≥16 years) GSW patients in the National Trauma Data Bank (2007-2010). Level 1 and 2 trauma centres (TC) receiving ≥50 GSW patients per year were included. Proportions of patients arriving by each transport mode for each TC were examined. In-hospital mortality was compared between the two groups, PV and EMS, using multivariable regression analyses. Models were adjusted for patient demographics, injury severity, and were adjusted for clustering by facility.
  
  
  RESULTS
  74,187 GSW patients were treated at 182 TCs. The majority (76%) were transported by EMS while 12.6% were transported by PV. By individual TC, the proportion of patients transported by each category varied widely: EMS (median 78%, interquartile range (IQR) 66-85%), PV (median 11%, IQR 7-17%), or others (median 7%, IQR 2-18%). Unadjusted mortality was significantly different between PV and EMS (2.1% vs. 9.7%, p<0.001). Multivariable analysis demonstrated that EMS transported patients had a greater than twofold odds of dying when compared to PV (OR=2.0, 95% CI 1.73-2.35).
  
  
  CONCLUSIONS
  Wide variation exists in transport mode for GSW patients across the United States. Mortality may be higher for GSW patients transported by EMS when compared to private vehicle transport. Further studies should be performed to examine this question.
authors: Department of Surgery, Howard University Hospital, Washington, DC, United States. Electronic address: zafar.nabeel@gmail.com.
authors: Syed Nabeel
authors: SN
authors: Zafar
authors: Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Anesthesiology/Critical Care Medicine (ACCM), The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health, United States. Electronic address: ahaider1@jhmi.edu.
authors: Adil H
authors: AH
authors: Haider
authors: Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Anesthesiology/Critical Care Medicine (ACCM), The Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: ksteve14@jhmi.edu.
authors: Kent A
authors: KA
authors: Stevens
authors: Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: nikrm@jhmi.edu.
authors: Nik
authors: N
authors: Ray-Mazumder
authors: Department of Surgery, University of Arizona, Tucson, AZ, United States. Electronic address: neerhem@gmail.com.
authors: Mehreen T
authors: MT
authors: Kisat
authors: Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: eschnei1@jhmi.edu.
authors: Eric B
authors: EB
authors: Schneider
authors: Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: achi3@jhmi.edu.
authors: Albert
authors: A
authors: Chi
authors: Department of Anesthesiology, Divisions of Trauma Anesthesiology and Adult Critical Care Medicine, University of Maryland & R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States. Electronic address: sgalvagno@anes.umm.edu.
authors: Samuel M
authors: SM
authors: Galvagno
authors: Department of Surgery, Howard University College of Medicine, Washington, DC, United States. Electronic address: ecornwell@howard.edu.
authors: Edward E
authors: EE
authors: Cornwell
authors: Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Anesthesiology/Critical Care Medicine (ACCM), The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Emergency Medicine, The Johns Hopkins University School of Medicine, United States. Electronic address: defron@jhmi.edu.
authors: David T
authors: DT
authors: Efron
authors: Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Anesthesiology/Critical Care Medicine (ACCM), The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Emergency Medicine, The Johns Hopkins University School of Medicine, United States. Electronic address: ehaut1@jhmi.edu.
authors: Elliott R
authors: ER
authors: Haut
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D001336:Automobiles; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards; D005260:Female; D005440:Fluid Therapy; D005676:Gravity Suits; D017052:Hospital Mortality; D006801:Humans; D007103:Immobilization; D015601:Injury Severity Score; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods / Q000592:standards; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000401:mortality* / Q000628:therapy
keywords: Comparative effectiveness research; Emergency medical services; Firearm injury; Gunshot wounds; Mortality; Pre hospital care; Pre hospital transport; Trauma