title: The evil of good is better: Making the case for basic life support transport for penetrating trauma victims in an urban environment.
abstract: BACKGROUND
  Controversy remains over the ideal way to transport penetrating trauma victims in an urban environment. Both advance life support (ALS) and basic life support (BLS) transports are used in most urban centers.
  
  
  METHODS
  A retrospective cohort study was conducted at an urban Level I trauma center. Victims of penetrating trauma transported by ALS, BLS, or police from January 1, 2008, to November 31, 2013, were identified. Patient survival by mode of transport and by level of care received was analyzed using logistic regression.
  
  
  RESULTS
  During the study period, 1,490 penetrating trauma patients were transported by ALS (44.8%), BLS (15.6%), or police (39.6%) personnel. The majority of injuries were gunshot wounds (72.9% for ALS, 66.8% for BLS, 90% for police). Median transport minutes were significantly longer for ALS (16 minutes) than for BLS (14.5 minutes) transports (p = 0.012). After adjusting for transport time and Injury Severity Score (ISS), among victims with an ISS of 0 to 30, there was a 2.4-fold increased odds of death (95% confidence interval [CI], 1.3-4.4) if transported by ALS as compared with BLS. With an ISS of greater than 30, this relationship did not exist (odds ratio, 0.9; 95% CI, 0.3-2.7). When examined by type of care provided, patients with an ISS of 0 to 30 given ALS support were 3.7 times more likely to die than those who received BLS support (95% CI, 2.0-6.8). Among those with an ISS of greater than 30, no relationship was evident (odds ratio, 0.9; 95% CI, 0.3-2.7).
  
  
  CONCLUSIONS
  Among penetrating trauma victims with an ISS of 30 or lower, an increased odds of death was identified for those treated and/or transported by ALS personnel. For those with an ISS of greater than 30, no survival advantage was identified with ALS transport or care. Results suggest that rapid transport may be more important than increased interventions.
  
  
  METHODS
  Therapeutic study, level IV.
authors: From the Department of Surgery (J.F.R., T.A.S., D.B., E.D.D., L.O.S., A.P., A.J.G.), Temple University School of Medicine, Philadelphia, Pennsylvania; UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences (K.A.H.), La Jolla, California.
authors: Joseph F
authors: JF
authors: Rappold
authors: Kathryn A
authors: KA
authors: Hollenbach
authors: Thomas A
authors: TA
authors: Santora
authors: Dania
authors: D
authors: Beadle
authors: Elizabeth D
authors: ED
authors: Dauer
authors: Lars O
authors: LO
authors: Sjoholm
authors: Abhijit
authors: A
authors: Pathak
authors: Amy J
authors: AJ
authors: Goldberg
mesh_terms: D000328:Adult; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008020:Life Support Care; D008297:Male; D015143:Philadelphia; D016495:Police; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014187:Transportation of Patients; D014193:Trauma Centers; D014505:Urban Population; D014950:Wounds, Penetrating / Q000401:mortality* / Q000628:therapy*