Stop the Bleed—Wait for the Ambulance or Get in the Car and Drive? A Post Hoc Analysis of an EAST Multicenter Trial

<b>Background:</b> The Stop the Bleed campaign gives bystanders an active role in prehospital hemorrhage control. Whether extending bystanders' role to private vehicle transport (PVT) for urban penetrating trauma improves survival is unknown, but past research has found benefit to police and PVT. We hypothesized that for penetrating trauma in an urban environment, where prehospital procedures have been proven harmful, PVT improves outcomes compared to any EMS or advanced life support (ALS) transport.<b>Methods:</b> Post-hoc analysis of an EAST multicenter trial was performed on adult patients with penetrating torso/proximal extremity trauma at 25 urban trauma centers from 5/2019-5/2020. Patients were allocated to PVT and any EMS or ALS transport using nearest neighbor propensity score matching. Univariate analyses included Wilcoxon signed rank or McNemar's Test and logistic regression.<b>Results:</b> Of 1999 penetrating trauma patients in urban settings, 397 (19.9%) had PVT, 1433 (71.7%) ALS transport, and 169 (8.5%) basic life support (BLS) transport. Propensity matching yielded 778 patients, distributed equally into balanced groups. PVT patients were primarily male (90.5%), Black (71.2%), and sustained gunshot wounds (68.9%). ALS transport had significantly higher ED mortality (3.9% vs 1.9%, <i>P</i> = 0.03). There was no difference in in-hospital mortality rate, hospital LOS, or complications for all EMS or ALS only transport patients.<b>Conclusion:</b> Compared to PVT, ALS, which provides more prehospital procedures than BLS, provided no survival benefit for penetrating trauma patients in urban settings. Bystander education incorporating PVT for early arrival of penetrating trauma patients in urban settings to definitive care merits further investigation.

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Publication Details

Journal
The American Surgeon
Published
2024-09-30
DOI
https://doi.org/10.1177/00031348241265135
Citations
2
Primary Topic
Trauma and Emergency Care Studies
Type
article
Field-Weighted Citation Impact
1.38
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article

Stop the Bleed—Wait for the Ambulance or Get in the Car and Drive? A Post Hoc Analysis of an EAST Multicenter Trial

Andrew C. Bernard, James Babowice, Kate Dellonte, Patrick Maluso et al.
2 citations
The American Surgeon
Trauma and Emergency Care Studies
1.38
article

Stop the Bleed—Wait for the Ambulance or Get in the Car and Drive? A Post Hoc Analysis of an EAST Multicenter Trial

Andrew C. Bernard, James Babowice, Kate Dellonte, Patrick Maluso, John T. Simpson, Danielle Tatum, Eric Etchill, Reza Askari, Barbara U. Okafor, M. Chance Spalding, Jason Murry, Jamie Williams, Emma Holler, Kelly Lightwine, James M. Haan, Antony Tatar, Raymond Fang, Ayman Ali, Apoorva Bhupathi, Marsha C. Nelson, Nikolay Bugaev, Kristen D. Nordham, Samantha L. Roche, Dalier R. Mederos, Sharven Taghavi, Jane Keating, Matthew Reeves, Christofer Anderson, Aimee LaRiccia, Mark J. Lieser, Leah C. Tatebe, Scott Ninokawa, Eman A. Toraih, Laura Whittenburg, Emily Bird, Elliott Richard Haut, John D. Berne, Lewis E. Jacobson, Grace Chang, Mark Gamber, David V. Shatz, Sigrid Burruss, Shariq Raza, Michelle Mendiola Plá, Lauren E. Craugh, Michael A. Vella, Matthew M. Carrick, Matthew R. Noorbakhsh, Zoë Maher, Thomas Z. Hayward, Amy J. Goldberg, Scott H. Norwood
article en
2 citations

Abstract

<b>Background:</b> The Stop the Bleed campaign gives bystanders an active role in prehospital hemorrhage control. Whether extending bystanders' role to private vehicle transport (PVT) for urban penetrating trauma improves survival is unknown, but past research has found benefit to police and PVT. We hypothesized that for penetrating trauma in an urban environment, where prehospital procedures have been proven harmful, PVT improves outcomes compared to any EMS or advanced life support (ALS) transport.<b>Methods:</b> Post-hoc analysis of an EAST multicenter trial was performed on adult patients with penetrating torso/proximal extremity trauma at 25 urban trauma centers from 5/2019-5/2020. Patients were allocated to PVT and any EMS or ALS transport using nearest neighbor propensity score matching. Univariate analyses included Wilcoxon signed rank or McNemar's Test and logistic regression.<b>Results:</b> Of 1999 penetrating trauma patients in urban settings, 397 (19.9%) had PVT, 1433 (71.7%) ALS transport, and 169 (8.5%) basic life support (BLS) transport. Propensity matching yielded 778 patients, distributed equally into balanced groups. PVT patients were primarily male (90.5%), Black (71.2%), and sustained gunshot wounds (68.9%). ALS transport had significantly higher ED mortality (3.9% vs 1.9%, <i>P</i> = 0.03). There was no difference in in-hospital mortality rate, hospital LOS, or complications for all EMS or ALS only transport patients.<b>Conclusion:</b> Compared to PVT, ALS, which provides more prehospital procedures than BLS, provided no survival benefit for penetrating trauma patients in urban settings. Bystander education incorporating PVT for early arrival of penetrating trauma patients in urban settings to definitive care merits further investigation.

The American SurgeonVol. 91(2)
Northwestern University (US), Tulane University (US), Johns Hopkins University (US), Johns Hopkins Medicine (US), Mount Sinai Hospital (US), Temple University (US)
Sustainable cities and communities
Openalex Percentile: Top 18%
Trauma and Emergency Care Studies
1.38
DOISourceOpenAlex
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