Shots Fired: When a Police Car Becomes an Ambulance

If a "shots fired" call goes out over the radio, it’s a good bet police will arrive on scene before EMS providers.

And with penetrating-trauma patients, where moments really do count, which option sounds better: waiting for an ambulance to arrive while the patient bleeds out, or cops loading the patient into the back of a squad car and transporting to the nearest trauma center themselves?

There’s evidence that supports the practice of police transport, and one need look no further than the city of Philadelphia.

More than a decade ago the city gave the OK to police to transport penetrating-trauma patients. It was a process that largely happened organically, says C. Crawford Mechem, MD, EMS medical director for the Philadelphia Fire Department and professor of emergency medicine at the Perelman School of Medicine at the University of Pennsylvania Hospital, but was born of necessity.

The Philadelphia Fire Department is the lone 9-1-1 EMS response agency for the city of Philadelphia. During peak hours 50 ambulances run. But with a 2012 EMS call volume of nearly 281,000, with five ambulances going on more than 8,000 runs each, it’s obvious that, at times, no ambulances are immediately available. It makes sense, then, for cops who respond to calls with penetrating-trauma patients to transport without waiting for EMS backup.

Philadelphia, like many other large cities, is no stranger to gun violence. In 2012 there were 331 homicides in the city, according to Mechem, 82% of which were due to firearms. It’s therefore become practice for police, if they’ve arrived on scene and no ambulance is present, to often just load and go—at times even as the ambulance arrives.

If this seems strange, it’s only because the practice isn’t more common. But it does happen, all over the world, and to great effect following the Aurora, CO, shootings on July 20, 2012. Twenty-three trauma patients were transported to the University of Colorado Hospital Emergency Department that day—12 by police, eight by personal motor vehicle and three by EMS. Within 45 minutes of the shootings, nine police cars and one ambulance arrived at the ED with victims. Police transport clearly made a difference.

Studies of Philadelphia's system show penetrating-trauma patients transported by Philadelphia Fire Department ambulance have a lower probability of survival when compared to police transport. Even when controlling for injury severity and other variables, the outcomes for patients transported by Philly police are equivalent to those transported by PFD, according to Mechem.

As with anything, there are pros and cons to the practice. An obvious upside is that, at times, trauma patients can be transported to the ED faster than if police were to wait for EMS—often in half the time it takes to dispatch EMS and transport the patient via ambulance, according to Mechem. The practice also gets police off emotionally charged scenes.

"However, one con is that the patient is being transported by non-medical personnel, with little to no medical care provided prior to hospital arrival," Mechem says. "In addition, as the practice falls outside the EMS system [police vehicles are not licensed ambulances, and police officers generally are not functioning as state-certified EMS providers], there is no ongoing medical oversight."

Additional concerns include:

• Unsecured patients.
• The possibility police will transport to a non-trauma center.
• The possibility the shooting may actually be police-related.
• The practice may foster resentment among EMS providers, especially if they’re pulling up to a scene right as police are leaving with the patient.
• There is less incentive for the city to provide more resources to EMS so it can handle these patients on its own.
• Transport by police is not reimbursed.

While police transport in Philadelphia is a long-standing practice, and those few minutes saved may have also saved lives, Mechem believes it’s ideally not a model for other systems to emulate. "It frequently will result in trauma patients getting to the hospital more rapidly than if police waited for EMS to arrive," he says. "However, I feel it reflects the need for more resources to be put toward EMS to better fulfill its mission."

Still, the patients will always be there, even if the EMS resources aren’t. Other EMS systems may want to consider allowing police to transport penetrating-trauma victims if it can potentially save lives.

Jason Busch is an associate editor for EMS World.