Does private vehicle transport in trauma really save you time and money?

Introduction: Current data suggest trauma patients arriving via private vehicle transport (PVT) have improved outcomes compared to patients arriving via EMS due to quicker hospital arrival. Though some researchers have speculated that this may be due to a quicker arrival to the hospital, arrival by PVT may actually impair resuscitation efforts due to the lack of pre-hospital triage leading to delayed mobilization of teams, patient drop-offs at the wrong location, more frequent transfers to another facility, and the transport of patients who may have otherwise been declared dead on scene. This study hypothesizes PVT actually lengthens time to care, impairs resuscitation efforts, and increases overall costs due to the lack of pre-hospital triage. Methods: This is a single-site retrospective study conducted at an academic, regional, Level 1 Trauma Center in Detroit from 2013-2017. Inclusion criteria were trauma patients presenting to the hospital utilizing PVT that were admitted, died in the emergency department, or transferred out of hospital. Exclusion criteria include patients transferred from outside hospitals. Patients with the same inclusion and exclusion criteria utilizing EMS transportation were the comparison group (N=4997, PVT n=1782). The data were obtained from a trauma registry and chart review. To describe statistical significance (p\u3c0.01), chi-square tests were utilized for nominal data and independent samples t-tests were utilized for continuous data. Results: In total, 36% of trauma patients utilized PVT. Of the 11% of patients were transferred out of the hospital, 60% arrived by PVT. The vast majority (76%) of patients transferred were burn or pediatric patients. The overall rate of DOA was 3%, 89% of which arrived by EMS. There was no significant difference in time from arrival to disposition from the ED overall. However time to disposition was shorter for patients arriving by PVT in patients activated at the highest level and longer for patients who were admitted to the ICU. Cost associated with patients who were transferred out of the hospital and those pronounced DOA are described. Conclusions: Though the hypothesis is supported by the significantly higher proportion of patients who arrived by PVT requiring transfer out of our hospital and associated cost, contrary to the hypothesis there was and no difference with time to disposition overall and a lower proportion of patients who were pronounced DOA. A possible explanation is extensive diagnostic studies and procedures for patients arriving by EMS as previous studies demonstrate these patients are more likely to have poly-trauma, injuries to the head or torso and higher injury severity.https://scholarlycommons.henryford.com/merf2019hvc/1007/thumbnail.jp