Written by Andy Hogan
When EMS is not immediately available, transporting adult patients with penetrating injuries in urban settings to trauma centers by police or private vehicle leads to improved survival.
Scoop and run for knife or gun?
Modern EMS guidelines have shifted from a “scoop and run” approach to emphasize on-scene stabilizing care. Certain interventions performed prior to ED arrival have demonstrated morbidity and mortality benefits for conditions including asthma, anaphylaxis, and acute coronary syndrome. Contrary to the trend favoring the “stay and play” philosophy, studies in patients with penetrating trauma suggest common EMS interventions (e.g., IV fluids, intubation) and prolonged scene times may worsen outcomes.
This meta-analysis synthesized several observational studies in adults with penetrating injuries in urban settings, comparing immediate transport in police or private vehicles to waiting for an EMS ambulance. Police transport revealed similar odds of survival to EMS transport for all comers and a survival benefit in the “severely” injured subgroup. Private vehicle transport suggested an overall survival benefit vs. EMS transport. These findings challenge the role of many EMS interventions for penetrating trauma in favor of expeditious transport to a trauma center. Based on these findings, the authors conditionally recommended non-ambulance transport for this specific population when EMS is not immediately available.
Importantly, the meta-analysis is limited by the small number of studies included (n=6 for police, n=2 for private vehicle). Moreover, most studies involving police vehicles were conducted in settings with preexisting “processes to optimize police transport.” This limits generalizability.
How does this change my practice?
As an EMS medical director, I view this population as the exception that proves the “stay and play” rule. In many conditions, EMS interventions do impact patient outcomes. For penetrating trauma, mode of transport is likely a proxy for time to definitive surgical management. Nevertheless, EMS leaders in urban settings with short transport times should re-examine their dispatch and treatment protocols for this population.
Source
Mode of transport and prehospital interventions in urban penetrating trauma: A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2025 Sep 19. doi: 10.1097/TA.0000000000004796. Epub ahead of print. PMID: 41114708.
