Rethinking trauma transport: Mortality and length of stay in non-EMS transported patients

The pre-hospital care and transport of trauma patients by trained providers remains a cornerstone of practice in the United States. Some studies suggested a survival benefit for patients transported via police or private vehicles, particularly in severe penetrating injuries. Prior work has focused on penetrating trauma and relied on outdated data. Further, most studies compare EMS with police, often excluding private transport.. This study evaluates whether non-EMS transport offers a risk-adjusted mortality or length of stay benefit using a large regional dataset across an entire decade.

This retrospective cohort study utilized the Michigan Trauma Quality Improvement Program data (2014-2024). Adults with trauma activation were included; transfers, direct admissions, air transport, and dead on arrival were excluded. 69,092 patients met our eligibility criteria. We used demographic data and measures of injury severity to assess for differences between the groups, and then multivariable logistic regression to assess risk-adjusted outcomes of interest.

The mean age of our population was 50.5 (S.D 21.3) years, and the mean New Injury Severity Score was 13.3 (S.D 9). The cohort was predominantly male (67.3 %) and White (67.6 %), with the majority sustaining blunt trauma (87.3 %). In the cohort, 87.6 % were transported by EMS, 0.4 % by police, and 12 % by private vehicles. Police transported patients were significantly more in shock, (mean shock index=0.8). Private transport had lower odds of mortality than ground EMS (OR 0.35, CI 0.29-0.43). Both private (LOS ratio 0.69, 95 % CI 0.67-0.70) and police transport (LOS ratio 0.81, 95 % CI 0.74-0.90) were associated with shorter LOS.

In our region, private transport of injured patients is associated with substantially lower odds of mortality and shorter length of stay compared to EMS. It is difficult to dismiss the idea that if it can be done safely, private transport should be considered as part of stakeholder discussions to improve trauma outcomes, particularly in urban settings. Police transport demonstrated a shorter length of stay, though its impact on mortality was not clear. Future research should address gaps in prehospital timing, evaluate specific EMS interventions, and explore how system-level adaptations can optimize outcomes across different transport modalities.