Nationwide transport by police to trauma centers - An analysis from the Trauma Quality Improvement Program (TQIP)...

Introduction: Timely access to definitive care is critical for trauma outcomes. In several U.S. cities, police transport of penetrating trauma patients has increased. While some studies suggest police transport may offer survival advantages, outcomes vary widely. Despite growing use, limited nationwide data exist on the epidemiological characteristics of patients transported by police, highlighting the need for a better understanding of this atypical transport modality. Methods: We analyzed TQIP registry data from 2017 to 2023 for all encounters with documented arrival by police. De-identified facility codes were used to assess the number of trauma centers associated with this practice. Results: From 2017 to 2023, there were 8,014,737 total encounters, of which, 24,499 (<1%) arrived by police. Of the total police arrivals, 15% had an ISS>15. There were 1331 who were pediatric in age (<18 years). Among the pediatric patients, 19% had an ISS>15. There were 656 documented as interfacility transfers. Blunt trauma accounted for 57% of patient transports whereas penetrating trauma accounted for 36%, the remaining 8% were classified as "other". The most common mechanisms were collisions (42%) followed by firearms (25%). The number of facilities with a documented encounter arriving by police increased throughout the study period from 452 to 520 each year. The median number of encounters arriving by police among facilities with reported police arrivals remained steady at 3. The percentage of facilities by year with at least one encounter arriving by police ranged from 60% to 63%. Throughout the study period, the top 10 facilities had between 258 and 3856 total encounters and accounted for 8,693 of the total police arrival encounters. The top two facilities accounted for the most at 3,856 and 1,585, with the number 3 facility having 787. Conclusions: Arrival by police was rare, however, when it did occur most of the time it was for blunt mechanisms and survival was high. A small number of centers saw the majority of police transported patients; typically involving more penetrating mechanisms. This pattern shows that while police transport is not widespread, it plays a notable role in certain regions and deserves more focused study. The use of civilian data for prehospital lessons learned could help enable military use of atypical transport methods.