Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Despite expectations that emergency medical services (EMS) transport following a gunshot wound (GSW) would improve 30-day mortality compared to transport by private vehicle, the opposite has been found in several studies. In response, EMS has adopted interventions over the past decade to reduce patient mortality. We compared mortality of GSW patients transported by EMS versus private vehicle as these field practice advancements became widespread. 

Methods: We conducted a retrospective cohort study using data from the National Trauma Data Bank (NTDB) from 2007–2021. We included adults (≥ 16 years of age) with GSW injuries transported solely by ground EMS (≤ 2 hours) or by personal vehicle to a Level I or Level II trauma center. The primary outcome was 30-day in-hospital mortality. We also aimed to describe demographic changes over time in these patient populations. A multivariable logistic regression model was developed to estimate the adjusted odds ratio (aOR) of mortality, with demographic and clinical controls. To describe change over time, we performed the multivariable logistic regression model separately within three-year periods. To determine whether the change was significant, we performed the multivariable logistic regression model with the same controls and the addition of an interaction term for transport mode with year group.

Results: Of 355,913 patients, 83.7% were transported by EMS and 16.3% by private vehicle. Unadjusted mortality was consistently higher for EMS patients, ranging from 18.8% (vs 3.7% private vehicle) in 2007–2009 to 19.3% (vs 4.3% private vehicle) in 2019–2021. The aOR for mortality in the EMS cohort decreased from 2.2 (95% CI, 1.7–2.8) in 2007–2009 to 1.6 (95% CI, 1.3–1.8) in 2019–2021. However, this temporal trend was not statistically significant (P = .17).

Conclusion: Our analysis suggests EMS transport remains associated with higher odds of mortality compared to private vehicle transport for patients with gunshot wounds. This may suggest that improvements in EMS clinical and transport practices have not yet proved sufficient to reduce relative mortality, or that there may be differences in injury severity or type of injury that are not adequately accountable from the NTDB data.