Why you should care
Because when you’re bleeding, you want the quickest way to help.
One of the worst things imaginable has just happened: You’ve been shot. Your first thought is to reach for your phone and call 911. Nothing is better than the ambulance, right? Turns out, the next time you’re facing a medical trauma, you might want to consider grabbing an Uber or a taxi.
Why? A recent study by Johns Hopkins University, published in JAMA Surgery, found:
Gunshot and stabbing victims are 62 percent less likely to die when transported by private vehicles.
The study examined data, collected by the American College of Surgeons’ National Trauma Data Bank, from 103,029 patients with a gunshot or stab wound. It found an overall 2.2 percent mortality rate for patients transported via private vehicle — taxi, ride-sharing program, a friend’s car — compared with 11.6 percent for ground emergency medical services and ambulance.
EMS providers are required to give patients IV fluids, but for stabbing or gunshot victims, it often wastes time and could increase their risk of dying.
Time and EMS protocol are to blame for the lower survival rate for patients transported by ambulance, says Dr. Elliott Haut, an associate professor of surgery and emergency medicine at the Johns Hopkins University School of Medicine and the paper’s senior author. If you’re only six blocks from the hospital when you get shot, and your friend drives, you can be there in minutes, Haut says. But, he adds, if you call 911, valuable treatment time can be lost. The dispatcher also sends the police to ensure it’s safe for the ambulance to come into the area — to make sure, for example, a potential gunman or perpetrator is gone.
Paramedics must follow medical procedures established by their state, city or county. But, Haut says, these treatments aren’t always helpful to people with gunshot or stab wounds. For instance, most EMS providers are required to give patients IV fluids, but for stabbing or gunshot victims, it often wastes time and could increase their risk of dying by causing them to bleed more.
So, should you opt for an Uber over an ambulance if you’ve been shot? Not necessarily, says Stuart Spitalnic, an emergency medicine doctor at Brown University. While he agrees that lifesaving interventions by EMS personnel are rare, he warns against taking a private vehicle to a trauma center. “Back of the car, quick transport is only better” when you’re certain nothing will happen en route that could be corrected by a trained EMS provider, Spitalnic says, and it’s almost impossible to know ahead of time which decision is the right one — “though it is easy to say which was correct in retrospect.”
It’s also dangerous to make sweeping generalizations about every trauma system, says Dr. Medell Briggs-Malonson, director of quality of emergency medicine at UCLA Health and founder and CEO of IPA Healthcare Solutions in Redondo Beach, California. Her recommendation? Trauma systems need to take a look at their own data and see how they can improve their processes.
Transportation by private vehicle is not the best option in rural areas where the nearest trauma center could be miles away, Haut points out, or when there are mass causalities, as in an active shooter situation. But in some trauma situations, calling an ambulance is a lifesaving move, he says. Everyone has been taught to call 911, but consider other options if you’ve been shot or stabbed and know the location of the nearest trauma center — ERs are not trauma centers — and that you’re close enough to get there quickly by private vehicle.
This map from the American Trauma Society shows the location of all U.S. trauma centers.