# "Cop Drops"



## PotatoMedic (Jun 4, 2012)

Philadelphia Police Begin Transporting Trauma Victims

"According to the directive, police must take people with serious penetrating injuries - meaning gunshot or stab wounds - to the nearest trauma center, and they are instructed not to wait for Fire Department paramedics."


What do you guys think of this?  Interesting read and the first time I have heard of a policy regarding it.


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## ffemt8978 (Jun 4, 2012)

Saw it on a episode of COPS about 15 years ago.  They transported a shooting victim in the back of their paddy wagon.


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## Meursault (Jun 4, 2012)

This sounds like a great idea, provided they call ahead. I don't have the study comparing outcomes for patients transported by homeboy ambulance vs. EMS handy, but it was interesting.


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## STXmedic (Jun 4, 2012)

Our Tac Medic trained PD guys are being told to do this. Most the area trauma surgeons are on board with it, too.


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## MMiz (Jun 4, 2012)

From what I understand it's not uncommon in some cities with an extended EMS response time.  If I was an officer that suffered a GSW I'd want my partner to throw me in the back and get me to the hospital.


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## Handsome Robb (Jun 4, 2012)

We had a pair cops transport a girl with an arterial bleed a couple years back.

Outlying area, they came on scene first, recognized the severity of the situation, tossed a TQ on, put her in the back with one of the cops while the other one hauled *** to the trauma center. They were at the ER faster than the ambulance would have been on scene. 

It's definitely appropriate under the right circumstances.


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## WTEngel (Jun 4, 2012)

All things being equal, if both units (paramedic and police) were on scene at the same time, I would say go with the ambulance. 

As long as the cops are trained in basic procedures to control bleeding it all seems well and good. I wonder if these are two man units, so one cop can attend to the patient and control bleeding, while the other drives, or if the patient is in the back alone.

The first person who bleeds out in the back of a cop car en route to the hospital and arrives without a pulse will probably cause quite an issue. At least if you bleed out and lose pulses in the back of an ambulance, they can begin resuscitation, not matter how in vain the situation may seem. CPR quality is crap enough in the back of an ambulance, I can't imagine what it is in the back of a cop car.

I am on the fence on this issue. I think dramatic delays in trauma transport are obviously bad, but it is hard for me to picture where the risk and benefit curves cross in this situation to justify which course of action to take. I am definitely interested in seeing the forthcoming data.

Do you think they can use this as a way to justify paramedics arresting potential criminals in certain cases where the police might be delayed?


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## Handsome Robb (Jun 4, 2012)

WTEngel said:


> All things being equal, if both units (paramedic and police) were on scene at the same time, I would say go with the ambulance.
> 
> As long as the cops are trained in basic procedures to control bleeding it all seems well and good. I wonder if these are two man units, so one cop can attend to the patient and control bleeding, while the other drives, or if the patient is in the back alone.
> 
> ...



You bring up a very valid point. In the case here there were two officers, one in back with the girl and one driving but most cops are single man units in my area, usually two man units are an FTO and a Trainee, I'm not sure how other departments do it.


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## medicsb (Jun 4, 2012)

WTEngel said:


> All things being equal, if both units (paramedic and police) were on scene at the same time, I would say go with the ambulance.
> 
> As long as the cops are trained in basic procedures to control bleeding it all seems well and good. I wonder if these are two man units, so one cop can attend to the patient and control bleeding, while the other drives, or if the patient is in the back alone.
> 
> ...



I have personally helped pull victims from PD cars in Philly and the policy couldn't get anymore "load and go".  They literally just put the person in the back seat and haul-*** to the hospital (no one is in the back with the victim).  A good number of the victims are dead by the time they arrive.  Who knows if they died enroute or not.  I doubt PD routinely checks for a pulse.  

However, the time is on their side considering that PD can be on scene of a shooting in 2-4 minutes on average and then be to a trauma center in 3-5 on average.  PFD EMS has an average response time of 7-8 minutes and that's not counting chute time (PFD only measures dispatch to arrival, not call to arrival).  So if the patient dies in the back of the cop car, chances are they would have died in the street waiting for EMS.  

I don't know the exact policies of the hospitals, but they do pronounce quite a few from the start, but they also crack a lot of chests.  One study found that you had double the chances of surviving an ED thoracotomy if you arrived via police car.  The other study (not limited to ED thoracotomies) showed no difference in survival after adjusting for confounders.  

So, despite no airway protection, no O2, no IV, and no restraints in the back seat of the police car, they are no worse than if brought by ambulance and may actually have a survival advantage.  

What isn't mentioned in the article is that PPD sometimes takes the patient to a non-trauma center (personally seen it) and they sometimes take patients who are not victims of penetrating trauma.  I've seen them bring in seizing kids, and a coworker of mine saw them bring in a guy from a motorcycle accident (yep).  Fortunately the cases of them bringing in blunt trauma is pretty rare, as far as I know.  

Overall, I think its a good policy, but I think that the medical community (EMS, actually) needs to have better oversight and at least provide the PPD with some education on who to transport and who not to transport.  Right now, its rather haphazard.

[Also, just so there's no confusion - I do not work for PFD nor have I ever.]


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## Tigger (Jun 4, 2012)

I suppose it might be nice if they put some sort of "blowout kit" in each cruiser and provided some rudimentary training in its use. Even a few 5x9s and a TK could make a fairly big difference if someone is bleeding that badly. I can't say I'm much for the idea of throwing them in back and just driving, but if it's increasing survival rates then what can you say?

Also are the hospitals notified of the police's arrival or do they just show up? Seems like notification of the trauma team is important here.


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## AnthonyM83 (Jun 4, 2012)

In my area, I would definitely want to be transported by police vehicle. Even if I were shot on-scene. 

My partners all know that unless I have an unmanageable airway or some other extreme circumstance, to drive me straight to the trauma center...by cop car or front seat of ambulance. I'll do the same for them if they'd like, even if it means losing a license or jail time.

A local study showed that patients had a higher survival rate if they went to hospital on their own, PROVIDED that they arrived at a trauma center. 

Going 80 to 140 MPH with superior maneuvering and braking without fear of being too rough on ambulance crew in the back will get you to the ER much faster than a heavy ambulance with long stopping/braking/stopping/braking times going only a few miles over the speed limit. Cops are also on the road and are sometimes on-scene before the call even gets forwarded to EMS.

I've been on many scenes with crews spending eons stripping, backboarding, trying to start a line over and over, carrying backboard to gurney, rolling gurney to ambulance, safely driving the bulky ambulance, calling the hospital, etc etc etc.

There are potential downsides, such as arriving to a hospital that is on diversion...


Trying to think of things that might kill me in the backseat that could be reversed by EMS, only tension pneumo comes to mind...In my area trauma centers aren't too far...if it was a 10+ minute trip, though, I might feel differently...


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## silver (Jun 4, 2012)

Injury-adjusted mortality of patients transported by police following penetrating trauma.

http://www.ncbi.nlm.nih.gov/pubmed/21166730

enjoy


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## Tigger (Jun 4, 2012)

The only other concern I have with this is how fast the officers are likely to be driving. Are cops better trained at high speed driving than we are? Generally yes, but if fear and adrenaline take over and the cop is hitting 100 in an urban area weaving in out of traffic, that is also not a good scenario.


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## AnthonyM83 (Jun 4, 2012)

Tigger said:


> The only other concern I have with this is how fast the officers are likely to be driving. Are cops better trained at high speed driving than we are? Generally yes, but if fear and adrenaline take over and the cop is hitting 100 in an urban area weaving in out of traffic, that is also not a good scenario.


Many times better than EMS at high speeds. At least in California, they give very detailed driving instruction by officers who teach that specific driving course over and over and know all kinds of driving theory. They've not only been to driving school, but to school on becoming a driving instructor. Versus what we get locally...a few cones in a large parking lot. Pass the maze and you're done. One day.

Also, I doubt most cops are going to be going too crazy. The 100+ would probably be on freeways and when transporting their own. But also remember cops don't have the do the full stop and go at each light (though they should) because they can't do a hard stop or maneuver around people who just stop in the middle of the road. Ambulances lose a lot of time on acceleration/deceleration and slow maneuvering around stopped cars. Not necessarily the max speed (cops aren't going to be maxing out for every patient...they've also probably seen more shootings than we have...for each one shooting I have, here's six to ten cops or so...)


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## CANDawg (Jun 5, 2012)

I'm curious about how the law would handle situations like this. It seems there would need to be a loophole built in. 

Cops aren't medical professionals, which means they don't have a scope of practice. (Other than if they're registered and up-to-date EMRs, which I doubt is 100% of all cops.)

That would mean they would be covered under good Samaritan laws AFAIK, which only covers you with basic first aid, and not under gross misconduct. I suspect that if you had c-spine injuries and a member of the public threw you in the back of their car and sped to the hospital, you would probably have a case to sue them if you ended up paralyzed. Would the cops be any different?

I may be totally off base, but its something to consider.


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## usalsfyre (Jun 5, 2012)

I suspect the chances of c-spine injures for penetrating injuries are d@mn near nil...


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## Aidey (Jun 5, 2012)

Quick, where is that study showing that you harm way more patients using backboards in penetrating trauma then you help?


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## CANDawg (Jun 5, 2012)

Ahhh, I missed the 'penetrating injuries' part, and assumed this was regarding all trauma. MVA's and the like. 

Makes more sense now. :lol:

EDIT: That said, my point still has merit.... to a point. Especially with the litigious environment the US has, I suspect that law enforcement would want to do some significant research into their legal liabilities if they are going to encourage their officers to do this.


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## usalsfyre (Jun 5, 2012)

Legal protection from liability of government entities, especially when they're not receiving remuneration for the service, is pretty broad usually.


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## 325Medic (Jun 5, 2012)

We as in the tac medics for the MIRT / warrant squad are training the officers to stop bleeding / place T.Q.'s and pack wounds with Q.C. in the possibility that the P.D. transport themselves in our area. We are in the burbs of Philly but in a realitive bad area of the burbs and our medical director produced plenty of info regarding bleeding and how it kills fast, as we all know including the officer, I think it was in S.C. that bleed to death from a thigh wound during transport. It has worked out well for the officers and now are teaching it to all officers on the dept. The P.D. here have transported a few seizing kids and a couple penetrating traumas but we have a "medic" or 3 in every township at one time.

325.


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## mycrofft (Jun 5, 2012)

Silver's NIH study cited above then supports grab and go as a treatment mode for trauma. Don't be afraid to question paradigms or statistics.

dbo789, Good Sam generally does not apply to people on the clock, and it can apply to more than first aid if the Samaritan is trained and equipped. coincidentally, above it.  If an untrained public member threw you into their car and you were paralyzed, (we had a slightly similar case in Calif not too long ago), and you acted in good faith (thought there was a danger that required transport) and knew no better (no first aid training, or suspected other medical complications requiring go-fast treatment), then you might be spared as well.
A LE officer on the job would by definition not be in "Good Sam" mode.


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## Veneficus (Jun 5, 2012)

usalsfyre said:


> I suspect the chances of c-spine injures for penetrating injuries are d@mn near nil...



I would be interested in seeing a study on cops without immobilization outcomes and EMS with...

I bet I already know the answer though 

Let's face it. In many areas, cops will be on scene and at the hospital before EMS. 

If the patient is truly in a time sensitive life threatening situation, the police I think are a better alternative.


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## Medic2409 (Jun 5, 2012)

Veneficus said:


> Let's face it. In many areas, cops will be on scene and at the hospital before EMS.
> 
> If the patient is truly in a time sensitive life threatening situation, the police I think are a better alternative.



Especially in my area, where the ambo's are forced to go the speed limit, and only the speed limit.


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## bigbaldguy (Jun 5, 2012)

Sounds like it would save a ton of time. Not only are the police on scene well ahead of ambos but lets face it if it's a shooting we generally have to stage as well. I've staged for 30+ minutes waiting for a scene to be declared "safe". This eliminates what 10 to 15 minutes? That's a lot of time in a patient with a major bleed.


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## Veneficus (Jun 5, 2012)

Medic2409 said:


> Especially in my area, where the ambo's are forced to go the speed limit, and only the speed limit.



The speed limit has very little to do with it.

It has been known for several years that a lights and siren response or transport doesn't save significant time, much less make a difference in most outcomes.

The insurance institute of America had staistics dating back to 2002 that lights and sirens increases the chance of an accident 300%. (they didn't even count wake effect accidents then)

The specifics of driving a car are also very different from a top heavy box. 

Were it up to me, the ambulance would also have to obey all traffic signals and laws without exception.

Perhaps if there was better mandatory driving education for EMS my opinion might be different.


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## Shishkabob (Jun 5, 2012)

That just ignoring the fault of the other drivers on the road with inattention, inability to hear due to volume of their stereo, and just plain old not caring about the emergency vehicles, with some people even purposefully trying to slow them down.


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## Akulahawk (Jun 5, 2012)

mycrofft said:


> Silver's NIH study cited above then supports grab and go as a treatment mode for trauma. Don't be afraid to question paradigms or statistics.
> 
> dbo789, Good Sam generally does not apply to people on the clock, and it can apply to more than first aid if the Samaritan is trained and equipped. coincidentally, above it.  If an untrained public member threw you into their car and you were paralyzed, (we had a slightly similar case in Calif not too long ago), and you acted in good faith (thought there was a danger that required transport) and knew no better (no first aid training, or suspected other medical complications requiring go-fast treatment), then you might be spared as well.
> *A LE officer on the job would by definition not be in "Good Sam" mode.*


That LEO may, however, be protected by governmental immunity, if his/her employer authorizes transport in emergent situations. In California, with regard to "rescues," the lay public has been specifically covered for that as well. The court case that threw-out rescue as a GS covered event spawned a legislative fix.


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## Akulahawk (Jun 5, 2012)

Linuss said:


> That just ignoring the fault of the other drivers on the road with inattention, inability to hear due to volume of their stereo, and just plain old not caring about the emergency vehicles, with some people even purposefully trying to slow them down.


I've seen people ignore my ambulance, only to part like the Red Sea and make lots of room when CHP or other LE car provides an escort. It's like LE is the traffic Moses...


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## Akulahawk (Jun 5, 2012)

Tigger said:


> The only other concern I have with this is how fast the officers are likely to be driving. A*re cops better trained at high speed driving than we are?* Generally yes, but if fear and adrenaline take over and the cop is hitting 100 in an urban area weaving in out of traffic, that is also not a good scenario.


Yes. They are given extremely detailed and thorough training in driving at high speeds. Their training is far better than what EMS gets. EVOC is just the beginning for them. They also learn how to fight with their car...h34r:


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## DPM (Jun 5, 2012)

Akulahawk said:


> Yes. They are given extremely detailed and thorough training in driving at high speeds. Their training is far better than what EMS gets. EVOC is just the beginning for them. They also learn how to fight with their car...h34r:



I fight with my car too... but my car is 18 and a total B*stard


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## DrParasite (Jun 6, 2012)

This is not new at all.  I was told that Philly PD has vans that drive around picking up shooting victims all night.  It was described to me as scoop the injured in a reeves, throw the injured in the back, drive fast to the hospital, and drop off on the ER stretcher.  It's probably been going on for at least the past decade.

Philly EMS is so overworked, an 8 minute response is a pipe dream on busy nights.  The FD circle of death is very prevalent (and articles have been written about it), so all too often there is no ambulance available.

IIRC, the studies show homeboy taxi has a higher save rate than EMS, because it's all scoop and run, and homeboys don't jerk around on scene starting an IV.  as my PHTLS instructor told me, these injured need bright lights and cold steel, not a paramedic.

Now if Philly would put on more ambulances, it would help with the problem.   or triage calls better.  or actually staff enough units to handle the volume.  or stop being abused by the FD for run numbers, and not funding them properly to do the job.  But again, why would any of the city leaders want to do that?


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## AnthonyM83 (Jun 6, 2012)

Veneficus said:


> Were it up to me, the ambulance would also have to obey all traffic signals and laws without exception.



There are others who feel that way, too.

I can't support that for my local area, though. 

A 5 minute "code 3" run can take 30 minutes in local traffic. Actually, it's taken a coworker *25 minutes* to go one large city block at prime rush hour. Going code 3 at 10mph under the speed limit, it would have taken may 50 seconds...


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## DrParasite (Jun 6, 2012)

Veneficus said:


> Were it up to me, the ambulance would also have to obey all traffic signals and laws without exception.


which would be great, except than everyone would complain more that the ambulance took too long, and people died as a result.  remember, right or wrong, response times is what people use as a benchmark for how good an emergency response agency is.


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## medicsb (Jun 6, 2012)

DrParasite said:


> This is not new at all.  I was told that Philly PD has vans that drive around picking up shooting victims all night.  It was described to me as scoop the injured in a reeves, throw the injured in the back, drive fast to the hospital, and drop off on the ER stretcher.  It's probably been going on for at least the past decade.



That is some interesting Philly folk-lore.  Though some PPD vans have reeves, most of the victims are transported in the back of a patrol car.  

Anyhow, I'd be curious to know exactly when this practice started, but PPD used to take people to the hospital before PFD did EMS and I believe they did it for quite a while after PFD started up their EMS.  Chances are that they have always done this and that the reason that it has endured is because "thats the way they do things".  Also, I think the infamous episode of COPS was from 1992.


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## silver (Jun 6, 2012)

medicsb said:


> That is some interesting Philly folk-lore.  Though some PPD vans have reeves, most of the victims are transported in the back of a patrol car.
> 
> Anyhow, I'd be curious to know exactly when this practice started, but PPD used to take people to the hospital before PFD did EMS and I believe they did it for quite a while after PFD started up their EMS.  Chances are that they have always done this and that the reason that it has endured is because "thats the way they do things".  Also, I think the infamous episode of COPS was from 1992.



The article I posted states that nearly two decades ago (as of 2010) the city implemented a policy authorizing police to transport penetrating trauma.


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## medicsb (Jun 6, 2012)

silver said:


> The article I posted states that nearly two decades ago (as of 2010) the city implemented a policy authorizing police to transport penetrating trauma.



Yeah, I saw that.  However, with this being Philadelphia, something tells me that the PD doesn't necessarily need a policy to do anything.  (Though they probably have tons of policies telling them what not to do.)  Maybe they did start doing it just 2 decades ago... or they were always doing it to some degree and someone decided to make it officially condoned at some point.  Basically I'm really skeptical that this started with a policy.


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## Veneficus (Jun 6, 2012)

medicsb said:


> Yeah, I saw that.  However, with this being Philadelphia, something tells me that the PD doesn't necessarily need a policy to do anything.  (Though they probably have tons of policies telling them what not to do.)  Maybe they did start doing it just 2 decades ago... or they were always doing it to some degree and someone decided to make it officially condoned at some point.  Basically I'm really skeptical that this started with a policy.



I know a retired police chief from my home area that said during the 70s most of the EMS was performed by PD, because many of the FDs were volunteer, but there were cops on duty 24/7.

He also said that it was probably one of the biggest mistakes in terms of public relations and perception PDs ever made by ditching it on fire as soon as the professional depts started forming. 

If PD provided EMS is one region during that era, it is not unrealistic it was done elsewhere too.

If I am shot and a cop is on sceen, please put me in the cruiser and drive me to the hospital rather than wait for an ambulance to respond.


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## EpiEMS (Jun 6, 2012)

I'd like to see an article or two on homeboy ambulances, if anybody has found any.


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## Medic2409 (Jun 7, 2012)

Might as well do away with EMS as a whole, eh?


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## Veneficus (Jun 7, 2012)

Medic2409 said:


> Might as well do away with EMS as a whole, eh?



No, it is just a matter of realizing when EMS has intervention that will help and when it will not.

There have been numerous articles published on BLS having better outcomes in major trauma than ALS. 

It is usually attributed to rapid transport, though I am willing to bet there are also a few cases of excessive fluid therapy with ALS.

In a truly time sensitive injury, transport without intervention or minimal intervention to definitive intervention is more important than waiting for response, packaging, and transport.

look at cardiac arrest, the most important intervention is immediate bystander CPR. Showing up in less than 8:59 90% of the time isn't going to replace that.


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## Medic2409 (Jun 7, 2012)

So, instead of getting rid of EMS, we need:

Better and more in depth training.
More EMT's and Medics.

Problem solved.

Nah...easier to just get rid of EMS.


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## Veneficus (Jun 7, 2012)

Medic2409 said:


> So, instead of getting rid of EMS, we need:
> 
> Better and more in depth training.
> More EMT's and Medics.
> ...



It wouldn't be the first vocation lost to history for refusing to change in order to remain valuable to an evolving society.


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## AnthonyM83 (Jun 7, 2012)

EpiEMS said:


> I'd like to see an article or two on homeboy ambulances, if anybody has found any.


http://www.ncbi.nlm.nih.gov/pubmed/8611068
This was done in an urban setting. They compared similar injury severities. 

This one just has to do with supporting that non-EMS transport gets them to the hospital faster:
http://www.ncbi.nlm.nih.gov/pubmed?term=ems vs non-ems transport

Combine that with this one supporting that shorter transport times is favorable for patient survival:
http://linkinghub.elsevier.com/retrieve/pii/0735675795900780?via=sd&cc=y

Starts to paint a picture...

Also keep in mind that these principles might not apply for all or even most settings.





Medic2409 said:


> So, instead of getting rid of EMS, we need:
> 
> Better and more in depth training.
> More EMT's and Medics.
> ...


We can keep EMS week very much. It's good for our local hospital / pre-hospital relations. Often the only time we get to sit down and talk with staff while pre-occupied with patients. And I enjoy the free food, TYVM.

The better education is a given year-round


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