increasing (earlier) lethality of gunshots and knife wounds

[J.R.@A&M]

https://hub.jhu.edu/2018/04/16/prehospi ... 3-69578297

The "gun violence" rhetoric aside, I thought this was interesting. If I understand it correctly, it analyzes fatal shootings and stabbings over time. The finding is that over time, more of the deaths are happening before arriving at a hospital, especially for stabbings.

What explains the quicker (pre-hospitalization) lethality of stabbings in the near term? I assume that the response time of EMS is unchanged, although I don't think the article addressed that.

"After adjusting for factors such as injury severity, hypotension, and other clinically relevant factors, the research team found that patients in the late period had higher odds of prehospital death—four times higher for gunshot wounds and nearly nine times higher for stab wounds—and lower odds of in-hospital deaths. The overall mortality of gunshot and stab wounds remained stagnant, but the location of death (prehospital versus in-hospital) appears to have changed."

[The Annoyed Man]

https://hub.jhu.edu/2018/04/16/prehospi ... 3-69578297

The "gun violence" rhetoric aside, I thought this was interesting. If I understand it correctly, it analyzes fatal shootings and stabbings over time. The finding is that over time, more of the deaths are happening before arriving at a hospital, especially for stabbings.

What explains the quicker (pre-hospitalization) lethality of stabbings in the near term? I assume that the response time of EMS is unchanged, although I don't think the article addressed that.

"After adjusting for factors such as injury severity, hypotension, and other clinically relevant factors, the research team found that patients in the late period had higher odds of prehospital death—four times higher for gunshot wounds and nearly nine times higher for stab wounds—and lower odds of in-hospital deaths. The overall mortality of gunshot and stab wounds remained stagnant, but the location of death (prehospital versus in-hospital) appears to have changed."

At the ER where I worked, it was not uncommon to transport someone who had been shot or stabbed to death to our ER, even when they were well past the point of recussitation.....more or less just to get the body off the street. They are pronounced DOA by an ER doc upon arrival at the ER. Their bodies were later recovered from the ER by the coroner’s office. But I also know that some bodies were never brought to our ER, and instead were picked up directly by the coroner’s office at the scene. Perhaps the increasing statistics are simply a reflection in a changing protocol, where fewer and fewer bodies are being transported to hospitals before being officially pronounced dead, and being picked up at the scene by coroners instead?

[anygunanywhere]

https://hub.jhu.edu/2018/04/16/prehospi ... 3-69578297

The "gun violence" rhetoric aside, I thought this was interesting. If I understand it correctly, it analyzes fatal shootings and stabbings over time. The finding is that over time, more of the deaths are happening before arriving at a hospital, especially for stabbings.

What explains the quicker (pre-hospitalization) lethality of stabbings in the near term? I assume that the response time of EMS is unchanged, although I don't think the article addressed that.

"After adjusting for factors such as injury severity, hypotension, and other clinically relevant factors, the research team found that patients in the late period had higher odds of prehospital death—four times higher for gunshot wounds and nearly nine times higher for stab wounds—and lower odds of in-hospital deaths. The overall mortality of gunshot and stab wounds remained stagnant, but the location of death (prehospital versus in-hospital) appears to have changed."

At the ER where I worked, it was not uncommon to transport someone who had been shot or stabbed to death to our ER, even when they were well past the point of recussitation.....more or less just to get the body off the street. They are pronounced DOA by an ER doc upon arrival at the ER. Their bodies were later recovered from the ER by the coroner’s office. But I also know that some bodies were never brought to our ER, and instead were picked up directly by the coroner’s office at the scene. Perhaps the increasing statistics are simply a reflection in a changing protocol, where fewer and fewer bodies are being transported to hospitals before being officially pronounced dead, and being picked up at the scene by coroners instead?

Back when I was a paramedic we couldn’t pronounce anyone as deceased. We had to transport to the ER. EMS agencies these days can pronounce death on the scene in a lot of instances. This happened at our church on Holy Thursday.

[Daddio-on-patio]

The researchers note that correlation does not imply causation, and the increased prehospital deaths may be explained by a number of other factors, including lack of access to a Level I trauma center or differences in prehospital interventions. Because of this, Sakran says, researchers need to examine markers of these findings in a more robust manner, such as merging data from police departments, medical examiners' office, and hospitals.

"This is a perfect example of why we need federal research dollars, which would allow us to investigate such findings and develop solutions that are specifically tailored to this problem," Sakran adds.

Aha. Just ambiguous enough to request more Federal funds for research. Go figure.
I do agree with previous comments regarding the change in pre-hospital service. Cardiac arrest as a result of traumatic injury is, unfortunately, highly unlikely to be reversed. The agencies that myself and acquaintances work with do not work (field vernacular) the majority of traumatic arrest victims. At times we will contact a local ER, give report to a physician, and ask to stop treatment. Approximately 90% of the time I have done this the physician has given authority to end efforts. If a patient dies inside your MICU due to traumatic injury you may have to sit with the body, on scene, until a JP or coroner comes out and determines time of death based on interviewing you. Then wait for a funeral home to receive the body. Been stuck like that for 3 hours before.