RESEARCH PROPOSAL

Anna Shaw
Independent Research
2019
Title: Emergency Transportation: Are We Doing it Right?

Introduction and Overview of Research:

Urban violent crime in the United States presents a major public health concern, and is primarily associated
with penetrating trauma, such as gunshot (GSW) or stab wounds. These injuries are severe and require
fast, efficient, and immediate medical attention. In 2018, they were the leading cause of homicides in
Baltimore, Maryland (Baltimore Sun 2018). Typically, when a person experiences penetrating trauma, an
ambulance arrives on-scene to provide basic or advanced life support before transporting them to the
nearest trauma center. However, due to the urgency of penetrating wounds, private transport via a police
officer or a bystander may yield faster transport times for the patient, thus increasing their chance of
survival. The aim of this study was to determine and compare the timeliness of EMS and private transport
times in Baltimore, MD.

Background and Rationale

Urban violent crime is a dire problem that plagues cities every year and presents a major public health
concern in the United States. In 2018 alone, there were 6,010 murders in 72 cities in the United States
(Murders in 72 US cities for 2018). A myriad of solutions have been proposed by health experts and and
policy makers to mitigate this crisis.
One potential solution is to decrease transport times of trauma patients and victims of violent crime to
trauma centers. Emergency Medical Services (EMS) transportation via ambulance is designed to be among
the most efficient methods of transport to definitive care[1] for a patient. It is also intended to minimize
patient mortality rates (What is EMS: A Definition 2011). However, recent studies suggest that private
vehicle transport (PT) may have better outcomes than EMS transportation. Both work on the principle of
scoop and run and stay and play, but it is unclear why private transport may be more beneficial (Huber, S.,
et. al 2016).
Timely access is a key component in the transportation of trauma patients. Medical health professionals
suggest that there is a “golden hour” in which care must be given to a patient within one hour of the injury
for the optimal patient outcome (The Golden Hour - Journal of Emergency Medical Services. 2008). So far,
there has been little data conducted to explore and quantify the differences between EMS and PT in
relation to response and transport times (Hashmi, Z. G, 2019). Existing data suggests that faster transport
times results in fewer prehospital deaths, and PT may be faster and more efficient at transporting trauma
patients. Therefore, the objective of this study was to quantify and compare EMS transport times and PT
times in Baltimore, Maryland, in order to achieve a better understanding of the methods used to transport
victims of penetrating trauma.

Research Methodology:
Research Question
What is the difference in timeliness between private transport and EMS transport for victims of
penetrating trauma in urban areas?
Research Thesis:
Because the study found that private transport is more timely than EMS transport, the EMS transport
system in Baltimore, Maryland, should be improved to reduce EMS response and transport times.
Research Design Model:

1
This data collection method used in this study is a quantitative method that most closely resembles meta
analysis, though the bulk of the data did not come from studies; it came from various online resources.
This data collection method was decided with the help of an advisor because there were many available
online resources that provided the data needed. The data was compiled and transferred from online into a
spreadsheet. It was then synthesized, and conclusions were drawn from it.
Data Collection:
The data was collected from the Baltimore Sun Homicide Map, which contained 290 homicides that
resulted from penetrating trauma across Baltimore, excluding those homicides that resulted from blunt
force, asphyxiation, or unknown injuries. After compiling the information the addresses of the homicides
were entered into Google Maps and the hypothetical transport times were observed, ensuring that the
time of day in which they were observed was consistent with the time of day in which the homicides
occurred. The time it would take for the victim to be driven from the scene to the nearest trauma center
was recorded in the spreadsheet; there were four trauma centers incorporated into the data collection:
Johns Hopkins Hospital (Level I), Johns Hopkins Bayview Medical Center (Level II), Sinai Hospital (Level II),
and Maryland Shock Trauma Center (Primary Adult Resource Center (PARC)).
After the hypothetical private transport times were collected and recorded, the hypothetical EMS
transport times were found. They were found using a type of variable, as there was no available data from
the actual EMS response and transport times from the homicides. In order to do this, the EMS response
times in Baltimore from FY2013 to FY2016 were averaged (12.75 minutes) and added to the hypothetical
private vehicle transport times. After that, the potential time ambulance lights and sirens saves (0.7-3.8
minutes) during transport were deducted, providing the hypothetical EMS transport times (from 911 call
definitive care). The data showed that private transport times are lower than EMS transport times in
Baltimore, MD when EMS response times and L&S are incorporated into the overall transport time.

Product Objectives:
This study focused primarily on the difference in timeliness between private transport and EMS transport,
however it did not consider the effect of the two methods of transport on patient outcome. Therefore,
further research is required. The product of this study is a proposal for further research that would
determine medical professionals’ opinions on how private and EMS transport would affect patient
outcome.

Logistical Considerations:
The product will be written in letter format by the researcher and emailed to a medical professional in the
field for approval. A timeline will be added that outlines the data collection, product development, and
audience distribution.

Approval:

Anna Shaw ___________________________ ________________

Student Signature GT Resource Teacher Signature Advisor Signature

References (if APA); Works Cited (if MLA):

List, using correct bibliographic citation, any sources you cited in-text.
- Huber, S., Crönlein, M., von Matthey, F., Hanschen, M., Seidl, F., Kirchhoff, C., ... & Huber-Wagner, S.
(2016). Effect of private versus emergency medical systems transportation in trauma patients in a mostly
physician based system-a retrospective multicenter study based on the TraumaRegister DGU®.
Scandinavian journal of trauma, resuscitation and emergency medicine, 24(1), 60.

2
- What is EMS: A Definition. (2011, March 06). Retrieved from
https://www.ems1.com/careers/articles/1058440-What-is-EMS-A-Definition/
- Murders in 72 US cities for 2018. (n.d.). Retrieved June 3, 2019, from https://www.americanviolence.org
-The Golden Hour - Journal of Emergency Medical Services. (2008, August 31). Retrieved June 9, 2019, from
https://www.jems.com/articles/2008/08/golden-hour.html
- Hashmi, Z. G.. Personal Communication. February 11, 2019.