By Daphne Sashin
Getting Patients to Lifesaving Care After Police Transport
James Glatts, BSN, CEN
Seconds count when Philadelphia police officers pull up to the Emergency Department at Penn Presbyterian Medical Center (PPMC) with a gunshot or stabbing victim. Thanks to a longstanding partnership between law enforcement and trauma centers across the city including PPMC, a fast-moving chain of survival has begun to get this patient to the hospital: The officers have already saved valuable minutes. Once they get to the hospital, the emergency staff know just what to do next.
A team of three – typically a combination of ED technicians, security officers, and nurses – dons protective equipment. Each assumes a different role to slide the patient out of the vehicle and onto a stretcher as safely and quickly as possible. Once inside the hospital vestibule, the team makes a quick “hard stop” for a security officer to check the patient for any weapons, before they’re off to the trauma bay, where lifesaving measures begin. All the PPMC emergency technicians and many nurses have been trained on this police drop-off process.
That wasn’t the case just a few years ago, before emergency and trauma nurse James Glatts, BSN, CEN, embarked on a project to standardize the drop-off process – making care safer for patients and staff alike.
‘Scoop and Run’
Philadelphia is one of the only cities where police rush gunshot and stabbing victims to trauma centers without waiting for paramedics, a practice known as “scoop and run.” Police are typically first to the scene and can get patients to a trauma center before an ambulance would be able to arrive. When there is extensive and rapid blood loss, timely transport to a trauma center can make the difference between life and death.
Twice as many Philadelphia patients are now brought to trauma centers by police than by EMS professionals, with comparable survival rates, according to a study published in early 2021 by researchers at the Perelman School of Medicine at the University of Pennsylvania. At PPMC, in 2020, 136 gunshot-wound patients were transported by police, compared with 50 by EMS.
But while police transport has been the norm in Philadelphia since 1987, until recently, hospital staff lacked training on how to most efficiently get patients into care once they arrived in the back of a police cruiser, rather than an ambulance. Rhonda Browning, BSN, TCRN, has served 18 years as an emergency and trauma nurse, first at the Hospital of the University of Pennsylvania (HUP) and then PPMC. She didn’t mince words as she recalled a typical scene: “I’m 58 years old, and you have me going out to the back of a police car, picking a 200-pound man up out of the car with blood everywhere. Usually they’re either on the floor or the back seat, and I’m trying to move fast,” said Browning, who now works in HUP’s post-anesthesia care unit.
In these critical moments, she was not only worried about getting patients to care as quickly as possible, but also about her own health and safety — injuring her back, or worse.
Things came to a head on Sept. 16, 2016, when a gunman in West Philadelphia shot a city police sergeant, a Penn police officer, and four other people. Police brought the five survivors to PPMC, where Glatts, a few years out of nursing school, was working the night shift. He watched as petite and older nurses did their best to extricate patients from the vehicles.
There had to be a better way, Glatts thought.
The System
With the mentorship of ED Clinical Nurse Specialist Jacob Weissenburger, MSN, CCRN, and support from ED Nurse Manager LeighAnn Mazzone, MSN, CEN, Glatts got to work.
“The goal was to provide a system so that staff were more comfortable, and to increase the efficiency by which we were extricating patients,” he said. “The whole point of the police transport is to get patients to care as fast as possible, and if we’re taking time trying to get them out, it’s defeating the purpose.”
Glatts and Weissenburger spent months reviewing research on “scoop and run” policies and existing EMS techniques for “extrications,” the term for taking patients out of vehicles.
In 2017, Glatts borrowed several vehicles from the police department and recruited about 20 staff volunteers from the emergency and security departments for a simulation exercise.
The simulation participants determined that three people with set responsibilities can easily get almost anybody out of a vehicle. One person identifies where the patient’s head is — because it’s easier to lift somebody by their torso than their feet – and a second person helps pull or push the patient out. The third person drives the stretcher, making sure it’s positioned so the patient is optimally oriented to receive chest X-rays.
They also worked out what to do when a larger patient is brought in a police car, versus an SUV or van. Even at its lowest position, a stretcher sits several inches higher than the back seat of a sedan, so it can be challenging to lift a heavier patient onto the stretcher.
It had also become clear that with multiple ED entrances, police didn’t always know where to drop off patients, so the nurses created a clearly marked police stopping zone by the ambulance bays.
Another critical improvement made as a result of the simulation was the “hard stop” in the ED vestibule to search for any weapons on the patient.
“The biggest thing that helped was standardizing the process to be able to say, ‘When a police car comes up into the driveway, we’re going to do the same thing every single time,’” Weissenburger said.
Implementing the New Methods
Since 2018, the drop-off routine has been part of ED nurses’ annual education series and is included in new employee orientation binders for ED technicians and certified nursing assistants.
“Everybody knows the routine now. No one is teaching them on the fly how to pull patients out,” Browning said. “It was a huge improvement that made a big difference.”
While Glatts wasn’t able to collect extensive data, he knows the system has shaved at least a few seconds off the time from police drop-off to the ED. Trauma surgeon Mark Seamon, MD, said the improvements have no doubt benefited patients.
“The processes … have been established and perfected over the years with one goal in mind – to stop bleeding and repair injuries as quickly and as safely as possible,” Seamon said. “This saves lives.”
And this process improvement could be useful to help patients brought to the hospital in private vehicles, not just police cars, as former PPMC Trauma Program Director John Gallagher, DNP, has pointed out. Based on that potential to help other hospitals adapt their processes, Glatts and Weissenburger presented the project at Penn Medicine’s annual trauma conference in 2018 and its annual Emergency Medicine Research Day in 2019. Recently, along with Mazzone; Director of Nursing, Practice and Education Margaret Mullen-Fortino, PhD, MSN; and Nurse-Scientist Pamela Z. Cacchione, PhD, CRNP, they wrote an article about the project for the Journal of Emergency Nursing.
Through the shared governance model, the nursing leadership team encourages nurses to be involved in guiding how they practice, Mazzone said: “They are the ones at the bedside and living it every day so they should be the ones identifying opportunities for improvement and developing innovative ways to make the improvements. We are there as a resource to help guide them. James identified an opportunity to improve the way we get patients out of a vehicle for both staff and patient safety and he acted on it.”
This is what nurses do – they innovate every day, said Gallagher, now a professor in the School of Nursing at the University of Pittsburgh. “Innovation doesn’t have to be some bold invention. A lot of times, it’s coming up with more efficient processes,” he said. “When you have good people and they come up with good ideas, the best thing to do is get out of the way and support them.”