Split-Second Destination Decisions

This past Sunday night about 2245 hours, a Detroit police officer was shot in the head while responding to a domestic violence call. The Detroit Free Press, in an article identifying the shooter, reported that the incident happened at an apartment complex in the vicinity of the 10000 block of Joy Road near Wyoming Avenue on Detroit’s west side. According to Channel 4 News in Detroit, Rapid Response EMS was dispatched and arrived on scene in less than 60 seconds. The officer was transported, with a police escort, to a level two trauma center,  as reported by another local news source, with the patient being handed over within 22 minutes of the original dispatch. Now, Detroit Police Chief James Craig is asking why the injured officer “wasn’t taken to the closest hospital.”

These are the facts as I have been able to glean them from multiple news reports and summaries. I have no inside knowledge of this particular incident or even any great understanding of Detroit in general, but I believe there are several interesting questions worth a larger discussion here from the perspective of a complete outsider. For those who may have more inside information of this situation, I will point out that I have no interest in any past conflicts that this particular EMS provider has had with the Detroit Fire Department or a memo now resurfacing from an incident last October specifying that injured “Detroit firefighters will be transported by Detroit EMS only.” That is a totally separate matter that relates potentially to medical care, not destination decisions.

A FOX 2 news article made a statement that they are “still looking into why a critically wounded Detroit police officer was taken to a hospital in Dearborn– when there were two hospitals that were closer. At least one of the hospitals that was passed up is better equipped to deal with a gunshot wound to the head [emphasis added].” Another article, updated during my research today, has since made a correction stating, “This story has been updated to clarify that an ambulance driver [sic] did not pass any hospitals while transporting a wounded Detroit police officer.”

The question we in EMS are often forced to answer is what facility is “closest,” however that question does not always have a static answer from every incident. One of the first articles I read on this case printed a thumbnail map (since removed) similar to the image on the left (which you can enlarge by clicking on it.) What immediately struck me was that the shooting occurred at the center of a triangle formed by the three “closest hospitals.”

If we consider distance to be “as the crow flies,” or perhaps more appropriately, “how the medical helicopter flies.” We will get one set of distances and travel times. Here, Henry Ford to the east appears closest in straight-line distance followed by Sinai-Grace to the north and finally Beaumont in Dearborn to the southwest. If we consider road miles of the shortest path, the order changes with Sinai-Grace at 4.8 miles, Henry Ford at 5.6 miles and lastly again, Beaumont at 6.8 miles. However, if distance is measured in drive-time, specific values change (according to my tests using Google Maps) depending on the amount and direction of flow of traffic. In all of my time tests, Sinai-Grace came in dead last due to the number of local street segments traversed and I suspect a large number of traffic signals. These typically narrower streets and signaled intersections are not only slower to travel, but more dangerous when traveled using red lights and sirens (some studies will show this is especially true with a police escort.)

The travel times in my daytime investigation during a typical work week varied with the other two destination hospitals and probably would still be different from a late drive on a Sunday evening. Of some significance in comparing the “best routes” is the number and direction of turns. As a general rule, right turns are safer than left turns which must cross opposing lanes of travel. The other consideration is the speed limit of the roadways. While I assume the ambulance was travelling above the posted rate going code 3, it is the faster roads that are built to a higher level of safety and will more easily accommodate higher speeds with fewer traffic control devices (lights or stop signs.) The route to Beaumont had the highest number of miles on restricted access highways that have the highest speed limits in any city. Consequently, this may have been a very good choice based on actual travel-time as well as safety considerations.

The call was still a judgement one and I will not defend one or the other as the best choice given my lack of knowledge in Detroit, but I will defer to the judgement of crews that travel these streets regularly both as emergent and routine traffic.

The other consideration in this call was the trauma rating of the hospital. As I understand it, both Henry Ford and Sinai-Grace are level 1 while Beaumont is only a level 2 facility. Given the severity of the wound, some deference would likely be given to the better equipped hospitals. However, the real difference between these levels is typically whether there is a teaching and research program available. The surgical capabilities should actually not be significantly different.

With drive times so close to being similar, I can sit comfortably in the safety of my arm chair typing that the choice of Henry Ford would have been quite practical; however, I may well have made a different choice myself as I place myself behind the wheel (as I will be doing tonight.) That immediate “split-second” decision of east versus south west is much more difficult in the moment. And this is exactly the type of situation where I would be grateful for the input from the MARVLIS in-vehicle client that sorts destinations choices by distance and provides an optimal path based on time-of-day with turn-by-turn driving directions.

 

3 Comments

  • Jon Kavanagh says:

    I would step past the issue of Level I vs Level II, given the clinically-relevant differences in accreditation criteria; some Level IIs are more prepared than some Level Is–only the local crews can comment.

    For EMS, the other issue in the shadows is that of the subjective reasons for choosing a destination; my my area, two Level Is are five minutes apart, but one historically wasn’t patient-friendly, so, for the sake of the person on my stretcher, all things being equal, I’d advocate for the “nicer” place.

  • Tom Langley-Smith says:

    It’s hard to judge the decision made, without all the facts. We have a “trauma by pass” agreement where I am, with our trauma centre roughly 45 min away. If the patient meets the criteria then we go.
    If the difference between level 1 and 2 is the teaching ability, that shouldn’t be the sole determinant. Maybe the level ones were overwhelmed and couldn’t accept anymore of a specific trauma patient, in this case one with a head injury, that possibly would need airway control and a ventilator. The level 1 may not have had any capability for that, where the level 2 did. Maybe such an agreement or protocol exists, I’ve seen ERs do it before in other cases, such as we can’t take anymore patients who require constant cardiac monitoring, but we can take those who don’t etc..

  • Ayan says:

    I will completely agree with with MR.Tom Langley
    Ecare Technologies

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