Scoop and run vs stay and play are traditionally EMS concepts. Do I stay at the scene to perform invasive procedures and begin resuscitation, or do I perform the minimum I can and get to the nearest hospital ASAP?
Some newer papers have addressed this debate very recently with some intriguing results, but I wanted to start out with one that I’ve discussed before.
For trauma patients time is the enemy and there is a different flavor of scoop and run vs stay and play. Do I take the patient to a nearby hospital that is not a high level trauma center to stay and play, or do I scoop and run to the nearest Level I or II center?
Here are the factoids:
- Admissions to a group of 8 trauma centers were analyzed over a 3 year period, and included a total of 1112 patients
- A total of 76% were taken directly to a Level I trauma center (scoop and run, 76%); 24% were transferred to the trauma center from another hospital (stay and play?).
- Patients who were taken to a non-trauma center first received 3 times more IV crystalloid, 12 times more blood, and were nearly 4 times more likely to die!
Obviously, the cause of this increased mortality cannot be determined from the data. The authors speculate that patients may undergo more aggressive resuscitation with crystalloid and blood at the outside hospital making them look better than they really are, and then they die. Alternatively, they may have been under-resuscitated at the outside hospital, making it more difficult to ensure survival at the trauma center.
Bottom line: This is an interesting paper, but it’s kind of a mutant. When I think about the stay and play concent, I’m really thinking about delays going to a trauma center, not a non-trauma hospital fierst! And the authors never really define a “nontrauma hospital.” Does a Level III or IV center count? How did patients who stayed at the outside hospital do?
Obviously, a lot of work needs to be done to add detail to this particular paper. Tomorrow, I’ll look at this concept as it applies to patients with penetrating injury.
Reference: Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer’s effect on mortality. J Trauma 69(3):595-601, 2010.