By Nathan Barton

Ambulance versus private transportation in a medical emergency
According to a study conducted by Johns Hopkins University, you made the right choice in an emergency where someone is bleeding, to have family or a friend -or EVEN Uber! – take you to the ER (or to an urgent care clinic) than if you called 9-1-1 and an ambulance (public or a public contract service). Published in JAMA Surgery, the study found, among other things, that victims of gunshots and stabbings are 62% less likely to die when transported privately.

In other words, government (and even government contractors) is BAD FOR YOUR HEALTH! In fact, it can KILL you and not just because you decided to revolt.

“The study,” Lisa Rabasca Roepe wrote on the OZY blog, “examined data, collected by the American College of Surgeons’ National Trauma Data Bank, from 103,029 patients with a gunshot or stab wound. It found an overall 2.2 percent mortality rate for patients transported via private vehicle — taxi, ride-sharing program, a friend’s car — compared with 11.6 percent for ground emergency medical services and ambulance.”That is NOT just a statistical oddity: that is nearly a 6 times BETTER chance of survival! And that is a nationwide average. And the other data is even more indicative of major problems and risks.

Why? Mama Liberty can explain still better, but looking at it from an emergency response point of view (mining and occupational safety and health perspective), EMT and paramedics are required (usually by laws, regulations, and contracts) to specific protocols that cost precious time. Add to that the time to respond: how far away is the EMS shop for where the victim is? And then, even with all the equipment and supplies in that big old ambulance, how much further – distance AND time – is the ER? And when someone is rapidly losing blood, time is everything.

And we won’t even talk about the triage process in large urban (or even small urban) emergency departments: more than one EMT can tell you stories of patients that they managed to keep alive TO the ER who then didn’t get the right treatment in the department in time – and died.

But I WILL talk about rural and frontier areas and dealing with bleeding injuries (including gun and knife wounds). For those who don’t know, “rural” means places like Virginia or Indiana outside the urban areas. But in states like the Dakotas, Montana, Wyoming, and outside the big complexes like the Front Range, the I-70 Corridor in the Rockies, or the Wasatch Front in Utah, most of the so-called rural areas are really “frontier” areas – defined by census and economics as areas with a population density of less than 5 persons per square mile. And often a LOT less than 5: I am very familiar with large areas of Utah, Colorado, Wyoming, Nebraska, and South Dakota, where the population density is more like 1 person per FIVE (or even TEN) square miles.

In those areas, the nearest EMS garage might be 30 or even 50 miles away, and often NOT 30 or 50 miles of paved, 55 or 65 mph highway: gravel roads where you can average 20-25 mph are common. And an emergency department (nothing anything like a real “trauma center”) might be another 50 or 60 miles away. And we don’t have a helicopter on-call, folks.

It has only been in recent years that organizations like the Red Cross have even started teaching “frontier first aid,” which is a lot different than that standard first aid class with CPR you might have taken in high school or as part of your OSHA training. And even their version of “frontier first aid” still assumes that “professional” emergency medical help is just a half-hour or so away. And government transportation is always available.

Fat chance. Government is bad for your health – and government can kill you. Depending on government is stupid. Very stupid, and often fatal. Especially when you believe the mantra of too many training organizations and government agencies when dealing with severe injuries and wounds, whether it is a shooting, a traffic accident, or an industrial or agricultural injury.

Don’t just stabilize and immobilize and apply direct pressure and wait for the EMTs. Not when they are an hour or more away. Be prepared to do more, if you care about yourself and about the people around you.

Plan and learn and practice. But above all, don’t trust the authorities or the do-gooders. That’ll get you killed.

Mama’s Note: Good thinking, Nathan. And all so true. I was a triage nurse in a small town emergency room for a while, and I can verify everything you wrote.

People who care about being prepared for such an emergency, especially out in the “frontier” parts of the country, need to take certain steps to be ready to deal with it.

1. Get some real, hands on training in “frontier” first aid. If you live in a frontier setting, volunteer for the fire department there and get some EMT training. Learning how to assess a situation and the patient is critical. Teach family members to assist you. (The Survival Medicine Handbook will help integrate that training to frontier situations, and is a minimum preparation if you can’t get EMT training.)
2. Be prepared to actually provide emergency care by carrying a bag of necessary gear and supplies. A “first aid kit” with band-aids and a roll of gauze won’t begin to meet that requirement. (It’s long past time for me to write a full piece listing what you need to carry – but there are plenty of other resources on line.)
3. Review and reassess your training and what you carry at least once a year.