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Shara's avatar

Interesting analysis! I think the question that you didn't fully address here is whether the well-being of the aggressor should be given significant weight relative to the victims. My personal opinion is that the well-being of the victims should take full precedence over the aggressors and the correct course of action is to disable the aggressor as quickly as possible (making sure victims are safe) before providing medical assistance to the aggressor.

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Jeremy Arnold's avatar

Excerpts from my emails with Dr. Zeineddin.

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Me:

Your paper came up in my research on baseline mortality from stab wounds, and was very helpful. Though one thing that wasn't clear was whether it was capturing 100% of the dead (in that the NTDB's data is predicated on ICD codes, which seem conditional on hospital admittance). To your knowledge, do the DOA-inclusive numbers in table 3 capture those who aren't sent to the hospital with hope of rescue/resuscitation?

My naive sense was that even if someone was clearly dead they'd still be sent to the hospital so that an ME could look them over. But wasn't 100% clear on that (or if MEs used the same codes), and I don't know anyone who works in trauma to ask. So thought you might know offhand.

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Dr. Zeineddin:

Other than the voluntary nature of data contribution you also highlight another [data] limitation in your question. Do all patients with a stab (or [gun shot wound]) present to a hospital or trauma center even if they are clearly dead at the scene? The answer is no. They could present to a hospital that is not a trauma center where they would not be captured in these databases or they could be pronounced at the scene as you were asking.

The laws regarding the ability of EMS personnel to pronounce death at the scene differ by jurisdiction so there is no clear percentage of how many victims are pronounced at the scene and how many are brought in to the hospital and pronounced there. *NTDB should be able to capture the latter but not the former.* Another factor that complicates this issue is that EMS in jurisdictions where they are able to pronounce at the scene by law, might elect to bring the victim in to the hospital due to safety concerns at the scene or as to not escalate the tense situation at the scene by declaring the death of the victim.

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(As an aside, he also noted that "with the improvement in trauma care, the fatality rate of stab wounds or even gunshot wounds to a single body region have improved significantly over the 14 years studied." So there's that too.)

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