August 2026
Sanghavi studied decades of ambulance protocol and found the standard practice backwards for gunshot wounds: the minutes spent stabilising on scene are minutes the patient needed a surgeon. The 'scoop and run' approach police sometimes improvise outperforms the protocol.
Transcript
Exactly. So there's a lot of, you know, there are a lot of problems. The nice thing about police is because they have to respond to so many different kinds of things, they are everywhere and they are fast. They get to a scene before an ambulance very, very often and they can leave and get you to the hospital a lot
faster. Well, I don't know. Maybe, maybe this is an obvious question. It seems to me that, you know, if you get some, if you get to a hospital faster, like, how is that not a better thing? But can you talk to us a little bit about kind of the actual differences between if you're going on a scoop and run or if you're going in a police car versus that ambulance that could potentially get you more care?
Yeah. So I think we can talk about this by looking at the two different types of ambulances and what their differences are and where the problems kind of arise. There are basically three types of explanations for why scoop and run has better outcomes. The first is this pure time factor, which is that, which is basically saying that the time that we're spending at the scene isn't worth it. That time would be better spent at the hospital. And the problem with that from a scientific standpoint is that it turns out to be very difficult to disentangle the time effect from the intervention performed. So we don't have any great studies actually that can isolate that piece. So that's more of a hypothesis. The other two explanations have quite a bit of evidence behind them. One is a category of things that basically just shouldn't be done in the field and it should wait till the person's at the hospital. And the classic example of that, especially for trauma, is the provision of intravenous fluids. And there's evidence that actually shows, including clinical trial evidence. That in the case of a penetrating wound, you really want the fluids to happen at the hospital and that saves lives, not in the field. The third kind of explanation
is
that there are interventions, they're basically problems with the quality of the delivery of interventions. So it's not that the intervention itself shouldn't be provided. It's just that it's really hard to get it right in the field. And the classic example there is the use of endotracheal intubation for providing airway support. And, you know, if you talk to someone in a hospital or, you know, like in a hospital, basically, it's the same, there's the people who do intubations are doing them all day long. So, you know, it's like an anesthesiologist or somebody. And in the field, it's a, it's a very, in general, it's considered a difficult procedure. And in the field, it's dark, there's blood, you don't have this nice setup that you have in the hospital.
And