In Reply We thank the authors for their letters responding to our study.1 We agree on the importance of identifying driving forces behind the survival benefit for private vehicle transportation over ground emergency medical services transportation in patients with penetrating trauma in urban settings. Previous work2,3 has shown that some prehospital interventions, such as fluid administration and spine immobilization, are associated with adverse outcomes in penetrating trauma. Additionally, advanced life support care is associated with higher mortality than basic life support care for similarly injured patients. These findings suggest that prehospital procedures negatively affect trauma outcomes, as Smith suggests.
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Wandling MW, Haut ER. Dangers of Private Vehicle Transportation vs Emergency Medical Services Transportation—Reply. JAMA Surg. 2018;153(6):596–597. doi:10.1001/jamasurg.2018.0111
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