Untitled Document

Why highway safety should engage Emergency Medical Services (EMS) in
the strategic highway safety planning process

By Brent Jennings
Highway Safety Manager

Each of the 4 "Es" -- Engineering, Enforcement, Education, and EMS -- is critically important in eliminating death and serious injury from vehicle crashes. The first three Es play a role in preventing or minimizing injury, while EMS contributes to eliminating death and serious injury in the post-crash phase, providing the last prehospital opportunity to improve health outcomes from motor vehicle crashes.

Understanding what happens to crash victims helps illustrate the essential role of EMS. Data from the National Highway Traffic Safety Administration (NHTSA) shows the majority of crash victims will survive a crash for up to 90 minutes following the incident.

Crash survival depends on a quick response by EMS
Some crash victims die within just a few minutes of a crash. In most of these cases the crash was not survivable, because victims lose consciousness and cannot keep their airway open, or they have injuries that cause such catastrophic bleeding or damage to organs that even the best surgeons could not save them. But many crash victims are able to survive within 10 to 90 minutes post-crash. Within this timeframe there are however mortalities that did not have to occur. You may have heard of the "golden hour," which refers to the critical window of time in which EMS systems can make a difference in reducing morbidity and mortality by:

detecting the incident more quickly
improving precision in locating the crash site
taking the optimal route to the site
having air transportation available when needed
having the best clinical resources on hand for the patient's needs
providing better care to the patient at the crash site and en route to a hospital
making the right choice about the optimal hospital or trauma center

Crash survival depends on proper triage
Some crash victims die more than 90 minutes post-crash. Better triage would improve outcomes for this group. This means better recognition of the probability of severe injury. Better triage also means better, faster decision-making about the destination hospital; whether or not a trauma center is needed; and whether a patient requires ground versus air transportation to a care facility. According to one study, the risk of dying was 25 percent lower for patients who received care at a Level-1 trauma center versus at a non-trauma center. Counties with coordinated systems for trauma care have been shown to have crash fatality rates as much as 50 percent lower than those without trauma systems.

As you can see it is critical that as a highway safety community we pay close attention to implementing all four"Es" in an effort to continue on the trail Towards Zero Deaths.