The History of EMS at NHTSA

50 Years of Modern EMS

NHTSA and its predecessor agency have supported comprehensive national Emergency Medical Services System development for more than 50 years. In 1966, a report entitled "Accidental Death and Disability" was released by the National Academies of Sciences, bringing to light the "neglected epidemic" of accidental injury. This report, along with passage of the 1966 Highway Safety Act, provided impetus for increased national attention on the plight of victims of motor vehicle trauma. The Federal government was given a leadership role in reducing the number of injuries and deaths on America's highways. As a result, the National Highway Safety Bureau (NHSB), which was the predecessor agency to NHTSA, was created. A part of this new agency, the Division of Emergency Treatment and Transfer of the Injured, was dedicated to EMS.

The Haddon Matrix

In 1969, Dr. William Haddon, then Director of the NHSB, introduced the Haddon Matrix at the First DOT Inter-Departmental Safety Seminar. This simple, yet ground-breaking model defined EMS as a critical element of a comprehensive strategy to reduce traffic-related death and injury.

Human Vehicle Environment
Pre-Event haddon matrix
haddon matrix
haddon matrix
How the car is manufactured and the safety requirements, such as front and side air bags and anti-lock brakes have an important effect on the severity of injury.
Highway safety experts are very aware of the environmental pre-crash factors and regularly work to address those. Additional collaboration between highway safety and EMS could improve response times and hospital delivery times by taking into account such environmental issues as creating access points in divided highways and considering potential EMS helicopter landing areas.
Event haddon matrix
haddon matrix
haddon matrix
These are factors that occur during the incident and include such things as the driver's ability to maintain control of the vehicle and proper use of seat belts and child restraints.
The design of the vehicle protects the occupant, such as the placement of air bags, head restraints and how impact is absorbed.
Break-away signs and light poles, barriers and guard rails, runaway truck ramps, and impact attenuators (water or sand containers placed in front of fixed structures, such as danger points near freeway exits or overpasses, to absorb the energy of a crash) are all examples of how the environment can be a factor in reducing the impact of an incident.
Post-Event haddon matrix
haddon matrix
haddon matrix
Post-crash human factors may include the ability of EMS to educate bystanders about immediate care. As EMS continues to evolve as an active educator in the pre-hospital phase of the healthcare continuum, the ability to educate and encourage Good Samaritans is key in fatality prevention. Additionally, the human factors of preventing secondary crashes fall within the realm of EMS response.
Highly trained EMS personnel, equipped with the right technology and safely built ambulances are key to successfully preventing deaths and further morbidity.
Post-crash environmental factors include access to 911, EMS response, triage and transfer protocols, EMS training, the location of the appropriate emergency department or trauma center. Again, pre-event inclusion of EMS could address environmental factors that can impact the "golden hour," including highway turn-around access and landing area for air medical.

The Haddon Matrix (illustrated above) applied a public health model to the "epidemic" of traffic-related injury. In this model, crashes can be prevented by changing human factors, vehicle factors, and environmental factors. Likewise, if a crash occurred, injuries can be prevented or minimized by changing the same three factors. Moreover, if these strategies fail, the matrix shows the importance of post-crash emergency care in reducing mortality and morbidity. In 1969, an organized system to provide emergency medical care did not yet exist.

 Graphic with images of ambulances showing the history of EMS
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