EMS, Highway Safety & Post-Crash Care
For more than 50 years the Department of Transportation (DOT) has supported EMS system development. Saving lives following a motor vehicle crash depends on a well-trained, well-resourced EMS system providing the right care at the right time.
At the core of the DOT’s National Roadway Safety Strategy (NRSS) is the Safe System Approach, with the goal of preventing crashes wherever possible and minimizing harm when crashes do occur. Post-crash care, one of the five primary objectives of the Safe System Approach, aims to enhance the survivability of crash victims through expedient access to emergency medical care.
EMS clinicians respond to approximately 1.5 million motor vehicle crashes on the nation's roadways every year. No matter when or where a crash occurs, 911 centers answer the call and utilize call-taking protocols to initiate dispatch of EMS clinicians to provide the critical medical care needed. Together, highway safety and EMS leaders can tackle system improvement opportunities to help reduce the number of people who die from a crash though they were alive when emergency responders arrive at the scene.
Post-Crash Care Countermeasures: How to Save More Lives
Reducing injury and death on our roadways requires collaboration. Improving crash statistics and saving more lives is dependent on 911, EMS and highway safety officials working together to implement a variety of post-crash care countermeasures:
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Finding the precise location of a crash matters and collaboration with 911 centers is foundational to highway safety. In rural areas, the limitations of 911 callers to specify crossroads, mile markers and other identifiable location markers hampers emergency response. In suburban areas, location accuracy may be easier to communicate, but the overlap of public safety jurisdictions due to city, town and county lines can hamper the dispatch of the closest available unit.
Technology can help identify the exact location of a crash, minimizing the risk of missed locations and delayed response. Geographic Information System (GIS) data is the foundation for location-based routing of wireless 911 calls. Next Generation 911-compliant addressing provides telecommunicators with the exact crash or caller location. 911 centers with NG911 systems are prepared to receive advanced automatic crash notification (AACN) data with crash location and severity information, which has the potential to save 360 to 721 lives annually, according to NHTSA’s May 2019 report on AACN.
Visit 911.gov for more information and materials on 911’s Role in Highway Safety.
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Structured police, fire and emergency medical dispatch (EMD) 911 call-taking protocols play a vital role in minimizing the impact of roadway incidents. EMD protocols - implemented by trained telecommunicators - ensure the appropriate emergency response is dispatched at the appropriate level of urgency and also prompt appropriate medical instructions for bystanders. Witnesses to a crash can provide life-saving care before responders arrive by applying a tourniquet, using an AED or delivering CPR.
Once EMS clinicians arrive, timely on-scene care using model EMS clinical guidelines is crucial for improving patient outcomes. The National Model EMS Clinical Guidelines, developed by the National Association of State EMS Officials (NASEMSO), aim to standardize prehospital patient care based on the latest knowledge and evidence-based practices. These guidelines help reduce morbidity and mortality, minimize complications and optimize treatment effectiveness.
One of the most effective treatment options for motor vehicle crash victims is prehospital blood transfusion. Severe blood loss is the leading cause of preventable death in trauma cases, and nearly half of patients die before they reach the hospital, but prehospital blood transfusion has proven to reduce mortality by 37% among trauma patients.
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Organized trauma care systems reduce mortality from motor vehicle crashes by eight percent. The National Trauma Field Triage Guidelines help EMS quickly determine the best destination for trauma patients. These guidelines prioritize transporting seriously injured patients to trauma centers that can provide the highest level of care, balancing the need to minimize under-triage (missing a necessary trauma center transfer) with the need to avoid over-triage (unnecessarily transporting a patient to a trauma center).
Key components of the guidelines include assessing the patient’s physiological and anatomic criteria, evaluating the circumstances surrounding the injury and considering special factors including the patient's age or pre-existing medical conditions. Together, EMS and highway safety can collaborate to ensure that appropriate guidelines are in use for each community.
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To reduce the number of motor vehicle crash fatalities, post-crash care should be an integral part of highway safety planning. EMS agencies and State Highway Safety Offices must work together on strategies that improve prehospital care.
Post-crash activities must also include the prevention of secondary crashes and the creation of a safe working environment for emergency responders through robust traffic incident management (TIM) practices. TIM training is pivotal for EMS clinicians and 911 centers to provide this support at incident sites.
The collection and use of 911 and EMS data is also essential for measuring post-crash care performance. Data is critical for identifying areas for improvement and ensuring victims receive optimal care. EMS crash data can be accessed through the National EMS Information System (NEMSIS) database to assess the various aspects of the response effort, including response times, quality of care at the scene and patient outcomes.