From Crash to Care:  A Road Towards Improved Safety and Efficiency of Emergency Medical Response

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Virginia Tech

Motor vehicle crashes (MVCs) are a global public health concern. In 2020 alone, there were an estimated 6.76 million police reported crashes in the United States [1]. In the wake of an MVC, those involved may have been inflicted with serious or fatal injuries. Despite large research and development efforts to design vehicles and safety features to help reduce the frequency and severity of MVCs, crashes are, and will continue to be, a reality. In response to MVCs, first responders are tasked to provide crash victims with rapid immediate care and transport them to an appropriate facility. In spite of continued progress in emergency medicine, there are still many operational hurdles that emergency medical technicians need to overcome to perform their duties proficiently. Development and deployment of advanced automatic crash notification (AACN) systems have the potential to reduce the time between a crash and 911 system activation, especially for unseen roadway departures or crashes that render occupants incapacitated. Ultimately, AACN systems may aid first responders and improve MVC patient outcomes, however, these systems only target the earliest elements of an emergency response event. Therefore, the work contained in this dissertation aimed to identify additional areas for improvement within an emergency response event, specifically MVCs, and propose and/or develop solutions to address them. The first area pertained to emergency medical services (EMS) transportation, which can include responding to and transporting patients from an MVC. Through the analysis of the national EMS Information System database, an existing light vehicle naturalistic driving study, and a pilot ambulance-based naturalistic driving study, this dissertation provides a comprehensive investigation into EMS roadway interactions. The findings of these investigations confirmed that traffic interactions are a common issue and leading cause of EMS delay during response and transport phases. Even when ambulance operators drive with observed "due regard" and utilize emergency lights and sirens appropriate, many drivers were observed to yield the right of way inappropriately or in a delayed manner that resulted in safety critical events on open roadways and in intersections. The second area of improvement pertained to providing EMS with detailed patient information following an MVC. This took shape through the development of a post-crash injury triage system that provides first responders with occupant condition prior to on-scene arrival. The proposed system collects and shares crash occupant respiration rate, heart rate, and mental status through vehicle cabin integrated sensors and a post-crash response operator. This information, and additional vehicle specific crash details, are then populated into post-crash web application that responding agencies can view and interact with to strategically allocate response resources and predevelop transportation plans. Collectively, the work included in this dissertation identified challenges that EMS face when responding to MVCs, and produced findings that can be used to develop technology, update policies, and innovate in the transportation sector to improve emergency response and post-crash care. The identified safety and efficiency benefits not only apply to emergency respondents but encompass benefits to crash victims and all other road users. Although targeted at MVCs, the findings of this dissertation may also be applicable to many different types of emergencies and can benefit other public safety domains such as law enforcement, fire services, towing, and infrastructure maintenance.

Post-crash care, Motor vehicle crash, Emergency response, Injury triage