A multidisciplinary, automobile crash investigation team at the University of Miami School of Medicine, William Lehman Injury Research Center of Jackson Memorial Hospital/Ryder Trauma Center in Miami, Florida, is conducting a detailed medical and engineering study. The focus is restrained (seatbelts, airbag, or both) occupants involved in frontal crashes who have been severely injured. More than 60 crashes have been included in the study to date. Analysis of the initial data supports the general conclusion that restraint systems are working to reduce many of the head and chest injuries suffered by unrestrained occupants. However, abdominal injuries among airbag-protected occupants still occur. Some are found among occupants who appeared uninjured at the scene. Case examples are provided to illustrate abdominal injuries associated with airbag-protected crashes. The challenges of recognizing injuries to airbag-protected occupants are discussed. To assist in recognizing the extent of injuries to occupants protected by airbags, it is suggested that evidence from the crash scene be used in the triage decision. For the abdominal injury cases observed in this study, deformation of the steering system was the vehicle characteristic most frequently observed. The presence of steering wheel deformation is an indicator of increased likelihood of internal injury. This may justify transporting the victim to a trauma center for a closer examination for abdominal injuries.
The data and literature unequivocally show a strong and disproportionate association between vehicle rollover and injury severity and death. Because it is difficult to devise simple, accurate decision rules for point of wounding and vehicle crash scene triage, simple, powerful relationships should be used when possible. Thus, the exclusion of rollover as a triage criterion seems to be ill advised.
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I n 2016, we published data, which showed decrease in vehicle-related deaths between 1978 and 2013, possibly related to introduction of trauma centers and an increased focus on trauma systems. 1 There have been over 1.5 million vehicle-related fatalities since the early 1980s, with a consistent approximate 50% prehospital (Fig. 1 and Fig. 2).The most recent data show that the death rates remains unabated over several years and that the percentage of prehospital deaths is identical in the face of increasing traffic deaths (Table 1).The source of these data is The Fatality Analysis Reporting System (FARS) managed by the Department of Transportation National Highway Traffic Safety Administration, which is arguably the most complete injury database for vehicle-related deaths in the world. It is close to census of US vehicle-related crash deaths and is meticulously maintained.Good and comprehensive data on the cause of death prehospital are rare and are required to focus strategies and tactics on reducing scene, en route triage, and early in hospital mortality.Persons killed in motor vehicle traffic crashes provide a useful metric of emergency trauma care and traffic safety. The Fatality Analysis Reporting System provides a close to census data set of both prehospital and in hospital vehicle-related deaths by state and nationally, allowing for valid comparisons to be made between states, regions, nationally, and over time. As expected, the number of patients who died at the scene or en route (prehospital) varies from state to state based on geography and access to care. There are clearly targeted interventions, which require some details of the anatomic pathology and physiology associated with these early deaths. In the latter case, the database has some shortcomings, but some individual states have excellent capabilities for such studies.The past two decades of warfare have advanced the capabilities of prehospital care to include technologies, such as resuscitative endovascular balloon occlusion of the aorta, 2 which might be of value in the prehospital setting when appropriate training and performance metrics are developed. Meanwhile, it should be noted that the challenges of reducing prehospital deaths both in numbers and as a percentage of early trauma deaths related to automobile crashes remains unassailed in the past several years. 3
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