Why Highway Safety Should Engage EMS in the SHSP Process

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

In this section, learn more about:

Highway Safety & EMS

"Engaging EMS in the SHSP process is not only important because it's a legislative requirement, but because EMS plays a vital role in the Toward Zero Deaths strategy by reducing fatalities in the post-crash phase."
— Tony Furst, FHWA Associate Administrator for Safety

Understanding what happens to crash victims helps illustrate the essential role of EMS. Based on FARS 2005 data, NHTSA's Office of EMS shares data that shows the majority of crash victims will survive a crash for up to ninety 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 can't keep their airway open, or they have injuries that cause such catastrophic bleeding or damage to organs that even the best surgeons couldn't save them. But many crash victims are able to survive within 10-90 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% lower than those without trauma systems.

The Haddon Matrix: The Intersection of Highway Safety and EMS

The Haddon Matrix is a familiar tool for understanding and addressing factors for injury prevention. Developed by William Haddon, the first director of the National Highway Traffic Safety Administration, the matrix is most appropriately viewed in terms of fatality prevention in the context of highway safety.

While EMS can and does play a role in primary injury prevention in many communities, its central involvement is post-crash, when the response time, proximity to a trauma center, and the skills and equipment of the responders are all factors in providing the best possible care, or even, the prevention of a fatality.

The Haddon Matrix, which was developed in 1970, addresses the human, vehicle and environmental factors of an event in the pre-crash, crash and post-crash settings. Highway safety and EMS leadership are likely quite familiar with this system for considering injury prevention.

"EMS is the last line of defense when it comes to saving lives. An investment here is an investment in our mutual goal of significantly reducing death and disability from crashes on our nation's roadways"
— Drew Dawson, Director, NHTSA Office of EMS

The matrix puts in perspective the relationship between the SHSP and EMS, identifying EMS as one of the most important factors in preventing a fatality after all pre-event and event safety measures have been implemented, yet a crash has occurred.

Not as obvious, but still important to the SHSP process is the role that EMS can play in the traditional pre-event factors, or primary intervention. See the matrix below for more information about how Highway Safety and EMS can work together toward injury prevention. (Image courtesy of the National Highway Traffic Safety Administration within the DOT)

Human Vehicle Environment
When looking at the intersection of human factors in the pre-crash setting, information, education and enforcement are important. As the men and women on scene, caring for the injured, EMTs and paramedics lend unique credibility as spokespeople for public awareness campaigns. Addressing pre-event human factors, EMS can join or lead public awareness campaigns for programs targeting such issues as DUIs, distracted driving, safety corridors, seat-belt use, child safety seat checks, and "move-over" programs to educate the public about appropriate responses to emergency vehicles.
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.
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-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.
Photos:National Highway Traffic Safety Administration (NHTSA)

More Information About EMS' Role in Reducing Highway Deaths »