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:
"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.
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:
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 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)