3rd International Conference on ESAR
A change emerges in hospital landscape due to health political measures, which in consequence also influences the pre-clinical medical care of emergencies. The main focus of this study was to gather information about emergency medical care after traffic accidents on the basis of data of Bavarian emergency medical services. In Bavaria, in 2006 it was necessary to call an emergency doctor in the case of 14.261 traffic accidents. Predominantly the patients were provided by land-based life saving appliances, air rescue services were only applied in 19.1 % of the cases. 47.6 % of patients being involved in a traffic accident were transported into a primary health care hospital. A prehospital interval of more than 60 minutes was calculated in 20 % of emergency care. 96.2 % of the patients were transported to hospitals of tertiary or maximum supply by air rescue services. The life saving appliances" readiness for action is however restricted to daylight. A further limitation appeared for routine office hours in hospitals: Only 36.7 % of accidents occurred in this time frame. An increase of hospitalizations in clinics of maximum supply appeared from 2002 until 2006 while simultaneously the prehospital period was extended. To assure a sufficient medical care of seriously injured persons further on, a fulltime and area-wide expostulation of efficient facilities is necessary. For this purpose it is necessary to establish regional trauma networks as well as emergency medical service at night time. Beyond that, a cost efficient compensation of the structural, personnel and logistic expenses has to be assured.
While many medical studies have dealt with the incidence, nature and treatment of polytrauma the injury-causing accident mechanisms are rarely discussed in detail, mostly due to the lack of documentation of the technical aspects. The present prospective study was started in late 2007 and collects data from traffic accidents with most severely injured in six south- German counties and two larger cities for the duration of one year. It is aimed at identifying and documenting all polytrauma cases (ISS ≥ 16) caused by traffic accidents and their crash circumstances. The data collection is based on an interdisciplinary concept to include both the police, emergency dispatch centers, hospitals and fire departments in the region and is completely anonymous. Potentially relevant cases where an emergency physician was called to the scene of a traffic accident are provided by the dispatch center. All three hospitals in the region suited for the treatment of polytraumatised patients record injuries, major diagnostic and surgery data. Data and images from the accident scene are provided by the police and by fire departments. The latter provide information which is usually not available from the police, like deployed airbags, vehicle extrication measures and detailed views of car interiors. The main objective of the study is to determine the structure of road users who sustain a polytrauma, their crash opponents and the injury patterns found in relation to the collision configuration and the protection by seat belts, air bags and other devices. With detailed documentation of vehicle damage and extrication measures the study is also intended to support the development of injury predictors for pre-hospital treatment and provide field data regarding further improvement of technical rescue.
The Centre for Automotive Safety Research (formerly the Road Accident Research Unit) at the University of Adelaide in South Australia has a history of in-depth crash investigation going back to the 1970s. In recent years, our focus has been on studying factors that contribute to road crashes, with an emphasis on the role of road infrastructure. Our method involves crash notification by the South Australian Ambulance Service and detailed investigation of the crash scene usually before the crash-involved vehicles have been moved. This at-scene data collection is supplemented with police crash reports, Coroner- reports including autopsy findings for fatal crashes, case notes from hospitals for all injured persons, structured interviews with crash participants and witnesses, and computerised reconstruction of the events of the crash. One of the most notable research findings to emerge from our in-depth work has been the relationship between travelling speed and the risk of crash involvement. By comparing the calculated free speeds of crash-involved vehicles (cases) with the measured speeds of non-crash-involved vehicles travelling on the same roads at the same time of day (controls), we were able to establish that an exponential relationship exists between travelling speed and the likelihood of involvement in a casualty crash. This was the case for both metropolitan and rural areas. This research prompted the reduction of some speed limits in Australia, which has resulted in notable decreases in crash numbers. Another finding of interest in our recent investigation of 298 mostly daytime crashes in metropolitan Adelaide was that medical conditions make a sizeable contribution to the occurrence of road crashes. We found that almost half of the drivers, riders and pedestrians involved in the collisions had at least one pre-existing medical condition, and half of these individuals had two or more such conditions. We found that a medical condition was the direct causal factor in 13% of the casualty crashes investigated and accounted for 23% of all hospital admission or fatal crash outcomes. A follow-up study of all hospital admissions for road crashes in Adelaide is now going ahead to look further at this problem. The paper also describes studies looking specifically at pedestrian crashes. These include studies of the relationship between travelling speed and the risk of a fatal pedestrian crash, and studies utilising real crash data to validate headforms and test dummies used in the assessment of the safety of new vehicles in the event of a collision with a pedestrian.
The aim of this study is to investigate the differences in car occupant injury severity recorded in AIS 2005 compared to AIS 1990 and to outline the likely effects on future data analysis findings. Occupant injury data in the UK Cooperative Crash Injury Study Database (CCIS) were coded for the period February 2006 to November 2007 using both AIS 1990 and AIS 2005. Data for 1,994 occupants with over 6000 coded injuries were reviewed at the AIS and MAIS level of severities and body regions to determine changes between the two coding methodologies. Overall there was an apparent general trend for fewer injuries to be coded at the AIS 4+ severity and more injuries to be coded at the AIS 2 severity. When these injury trends were reviewed in more detail it was found that the body regions which contributed the most to these changes in severity were the head, thorax and extremities. This is one of the first studies to examine the implications for large databases when changing to an updated method for coding injuries.