Accident and risk analysis journal

Do EMS Associate with injury severity?

                                         - ARYAN HOSSEINZADEH ,ROBER KLUGER

                         Introduction

 More than 38,000 fatalities  have been reported in us as part of motor vehicle
crashes
 Individual factors ,crash characteristics, environmental conditions 
 EMS is an potential factor in reducing injury severity
 Some studies  focus on reducing prehospital time impacts  fatality 
 Shorter the prehospital time the more advanced treatment the patient gets
 As the time of EMS increases the severity of victim increases
 The traffic accident fatalities can reduced by decreasing the time of EMS
  FARS study was utilised in studies which limited EMS runs only to ones including fatal injury 
 On a study conducted among 848 injuries ,52% were motor vehicle crashes .Found higher
preventable death rate among crashes in urban compared to rural due to longer EMS times
 3 sets of explanatory variables are considered in each model 
1)crash  related variables
2)crash related variables + EMS times
3)crash related variables + EMS +interaction effects of EMS times and injury location on the body
 Every minute increase in EMS response time increase the probability of crash injuries
                       DATA PREPARATION
 The study utilised police reported crash data and ems data
 The data sets like crash records (police station),CAD(emergency Services) ,patient care reports
filed by emergency medical technicians and paramedics
 EMS  CAD data with MVC labels are queried for this study
 The data includes run time feautres ,approximate location ,event type and run priority 
 Crashes with an injury or fatality where EMS transported to hospital are used in this study
 An adaptive set wise algorithm has been devoloped  to link the data sets. This approach
implemented some checks and filters to match records in a step wise manner and match EMS
runs through time location and other indicators
               Summary of datasets used for linkage purpose. 
        Data Source                                     Number of records                                      Field name

Crash (Event Table)                                   21,358 records                                  Lat/Long

                                                                                                                                 Crash time
                                                                                                                                 Crash type
                                                                                                                                 Number of injuries
                                                                                                                                 Number of fatalities 

Crash (Person Table)                                 80,786 records                                 age

                                                                                                                                 Gender
                                                                                                                                 Lat/long
                                                                                                                                 Event type 
                                                                                                                                 Date
EMS                                                              5473 records                                    create time 
                                                                                                                                  Scene time
                                                                                                                                  Transportation time
                                                                                                                                  Incident time
                                                                                                                                   Dispatch time
PCR                                                              4242 records                                      age
                                                                                                                                   gender
                                   METHOD

 A typical approach in these studies is to use a statistical modelling approach, with crash severity
as a dependent variable and characteristics of the crash, driver, roadway, weather, etc. as
independent variables
  modelling formulation
      y∗ ij = Xijβ + vij + ui     -(1)
: (1) fatal/ incapacitating injury,
(2) non-incapacitating injury and
 (3) possible injury can be written as Eq. 2. 
             yij =  1 if y∗ ij ≤ μ1           )
              2 if μ1 < y∗ ij ≤ μ2  }----(2)
               3 if μ2 < y∗ ij          )   
           ICC = Var (vij)/ Var(y∗ ij)

 three models of (1) crash-related variables, (2) crash related and EMS times and
(3) crash-related, EMS times and interaction effects were estimated to identify the
impact of factors on injury severity in MVC with a focus on EMS times
                               Result
  In all three models, age of the injured individual, trapped/ejected injuries of the
crash in a motor vehicle, airbag status, weather, manner of collision and patients’
levels of distress were found to be significantly associated with injury severity in a
crash
 Older occupants, trapped/ejected individuals, vehicles with the deployed airbag or
without airbag available, cloudy/ foggy weather, single-vehicle crashes, individuals
with position in the vehicle after the second-row seats, individuals with higher
distress level were more likely to be more severe.
  individuals with injury location of chest/back/abdomen/pelvis and
arms/hands/legs/feet found to have less severe injuries than individuals with
head/face/neck injuries.
 In the second model, the EMS times were added to the model. Among EMS times,
in the second model, none of the EMS times were found significant
                             conclusion

 Although the importance of optimized and efficient EMS in saving lives is

undisputable, there is not a consensus that how EMS times impact on injured
individuals of the crashes.
  Based on the outcome, although the authors did not find a significant relationship
between EMS times and injury severity in all types of injuries, EMS times based
on injured body severity. The outcome showed faster response time was
associated with less severe injuries in cases with an entire body injury