No description available.

Motor vehicle crashes (MVCs) are a global public health concern. In 2020 alone, there were an estimated 6.76 million police reported crashes in the United States [1]. In the wake of an MVC, those involved may have been inflicted with serious or fatal injuries. Despite large research and development efforts to design vehicles and safety features to help reduce the frequency and severity of MVCs, crashes are, and will continue to be, a reality. In response to MVCs, first responders are tasked to provide crash victims with rapid immediate care and transport them to an appropriate facility. In spite of continued progress in emergency medicine, there are still many operational hurdles that emergency medical technicians need to overcome to perform their duties proficiently. Development and deployment of advanced automatic crash notification (AACN) systems have the potential to reduce the time between a crash and 911 system activation, especially for unseen roadway departures or crashes that render occupants incapacitated. Ultimately, AACN systems may aid first responders and improve MVC patient outcomes, however, these systems only target the earliest elements of an emergency response event. Therefore, the work contained in this dissertation aimed to identify additional areas for improvement within an emergency response event, specifically MVCs, and propose and/or develop solutions to address them. The first area pertained to emergency medical services (EMS) transportation, which can include responding to and transporting patients from an MVC. Through the analysis of the national EMS Information System database, an existing light vehicle naturalistic driving study, and a pilot ambulance-based naturalistic driving study, this dissertation provides a comprehensive investigation into EMS roadway interactions. The findings of these investigations confirmed that traffic interactions are a common issue and leading cause of EMS delay during response and transport phases. Even when ambulance operators drive with observed "due regard" and utilize emergency lights and sirens appropriate, many drivers were observed to yield the right of way inappropriately or in a delayed manner that resulted in safety critical events on open roadways and in intersections. The second area of improvement pertained to providing EMS with detailed patient information following an MVC. This took shape through the development of a post-crash injury triage system that provides first responders with occupant condition prior to on-scene arrival. The proposed system collects and shares crash occupant respiration rate, heart rate, and mental status through vehicle cabin integrated sensors and a post-crash response operator. This information, and additional vehicle specific crash details, are then populated into post-crash web application that responding agencies can view and interact with to strategically allocate response resources and predevelop transportation plans. Collectively, the work included in this dissertation identified challenges that EMS face when responding to MVCs, and produced findings that can be used to develop technology, update policies, and innovate in the transportation sector to improve emergency response and post-crash care. The identified safety and efficiency benefits not only apply to emergency respondents but encompass benefits to crash victims and all other road users. Although targeted at MVCs, the findings of this dissertation may also be applicable to many different types of emergencies and can benefit other public safety domains such as law enforcement, fire services, towing, and infrastructure maintenance. / Doctor of Philosophy / Motor vehicle crashes (MVCs) are a global public health concern. In 2020 alone, there were an estimated 6.76 million police reported crashes in the United States [1]. In the wake of an MVC, those involved may have been seriously or fatally injuries. Despite large research and development efforts to design vehicles and safety features to help reduce the frequency and severity of MVCs, crashes are, and will continue to be, a reality. In response to MVCs, first responders are tasked to provide crash victims with rapid immediate care and transport them to an appropriate facility. In spite of continued progress in emergency medicine, there are still many operational hurdles that emergency medical technicians need to overcome to perform their duties proficiently. Development and deployment of advanced automatic crash notification (AACN) systems have the potential to reduce the time between a crash when a 911 response is started, especially for unseen roadway departures or crashes that render occupants incapacitated. Ultimately, AACN systems may aid first responders and improve MVC patient outcomes, however, these systems only target the earliest elements of an emergency response event. Therefore, the work contained in this dissertation aimed to identify additional areas for improvement within an emergency response event, specifically MVCs, and propose and/or develop solutions to address them. The first area pertained to emergency medical services (EMS) transportation, which can include responding to and transporting patients from an MVC. Through the analysis of a national database, an existing light vehicle driving study, and a pilot ambulance-based driving study, this dissertation provides a comprehensive investigation into EMS roadway interactions. The findings can be used to better understand EMS roadway interactions and applied to develop innovative ways to improve safety and efficiency for all road users. The second area of improvement pertained to providing EMS with detailed patient information following an MVC. This took shape through the development of a post-crash injury triage system that provides first responders with occupant condition prior to on-scene arrival. The proposed system collects and shares crash occupant respiration rate, heart rate, and mental status, allowing responding agencies to strategically allocate response resources and predevelop transportation plans. Collectively, the work included in this dissertation identified challenges that EMS face when responding to MVCs, and produced findings that can be used to develop technology, update policies, and innovate in the transportation sector to improve emergency response and post-crash care. The identified safety and efficiency benefits not only apply to emergency respondents but encompass benefits to crash victims and all other road users. Although targeted at MVCs, the findings of this dissertation may also be applicable to many different types of emergencies and can benefit other public safety domains such as law enforcement, fire services, towing, and infrastructure maintenance. Therefore, the work contained in this dissertation aimed to identify additional areas for improvement within an emergency response event, specifically MVCs, and propose and/or develop solutions to address them. The first area pertained to emergency medical services (EMS) transportation, which can include responding to and transporting patients from an MVC. Through the analysis of a national database, an existing light vehicle naturalistic driving study, and a pilot ambulance-based naturalistic driving study, this dissertation provides a comprehensive investigation into EMS roadway interactions. The findings can be used to better understand EMS roadway interactions and applied to develop innovative ways to improve safety and efficiency for all road users. The second area of improvement pertained to providing EMS with detailed patient information following an MVC. This took shape through the development of a post-crash injury triage system that provides first responders with occupant condition prior to on-scene arrival. The proposed system collects and shares crash occupant respiration rate, heart rate, and mental status, allowing responding agencies to strategically allocate response resources and predevelop transportation plans. Collectively, the work included in this dissertation identified challenges that EMS face when responding to MVCs, and produced findings that can be used to develop technology, update policies, and innovate in the transportation sector to improve emergency response and post-crash care. The identified safety and efficiency benefits not only apply to emergency respondents but encompass benefits to crash victims and all other road users. Although targeted at MVCs, the findings of this dissertation may also be applicable to many different types of emergencies and can benefit other public safety domains such as law enforcement, fire services, towing, and infrastructure maintenance.

Automobile crashes are the largest cause of death for pregnant females and the leading cause of traumatic fetal injury mortality in the United States. The first way to protect the fetus is to protect the mother considering that maternal death has a near 100% fetal loss rate. If the mother survives, protection of the fetus may best be accomplished by preventing placental abruption. Placental abruption, which is the premature separation of the placenta from the uterus, has been shown to account for 50% to 70% of fetal losses in motor vehicle crashes. Since real world crash data for pregnant occupants is limited to a retrospective analysis and pregnant cadaver studies are not feasible, crash test dummies and computational modeling have been utilized to evaluate the risk of adverse fetal outcome. Although pregnant occupant research has progressed with these tools, they are based on limited tissue data. In order to have more accurate research tools, better pregnant tissue material data are needed. Therefore, the purpose of this dissertation is to provide material properties for the placenta and pregnant uterine tissue in dynamic tension. / Ph. D.

O Atendimento Pré Hospitalar (APH) é um importante recurso no atendimento à vítimas de trauma. No entanto, há muitas dificuldades para demonstrar o efeito benéfico das intervenções do APH na sobrevivência das vítimas, sobretudo as de suporte avançado à vida (SAV). A proposta deste estudo é caracterizar as vítimas de acidentes trânsito, com Revised Trauma Score (RTS) <11, atendidas pelo SAV municipal e encaminhadas a hospitais terciários em São Paulo, além de identificar as variáveis da fase pré-hospitalar associadas à sobrevivência e avaliar o valor predeterminante dessas variáveis sobre o resultado obtido pelas vítimas. As variáveis avaliadas foram: sexo, idade, mecanismos do acidente, procedimentos de suporte básico e SAV realizados, repercussão fisiológica do trauma na cena do acidente, (considerando o RTS , seus parâmetros e flutuações), o tempo consumido no APH, gravidade do trauma segundo o Injury Severity Score (ISS),a Maximum Abbreviated Injury Scale (MAIS) e número de lesões para cada segmento corporal. Os resultados obtidos por 175 vítimas entre 12 e 65 anos, foram submetidos a "Análise de Sobrevivência de Kaplan Meier" e ao “Modelo de Riscos Proporcionais de Cox". A variável dependente foi o tempo de sobrevivência após o acidente, considerando os intervalos até 6h,12h, 24h, 48h, até 7 dias e até o término da internação. Os homens (86,9%) e a faixa etária de 20 a 29 anos (36,0%) foram as mais freqüentes. Os atropelamentos (45,1%) e o envolvimento de motocicletas e seus ocupantes (30,9%) foram os destaques dentre os mecanismos de trauma. A média do RTS na cena e do ISS, foram respectivamente 8,8 e 19,4.Os segmentos corpóreos mais atingidos foram: cabeça (58,8%), membros inferiores (45,1%) e superfície externa (40%). A média de tempo consumido na fase de APH foi 41min (tempo de cena 20,2min). Ocorreram 36% de óbitos, (metade em até 6 horas). A análise estatística revelou 24 fatores associados à sobrevivência, dentre eles, os procedimentos respiratórios avançados e os circulatórios básicos, as variáveis relativas ao RTS e a gravidade (ISS, MAIS e o número de lesões). No modelo final de Cox, ter sido submetido a procedimentos respiratórios avançados, compressões torácicas, apresentar lesão abdominal e ISS>25, foi associado a maior risco para o óbito até 48h após o trauma. Até 7 dias, a compressão torácica não se manteve no modelo final e a PAS de zero a 75mmHg apresentou associação com a morte após o acidente. Até a alta hospitalar, a ausência de PAS na avaliação inicial permaneceu no modelo. A reposição de volume foi o único fator com valor protetor para o risco de óbito presente em todos os momentos / The prehospital care (PH) is an important resource to trauma victims’ care. Nevertheless, there is great difficulty in demonstrating the PH intervention’s positive effect in victim’s survival, especially when concerning the advanced life support (ALS). The aim of this study is to characterize motor vehicle crash victims with Revised Trauma Score (RTS) <11 cared by municipal ALS and moved to tertiary hospitals in São Paulo in addition to identifying the prehospital variables associated to survival, and to evaluate their values as victim survival outcome determinant. The variables evaluated were: sex, age, trauma mechanism, basic life support and ALS procedures, physiological measures in the accident scene (considering the RTS, its parameters and fluctuations), the time consumed in PH phase, trauma severity by Injury Severity Score (ISS), the Maximum Abbreviated Injury Scale (MAIS) and number of lesions in each body region. The main results obtained by 175 victims between 12 e 65 years of age were submitted to the Kaplan Meier Survival Analysis and to Cox Proportional hazards Regression Analysis. The dependent variable was the survival time after the motor vehicle accident considering the intervals up to 6,12,24 and 48hs , up to 7 days and until the time of hospital discharge. Men (86,9%) and the 20 to 29 aged group (36%) were the most frequent. The pedestrians struck by car (45,1%) and the motorcycles (and their riders) (30,9%)were the highlight in trauma mechanisms. The RTS and the ISS average were 8,8 and 19,4 respectively. The more damaged body regions were head (58,8%), lower limbs (45,1%) and external surface (40%).The prehospital time average was 41 min (scene time 20,2min).Death rate was 36% (half of which up to 6hs).The statistical analysis revealed 24 survival associated factors. The ALS and the circulatory basic procedures, the RTS variables and the trauma severity (ISS,MAIS and number of lesions) were within them. In the final Cox Model were associated to higher risk of death up to 48hs after trauma: the submission to ALS respiratory procedures, chest compressions, the presence of abdominal injuries and ISS>25 .Until the 7th day the chest compression was not sustained in a final model and the systolic blood pressure (SBP) from zero to 75mmHg revealed statistical association with death after trauma. Until hospital discharge the SBP absence in scene evaluation remained in the model. The prehospital intravenous fluid refilling was the only factor of protector value to death risk in all moments

O Atendimento Pré Hospitalar (APH) é um importante recurso no atendimento à vítimas de trauma. No entanto, há muitas dificuldades para demonstrar o efeito benéfico das intervenções do APH na sobrevivência das vítimas, sobretudo as de suporte avançado à vida (SAV). A proposta deste estudo é caracterizar as vítimas de acidentes trânsito, com Revised Trauma Score (RTS) <11, atendidas pelo SAV municipal e encaminhadas a hospitais terciários em São Paulo, além de identificar as variáveis da fase pré-hospitalar associadas à sobrevivência e avaliar o valor predeterminante dessas variáveis sobre o resultado obtido pelas vítimas. As variáveis avaliadas foram: sexo, idade, mecanismos do acidente, procedimentos de suporte básico e SAV realizados, repercussão fisiológica do trauma na cena do acidente, (considerando o RTS , seus parâmetros e flutuações), o tempo consumido no APH, gravidade do trauma segundo o Injury Severity Score (ISS),a Maximum Abbreviated Injury Scale (MAIS) e número de lesões para cada segmento corporal. Os resultados obtidos por 175 vítimas entre 12 e 65 anos, foram submetidos a ”Análise de Sobrevivência de Kaplan Meier” e ao “Modelo de Riscos Proporcionais de Cox”. A variável dependente foi o tempo de sobrevivência após o acidente, considerando os intervalos até 6h,12h, 24h, 48h, até 7 dias e até o término da internação. Os homens (86,9%) e a faixa etária de 20 a 29 anos (36,0%) foram as mais freqüentes. Os atropelamentos (45,1%) e o envolvimento de motocicletas e seus ocupantes (30,9%) foram os destaques dentre os mecanismos de trauma. A média do RTS na cena e do ISS, foram respectivamente 8,8 e 19,4.Os segmentos corpóreos mais atingidos foram: cabeça (58,8%), membros inferiores (45,1%) e superfície externa (40%). A média de tempo consumido na fase de APH foi 41min (tempo de cena 20,2min). Ocorreram 36% de óbitos, (metade em até 6 horas). A análise estatística revelou 24 fatores associados à sobrevivência, dentre eles, os procedimentos respiratórios avançados e os circulatórios básicos, as variáveis relativas ao RTS e a gravidade (ISS, MAIS e o número de lesões). No modelo final de Cox, ter sido submetido a procedimentos respiratórios avançados, compressões torácicas, apresentar lesão abdominal e ISS>25, foi associado a maior risco para o óbito até 48h após o trauma. Até 7 dias, a compressão torácica não se manteve no modelo final e a PAS de zero a 75mmHg apresentou associação com a morte após o acidente. Até a alta hospitalar, a ausência de PAS na avaliação inicial permaneceu no modelo. A reposição de volume foi o único fator com valor protetor para o risco de óbito presente em todos os momentos / The prehospital care (PH) is an important resource to trauma victims’ care. Nevertheless, there is great difficulty in demonstrating the PH intervention’s positive effect in victim’s survival, especially when concerning the advanced life support (ALS). The aim of this study is to characterize motor vehicle crash victims with Revised Trauma Score (RTS) <11 cared by municipal ALS and moved to tertiary hospitals in São Paulo in addition to identifying the prehospital variables associated to survival, and to evaluate their values as victim survival outcome determinant. The variables evaluated were: sex, age, trauma mechanism, basic life support and ALS procedures, physiological measures in the accident scene (considering the RTS, its parameters and fluctuations), the time consumed in PH phase, trauma severity by Injury Severity Score (ISS), the Maximum Abbreviated Injury Scale (MAIS) and number of lesions in each body region. The main results obtained by 175 victims between 12 e 65 years of age were submitted to the Kaplan Meier Survival Analysis and to Cox Proportional hazards Regression Analysis. The dependent variable was the survival time after the motor vehicle accident considering the intervals up to 6,12,24 and 48hs , up to 7 days and until the time of hospital discharge. Men (86,9%) and the 20 to 29 aged group (36%) were the most frequent. The pedestrians struck by car (45,1%) and the motorcycles (and their riders) (30,9%)were the highlight in trauma mechanisms. The RTS and the ISS average were 8,8 and 19,4 respectively. The more damaged body regions were head (58,8%), lower limbs (45,1%) and external surface (40%).The prehospital time average was 41 min (scene time 20,2min).Death rate was 36% (half of which up to 6hs).The statistical analysis revealed 24 survival associated factors. The ALS and the circulatory basic procedures, the RTS variables and the trauma severity (ISS,MAIS and number of lesions) were within them. In the final Cox Model were associated to higher risk of death up to 48hs after trauma: the submission to ALS respiratory procedures, chest compressions, the presence of abdominal injuries and ISS>25 .Until the 7th day the chest compression was not sustained in a final model and the systolic blood pressure (SBP) from zero to 75mmHg revealed statistical association with death after trauma. Until hospital discharge the SBP absence in scene evaluation remained in the model. The prehospital intravenous fluid refilling was the only factor of protector value to death risk in all moments

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Seat belts save lives; however, unintentional injuries are still the leading cause of death for those between 1 and 44 years in the United States. Seat belts also cause injuries during motor vehicle crashes (MVCs) and obesity changes how seat belts fit. The purpose of this retrospective causal inference quantitative study was to reduce the knowledge gap in scholarly research on seat belt fit in relation to blunt cerebrovascular injuries (BCVI) during MVCs and seat belt compliance. The theoretical framework used was based on H.W. Heinrich's domino theory. The research questions focused on the following dependent variables: BCVI, compliance, and seat belt fit; and independent variables: the size of the individual and seat belt fit. Secondary and primary data were used and analyzed using Spearman's Rank-Order Correlation. The results yielded no relationship between seat belt fit and BCVI in the secondary data (n = 97). In the primary data (n = 138), there was significance found between seatbelt fit and a) seat belt use, and b) BMI. The study contributed to positive social change by enhancing the awareness of the knowledge deficit regarding seat belt fit, and BCVIs sustained during MVCs, and that comfort was influenced by seat belt fit and had a role in compliance. Seat belts were not used by 5.3% and 9.5% or used incorrectly by 3.2% and 2.9% of the people in the primary data and secondary data sets. This knowledge may contribute to a) future seat belt testing to ensure it is done in such a manner that seat belts fit everyone; b) new seat belt laws to ensure that they are consistent across all states, and c) medical care focusing on seat belt fit as a mechanism of injury (blunt) to ensure screenings are done with the appropriate diagnostic tools.

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No description available.