Photo Courtesy AJ Heightman

By John Hunt
Emergency department physicians and trauma surgeons repeatedly discuss the importance of expediting first responder assistance, accurate injury diagnosis and proper treatment for automobile crash victims. Equally important is understanding when a patient needs the specialized expertise of a trauma center. The sooner victims receive the proper level of care, the better their odds for a positive outcome.

For many years, some American automobile manufacturers have been able to remotely detect the deployment of an air bag. This capability was originally called Automatic Collision Notification, but with the advent of new vehicle sensors, additional vehicle and collision data can now be monitored and analyzed. This incremental data, which General Motors (GM) began using in 2004 in some vehicles, is called Advanced Automatic Collision Notification, and can include the following types of vehicle data:

• Delta velocity (change in velocity);
• Principle direction of force (where the impacts occurred);
• Whether multiple impacts occurred;
• Air-bag deployment;
• Rollover status; and
• Vehicle make and model.

With a grant from the GM Foundation and OnStar, the Centers for Disease Control and Prevention (CDC) formed an interdisciplinary panel of experts to investigate the potential impact of the use of Advanced Automatic Collision Notification data on the outcome of medical situations resulting from automotive collisions. The report from the panel identified specific data elements to include in an urgency algorithm, which could generate an estimation of the likelihood that vehicle occupants have sustained severe injuries as a result of the crash. OnStar calls this estimation theinjury severity prediction.The complete CDC report, titled Recommendations from the Expert Panel: Advanced Automatic Collision Notification and Triage of the Injured Patient, can be viewed on the CDC Web site (www.cdc.gov/injuryresponse/pdf/aacn%20report_final-a.pdf).

Some telematics service providers (TSPs), such as OnStar, can verbally provide crash data to 9-1-1 centers today. OnStar has a group of highly trained, specialized advisors who interface with PSAPs more than 20,000 times each month. There’s currently no way to insert that data into a PSAP’s legacy 9-1-1 ALI data display system, but that may soon change. APCO and NENA have agreed to work with TSPs to develop standards for the transmission and display of the injury severity prediction indicator and operational procedures for providing the data to emergency responders and hospitals.

While NG9-1-1 work continues, ubiquitous PSAP adoption of this new approach to 9-1-1 may be some time in coming. That’s why an interim solution that can accommodate legacy 9-1-1 systems is also required. This joint project between the telematics industry, APCO and NENA will help ensure that desired NG9-1-1 capabilities are in place, but it will also focus on ways to adapt legacy systems to facilitate the timely receipt and use of the injury severity prediction data.

The goal is to present this data to PSAPs in a consistent and meaningful way for the use of all emergency personnel, hospitals and trauma centers. The injury severity prediction indicator could be meaningful to the PSAP if the TSP can demonstrate accuracy in its prediction process compared with actual patient outcomes. Data could be available on a “pull” basis (e.g., via a highly secure Web site). Privacy concerns and legal protection of vehicle-occupant-specific data will have to be addressed, but the processes would be engaged in parallel and should not be an impediment to moving forward with the project.

Next steps:1) Some TSPs are in the process of validating the accuracy of their versions of the urgency algorithms against actual medical outcomes. Multiple field studies/trials are underway, and more will start in 2010. 2) APCO has agreed to develop the data standards, and NENA has agreed to work with the TSP industry to develop the educational and training aspects that will be required for the PSAP community. Rollout of the joint project should be before year end 2010.

The benefits of injury severity prediction are numerous. It will:

• Aid the PSAP in making initial response decisions;
• Assist first responders in accurately triaging crash victim(s) and properly identifying the appropriate hospital or trauma center to receive the victims, thereby providing faster access to the proper level of response and treatment; and
• Potentially improve medical outcomes.

The timely use of this data can play an important role in the successful outcome of automobile collisions. We all need to become advocates for making this capability part of the nation’s 9-1-1 systems.

About the Author
John Hunt is a public policy manager for OnStar and has been an APCO member since 1987. Contact him at [email protected]. For more information, visit www.onstar.com/publicsafety.

Originally published in Public Safety Communications, 76(5):64, May 2010.