EMS World Expo Quick Take: Motor vehicle collisions and the golden hour, platinum 10

Understanding the mechanisms of injury in a MVC and how to reduce ambulance collisions


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By Nicole M. Volpi, PhDc, NREMTB

NASHVILLE — Motor vehicle collisions accounted for 37,133 fatalities on U.S. roadways in 2017. Overall, MVC fatalities have been reduced by an increase in seat belt use, reducing impaired driving and vehicle safety improvements.

Motor vehicle collisions can happen on any rural or urban roadways, at any speed, at any time, causing the potential for traumatic injuries. (Photo/Flickr)
Motor vehicle collisions can happen on any rural or urban roadways, at any speed, at any time, causing the potential for traumatic injuries. (Photo/Flickr)

At this year’s EMS World Expo, drawing on over four decades of experience in emergency medical services, Ken Bouvier, NRP, deputy chief of operations, New Orleans EMS, provided an overview of:

  • How the mechanism of injuries and kinetic energy could potentially cause a patient’s injuries
  • The importance of the golden hour/platinum 10
  • Understanding of deceleration and rear-end collisions
  • The impact collisions have on ambulance crews  

Memorable quotes on motor vehicle collisions

Here are some memorable quotes from Bouvier on motor vehicle collisions and their impact on the body.

“For severely injured patients, survival is time dependent.”

“Energy and action that produces motion.”

“We’ve got to make sure that we train like we respond and we respond like we train.”

Top takeaways on motor vehicle collisions

Motor vehicle collisions can happen on any rural or urban roadways, at any speed, at any time, causing the potential for traumatic injuries. It is important that first responders are prepared to quickly triage the scene to transport critically injured patients to the appropriate care facility within that golden hour for the best chances of survival. Here are some top takeaways from this session.

1. Defining trauma and triage

Translated from late 17th century Greek origin, the word trauma means “wound” or “physical injury.” These injuries can be intentional or unintentional. In the 1980s, research by Dr. R. Adam Cowley revealed that the greatest chance of survival for an injured patient is within that golden hour, which starts at the time of jury, not the time of EMS arrival one scene. This allows EMS crews the platinum 10 minutes to:

  • Identify live patients by rapid triage
  • Make quick treatment decisions
  • Transport to appropriate medical facilities for definitive care

2. Scene safety

It is essential that all first responders rendering rescue efforts assess and consider scene safety. Prior to arriving on scene, EMS personnel should take the time to gather information from the dispatcher and communicate with their partner the response plan based on the information available at the time, Bouvier instructed. The following safety issues may arise while on scene and should be mitigated to the extent possible with the resources available:

  • Traffic safety
  • Patient safety
  • Violence
  • Hazardous materials
  • Crime scenes 

3. Kinematics of trauma

(Photo/Nicole M. Volpi)
(Photo/Nicole M. Volpi)

The science behind motor vehicle collisions is supported by Sir Isaac Newton’s Laws of Energy and Motion.

  • First law of motion: an object will remain at rest or in motion unless acted upon by an external force.
  • Second law of motion: energy can never be created or destroyed, but can be changed in form.
  • Third law of motion: for every action or force there is an equal and opposite reaction.     

Factors in these collisions are calculated as: KE (kinetic energy) = one-half the mass (patient’s weight) times the velocity (speed) squared or KE = 1/2mv2.

Bouvier related these laws to potential injuries caused by three collisions:

  1. The vehicle hitting the object (either stationary or moving)
  2. The patient's movement inside the vehicle hitting objects
  3. The patient's internal organs hitting the inside of the body in a “coup contrecoup” motion

Bouvier explains five different types of vehicle collision impacts that could give providers an idea of potential injuries and directional impact:

  1. Frontal
  2. Rear
  3. Lateral
  4. Rotational
  5. Rollover

Motorcycle crashes are known to have head-on, angular and ejection impacts.

Pedestrian collisions by motor vehicles have the potential to cause three separate injury patterns:

  1. First, with the initial impact from the vehicle
  2. Then, the impact from the pedestrian striking the windshield
  3. Then from hitting the pavement

4. Ambulance collisions 

The EMS Workforce Agenda for the Future, published by the National Highway Traffic Safety Administration (NHTSA) EMS, states “Given the nature of EMS work, EMTs and paramedics are vulnerable to serious, potentially fatal risks including, but not limited to, vehicle crashes, musculoskeletal injuries, infectious diseases, and assaults.”     

In a study conducted by the NHTSA between 1992-2011, there were an average 4,500 vehicle traffic crashes involving an ambulance per year. Of these crashes, 84 percent of EMS providers were not restrained in the patient compartment, which caused incapacitating or fatal injuries to the crew or the patient. Bouvier suggests further research is needed to better understand ambulance crashes and how they effect our providers.

Learn more about motor vehicle accident trauma

Learn more about treating trauma from motor vehicle accidents and roadway safety with these resources from EMS1:

Keeping patients and providers safe during transport

Treating trauma in MVC victims

References

  1. McSwain, JR, N. E. (2012). Chapter 16: Prehospital Trauma Care: Fundamental Principles. Acute Care Surgery, 219.
  2. National Association of Emergency Medical Technicians (U.S.)., & American College of Surgeons. (2016). PHTLS: Prehospital trauma life support. 8th ed. Burlington, MA: Jones & Bartlett Learning.
  3. NHTSA. Fatality Analysis Reporting System (FARS) 1992–2010 Final and 2011 Annual Report File (ARF).
  4. NHTSA Office of EMS. 2011. When ambulances crash: EMS Provider & Patient Safety Infographic.

About the author

Nicole M. Volpi, PhDc, NREMTB, has experience in emergency medical services, law enforcement, military and civilian disaster response, and disaster management research. She currently works for the City of Westwego EMS as an Emergency Medical Technician. Also, she volunteers for the City of New Orleans VIGOR program as an EMT.

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