CIREN Crash Injury Research and Engineering Network Program Report Engineering Medical Prevention Treatment Serious Injury Crashes 42,000 Crash Deaths Crash Transports to Trauma Centers Investigations 250,000 Life Threatening Injuries 500,000 Hospitalized 2,000,000 Disabling Injuries 4,000,000 ER Visits 27,000,000 Vehicles in Crashes Crash Injury Costs Incurred Each Year Better Medical $100 Billion in Economic Costs Treatments $350 Billion in Comprehensive Costs Smarter Crash (including costs for pain and suffering) Test Dummies Safer Cars People Saved Engineering Medical Prevention Treatment Foreword by Jeffrey W. Runge, M.D., NHTSA Administrator As an emergency physician I personally have learned from CIREN research. I have used the life- saving techniques developed by CIREN for the diagnosis of liver injuries in crashes with 2-point belts. Furthermore, I have been able to teach better emergency care for crash victims because of CIREN findings. The medical and engineering research efforts of CIREN form a valuable program of the National Highway Traffic Safety Administration (NHTSA). CIREN has forged powerful teams of medical researchers and safety engineers from NHTSA, universities, and the automotive industry. These teams are performing leading edge research on serious injuries in real-world crashes to advance safety. The crash injury research contributions of the CIREN centers that are noted in this report include many findings that currently are in various stages of development, testing, and evaluation. As these findings are applied over time, the safety benefits of this basic research will become a reality and result in a Safer America. CIREN researchers have produced more than 100 scientific publications based on research on more than 1,000 crash injured people. But, the past accomplishments of CIREN are simply a pro- logue to its future contributions. I can attest to this for several reasons: I The nation has a great and urgent need to reduce the toll of nearly 42,000 crash deaths, half of which do not receive medical care at a hospital, and more than 3 million people suffering injuries in crashes that result in economic costs to the nation of $100 billion each year. I The opportunities for CIREN contributions to advance safety are growing each year as the researchers at each center develop a greater level of understanding of opportunities to prevent and treat crash injuries. I The collaboration of NHTSA, CIREN, and automotive industry researchers continues to grow. I The opportunity for advancing safety is also growing as the Centers now engage in multi-cen- ter research using networked data. This CIREN Program report highlights cumulative contributions of the center researchers to advance the prevention and treatment of crash injuries. But, the nation’s need for improvements in safety demands that we not rest on our laurels. We must move forward to produce further med- ical and engineering advances in automotive safety. Physicians and engineers are on the threshold of using new technologies to apply information from crash sensors to achieve faster and smarter emergency medical treatment of crash victims. We are working together to develop new safety technologies such as better air bags and Automatic Crash Notification (ACN) to reduce the incidence, severity, consequences, and costs of crash injuries. NHTSA’s CIREN centers are now providing the nation with its most detailed medical and engi- neering analyses of serious injuries occurring in real world crashes. CIREN crash injury data and analyses are growing each year and are being organized by NHTSA into a powerful scientific knowledge base. The result is an increasingly useful research resource for discovering and defining opportunities to reduce the tragedies of deaths, injuries, disabilities and human suffering. i CIREN centers are educating and training graduate students in medicine and engineering. Many of these individuals will go on to make additional contributions to the practice of emergency care in hospitals and universities around the nation. In addition, a growing number of engineers are gaining medical knowledge and going back to jobs in the automotive industry. There they are able to apply their knowledge of injuries to design safer vehicles. Thus, the work of CIREN researchers serves to improve the nation’s safety infrastructure. CIREN researchers are sharing their safety findings at the federal, State and local level. This sharing of information conveys their life-protecting findings so that others may live, learn, and leave a legacy of a Safer America. Jeffrey W. Runge, MD Administrator, NHTSA ii Engineering Medical Prevention Treatment Table of Contents Page NHTSA Overview . 1 Children’s National Medical Center . 9 University of Maryland, National Study Center for Trauma & EMS . 23 New Jersey Medical School: UMDNJ CIREN Center . 31 William Lehman Injury Research Center at University of Miami School of Medicine . 45 Harborview Injury Prevention & Research Center at University of Washington . 55 San Diego County Trauma System CIREN Center . 63 University of Michigan at Ann Arbor CIREN Center . 73 Mercedes-Benz CIREN Center at University of Alabama, Birmingham . 83 Ford Inova Fairfax Hospital CIREN Center . 91 Froedtert Hospital-Medical College of Wisconsin CIREN Center . 97 References . 105 iii iv Engineering Medical Prevention Treatment CIREN Program Report National Highway Traffic Safety Administration (NHTSA) Introduction ization of the extremely detailed crash and medical data con- This is the NHTSA CIREN program’s first Program tained in CIREN on serious injuries and their consequences. Report. The report provides a description of the CIREN The CIREN program strengthens America’s highway safety centers, the researchers, and their work. The individual infrastructure of people working at the national, State and centers have been operating for varying periods of time. local levels by providing a more realistic understanding of While some centers have existed for nearly a decade others serious crash injuries. Valuable lessons are being learned have been established more recently. This Overview chap- from the study of real-world serious crash injuries in terms ter provides a brief description of the CIREN research of both what is needed and what actually works. process and presents a summary of research findings that have contributed to advancing the scientific understanding CIREN research is also helping to advance the develop- of serious crash injuries. ment of new technologies for improving crash safety, such as Automatic Crash Notification (ACN) systems. The CIREN Mission Research published in a series o papers co-authored by sev- The mission of NHTSA’s Crash Injury Research and eral CIREN investigators was influential in the enactment Engineering Network (CIREN) is to improve the preven- by Congress of the Wireless Communications and Public Automatic Crash Notification,” tion, treatment, and rehabilitation of motor vehicle crash Safety Act of 1999, e.g., “ “URGENCY for a Safer America,” “Reducing Highway injuries to reduce deaths, disabilities, and human and and Deaths and Disabilities with Automatic Wireless Transmission of economic costs. Serious Injury Probability Ratings from Crash Recorders to The CIREN Centers perform medical and engineering Emergency Medical Services Providers” (See citations in the research on serious crash injuries that contributes to the Reference Section). The Wireless Communications and efforts of NHTSA and the automotive industry to improve Public Safety Act’s first finding states: safety. CIREN research helps advance the development, “(1) the establishment and maintenance of an end-to- testing, and evaluation of new technologies for the preven- end communications infrastructure among members of tion of injuries and new techniques for more effective the public, emergency safety, fire service and law enforce- emergency medical transport and treatment of crash ment officials, emergency dispatch providers, transporta- injured people. tion officials, and hospital emergency and trauma care facilities will reduce response times for the delivery of The Goal emergency care, assist in delivering appropriate care, and thereby prevent fatalities, substantially reduce the severi- The goal of CIREN research is to identify opportunities for ty and extent of injuries, reduce time lost from work, and improvement in the prevention and treatment of crash save thousands of lives and billions of dollars” injuries. This is accomplished through the coordinated efforts of medical researchers, working with engineers at A fundamental means of achieving CIREN goals is through NHTSA, the automobile industry, and academia to better research, education, and professional training. Numerous understand the complex mechanisms of crash impact CIREN research findings have been published in scientific injuries. journals, and presented at international, national, state and local conferences. A unique feature of the CIREN program This synergistic scientific approach enables engineers to is its outreach efforts to educate and train a growing num- learn how to improve vehicle designs, and medical practi- ber of engineers and medical practitioners including physi- tioners to learn better means of treating crash victims. cians, nurses, paramedics, fire, rescue, and police (who CIREN research provides the safety community with a often are the first emergency responders to crash victims). “microscope” for the study of crash injuries in the real The result