Improving the prehospital acute care process for road traffic injuries (IPCaR)
Every year 1.3 million people are killed in road traffic accidents around the world, of which about 130 000 in Europe, and it is the most common cause of death with exception for diseases. In addition, between 20 and 50 million people are injured yearly. The world health organization estimates that the number of deaths will increase to 2.4 million in 2030. If traffic safety and emergency medical care of accident victims are not markedly improved road traffic injury will put an even heavier burden on our society in the near future.
Clinical problem
It is of utmost importance that severely injured victims receive appropriate medical care as soon as possible after an accident. Swift treatment saves lives. Effective emergency response requires a well functioning prehospital workflow and information exchange, so that the stabilized patient is transported to the hospital without unnecessary delay and the receiving trauma team has a good understanding of the accident, the vital status of the patient, and what possible occult injuries that can be expected. The transportation time to the hospital can be decreased with the upcoming public service eCall in the European Union. Vehicles involved in an accident will automatically transmit location coordinates and establish a voice connection to the emergency call center. eCall is expected to save up to 2500 lives, and increase the prospects for good recovery for tens of thousands severely injured, every year. Although eCall holds much promise, no indication of the severity of the accident is included in the transmitted set of minimum data currently recommended. Having this information available would help to plan the emergency service operations so that all necessary resources are dispatched early on, e.g. for deciding when to send out an ambulance helicopter and whether extrication equipment is needed. The probability that an occupant is severely injured can be estimated from deceleration and other parameters measured by on-board sensors. Prediction of injury severity would in particular be valuable when there is no voice response from the crashed vehicle. Furthermore, it is not uncommon that occupants do not realize the extent of their injuries.
To make an early decision on what treatment is needed it is advantageous to collect as much information about the status of the patient as possible already in the ambulance. Patients with severe injuries should be transported to a specialized trauma center, which increases their chances of survival. The accurate identification of those patients relies on the triage protocol, which is a standardized procedure to assess the clinical priority level of patients. Development of decision support algorithms for triage has potential to reduce over- and undertriage, i.e. giving a too high and too low priority level for a patient, respectively. Patients with occult injuries are at higher risk of being undertriaged, and patients that look and feel fine but still have life‐threatening occult injuries have become more common due to the use of effective restraint systems with airbags in modern vehicle fleets. Furthermore, there is a high rate of overtriage of trauma patients today, which wastes hospital resources. The decision support algorithms could use predictions of accident severity in combination with current triage criteria, such as assessment of consciousness level and measuring blood pressure and respiratory rate, as input. New diagnostic tools for early detection of occult injuries could also be integrated into an improved triage protocol. We will investigate the possibility of using microwave technology for detection of internal bleedings in the head and the chest, and this equipment can be fitted into air/road ambulances. Head injuries are a common cause of death in road accidents, especially for children in motor vehicle crashes, in motorcycle crashes, and in accidents involving vulnerable road users such as pedestrians. The chances of surviving life-threatening head injuries are much better when treatment is received without significant delay after trauma. Severe head injuries can often be asymptomatic at first, and these patients are therefore at increased risk of being undertriaged and treated too late. Microwave technology has shown promising results for detection of intracranial bleedings in stroke patients. The method may also be valuable for detecting typical intracranial hemorrhages, such as subdural hematomas, in road accident victims. If bleedings could be detected already in the ambulance the time to treatment may be shortened and the clinical outcome improved.
Clinical benefits with concept
An enhanced version of eCall including an estimation of accident severity would assist in planning emergency operations and decrease the time required to bring patients with time-critical injuries to the trauma center. Decision support algorithms using information from vehicle on-board sensors to describe the nature and severity of the accident could be used to improve current triage protocols. Microwave technology is promising for early detection of occult injuries that may otherwise be realized too late. All of this could save many lives and decrease the rate of patients that are disabled for life after a crash. Furthermore, crash victims not likely to have been severely injured could be taken to another health care provider than the emergency department, which would bring a more efficient use of resources overall. Collection of accident statistics related to clinical outcome will be valuable in future research for improving traffic safety in general.
Medical device
In the event of a crash the probability for that any occupant is severely injured is calculated using data from on-board vehicle accelerometers and other sensors. This information is included in the eCall transmission and presented to the personnel in the emergency service dispatch center in a simple way, e.g. as high, intermediate and low risk for severe injury. In the ambulance a handheld computer or similar device can be used to simplify the triage procedure, which today is done using paper and pen, and increase triage accuracy by adding more specific information about the crash to the current criteria. Parameters may be automatically (via wireless transmission from cars and equipment in the ambulance) or manually input. An algorithm calculates the patient’s risk level according to triage criteria, and the level will be updated if any vital signs change or as more pertinent information about the crash and/or patient becomes available. The information will be sent wirelessly to the hospital and other healthcare stakeholders in the care chain. A helmet or cap with microwave antennas for detection of intracranial bleedings using a diagnostic algorithm. This device could automatically monitor the patient and issue an audible/visible warning if a bleeding develops. The data could be combined with other clinical parameters and information about the crash, in order to increase the diagnostic accuracy.
Research team
MedTech West partner
Dr. Stefan Candefjord, Chalmers Unversity of Tehnology
Clinical partners
Prof. Mikael Elam, University of Gothenburg/Sahlgrenska Universitetssjukhuset
Dr. Per Örtenwall, Swedish Armed Forces, Centre for Defence Medicine/Sahlgrenska Universitetssjukhuset.
Technical research partners
Dr. Andreas Fhager, Prof. Mikael Persson, Dr. Ants Silberberg, Adj. Prof. Bengt Arne Sjöqvist, Chalmers University of Technology.
Anna Nilsson-Ehle, SAFER
Industrial partners
Patrik Dahlqvist and Stefan Kilborg, Medfield Diagnostics.
Adj. Prof. Bengt Arne Sjöqvist, Ortivus.
