Emergency Medical Services and Congestion

Traffic congestion, upon first consideration, would appear to be a problem primarily of interest to those in the fields of engineering and transportation. While it is true these disciplines are principally responsible for characterizing and mitigating traffic congestion, in the "real world" its impact extends well beyond these fields. For example, traffic congestion has important environmental and worker productivity implications. Similarly, congestion-related pollution has come to be associated with certain chronic medical conditions. Moreover, of no small consequence is the reality that traffic congestion may have an impact on acute health problems resulting from delays in the provision of emergency medical services (EMS). For example, ambulances are not always able to avoid traffic congestion chokepoints. It follows that when there are even short delays in the delivery of care to a patient or delays in transporting a patient to definitive care, such delays can have adverse implications on outcomes. Thus, when viewed from a public health perspective the relationship between congestion and EMS reveals several important opportunities for multi-disciplinary, translational research. The first of these opportunities focuses on the issue of primary prevention; that is, opportunities to prevent congestion-related EMS delays and thereby prevent adverse patient outcomes associated with such delays. Research has suggested that suburban areas have longer average EMS response times than urban areas. However, the specific relationship between urban sprawl and EMS response times remains unclear. With the rapid growth of suburbs, shifts towards a more elderly population, and the ongoing need for improved emergency preparedness, there is an urgent need for systematic evaluation of sprawl's impact on EMS delivery in the United States to identify opportunities for intervention. Towards this end, one component of the proposed study will quantify the association between urban sprawl and EMS response time in the United States using national EMS data linked to a widely used county-level sprawl index. This information may be useful to policy-makers considering land use alternatives in rapidly growing areas of the country. In addition to primary prevention, the issue of congestion and EMS can also be viewed from a secondary prevention perspective; that is, identifying early opportunities for interventions to minimize congestion from impacting patient outcomes. In contrast to primary prevention, which in the present case would be focused on preventing congestion-related delays, secondary prevention assumes such delays will occur yet attempts to minimize their impact. To accomplish this task, so as to fully understand the impact of congestion on EMS, it is first necessary to understand EMS providers experience with it. Thus, a survey of EMS providers¡¦ professional experience with congestion in terms of education / training, knowledge regarding role of congestion on patient outcomes, congestion-related driving behaviors, congestion-related decision making will be conducted. This will provide valuable information on the actual role of congestion of EMS provider behavior. Another valuable secondary prevention initiative that will be addressed by the proposed study seeks to minimize the impact of congestion by evaluating a strategy to reduce the amount of time occupants of motor vehicle collisions (MVCs) must wait for the arrival of EMS. By providing EMS care in a more timely and informed manner, the potential impact of congestion may be mitigated. With respect to the strategy of interest, automatic collision notification (ACN) systems utilize collision sensors and wireless technology to detect and transmit information regarding the occurrence of a MVC. ACN systems represent a unique opportunity to potentially extend the Golden Hour by reducing the time between MVC occurrence and EMS arrival. While debate exists regarding the association between pre-hospital times and subsequent survival, more rapid EMS arrival reduces time to definitive care and such care has been shown to reduce mortality. Thus, this study will also evaluate whether the integration of OnStar technology into pre-hospital care systems may yield of time savings that (theoretically) improve patient outcomes. Evidence to support the integration of ACN technology into EMS / transportation systems may speed the provision of care and subsequent patient outcomes. While secondary prevention is interested in the early detection of public health problems, tertiary prevention focuses on reducing longer term impacts. With respect to congestion and EMS, research suggests that rapid transport times matter for moderate- and high-risk patients. Thus, pre-transport information regarding injury severity may serve to help tailor pre-hospital / hospital care resources which may result in a more informed EMS response thereby improving patient outcomes. To address this need, the fourth component of the proposed study will build upon existing post-crash injury assessment techniques by using ACN-related occupant, collision, and vehicle information coupled with advanced regression analysis and multi-body modeling to estimate the regional and overall injury likelihood for MVC victims. The results of such research can be used to aid EMS personnel in the making the following decisions regarding the identification of: the most appropriate EMS unit(s) required to respond to specific MVC events (basic versus advanced life support); the most appropriate mode of transportation (e.g., ground versus air ambulance); the most appropriate medical facility (closest hospital or regional trauma center); and the most appropriate group of specialized medical/surgical professionals (neurosurgeons, orthopedists, etc.) needed. The final component of this effort will be to translate the findings of the research tasks into practical congestion mitigation techniques for emergency responders, dispatchers, traffic managers, and planners. It is expected the research program will reveal opportunities to address the congestion problem from several different perspectives. The end product of this task will be a set of techniques to address congestion along with practical guidelines for implementation coupled with cost projections and cost-benefit specification. This multidisciplinary, public-health approach will yield valuable information that can be subsequently used to address the congestion problem on multiple fronts.


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Filing Info

  • Accession Number: 01462652
  • Record Type: Research project
  • Source Agency: University of Alabama at Birmingham University Transportation Center
  • Contract Numbers: DTR06G0048
  • Files: UTC, RiP
  • Created Date: Jan 3 2013 2:07PM