RECOMMENDATIONS FROM THE EXPERT PANEL:
`
`ADVANCED AUTOMATIC
`COLLISION NOTIFICATION AND
`TRIAGE OF THE INJURED PATIENT
`
`— P R E PA R E D B Y T H E —
`CENTERS FOR DISEASE CONTROL AND PREVENTION,
`NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL, DIVISION OF INJURY RESPONSE
`
`— W I T H S U P P O R T F R O M —
`ONSTAR, THE GENERAL MOTORS FOUNDATION, AND THE CDC FOUNDATION
`
`U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
`Centers for Disease Control and Prevention
`
`(cid:50)(cid:58)(cid:49)(cid:40)(cid:53)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:21)(cid:19)(cid:19)(cid:24)(cid:15)(cid:3)(cid:83)(cid:68)(cid:74)(cid:72)(cid:3)(cid:20)
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`RECOMMENDATIONS FROM THE EXPERT PANEL:
`
`ADVANCED AUTOMATIC
`COLLISION NOTIFICATION AND
`TRIAGE OF THE INJURED PATIENT
`
`U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
`Centers for Disease Control and Preven(cid:415)on
`Na(cid:415)onal Center for Injury Preven(cid:415)on and Control
`Division of Injury Response
`
`Atlanta, Georgia
`2008
`
`(cid:50)(cid:58)(cid:49)(cid:40)(cid:53)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:21)(cid:19)(cid:19)(cid:24)(cid:15)(cid:3)(cid:83)(cid:68)(cid:74)(cid:72)(cid:3)(cid:22)
`
`

`

`“RECOMMENDATIONS FROM THE EXPERT PANEL: ADVANCED AUTOMATIC
`COLLISION NOTIFICATION AND TRIAGE OF THE INJURED PATIENT,”
`is a publica(cid:415)on of the
`Na(cid:415)onal Center for Injury Preven(cid:415)on and Control,
`Centers for Disease Control and Preven(cid:415)on.
`
`CENTERS FOR DISEASE CONTROL AND PREVENTION
`Julie L. Gerberding, MD, MPH
`Director
`
`COORDINATING CENTER FOR ENVIRONMENTAL HEALTH AND INJURY PREVENTION
`Henry Falk, MD, MPH
`Director
`
`NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL
`Ileana Arias, PhD
`Director
`
`DIVISION OF INJURY RESPONSE
`Richard C. Hunt, MD, FACEP
`Director
`
`SUGGESTED CITATION: Na(cid:415)onal Center for Injury Preven(cid:415)on and Control.
`RECOMMENDATIONS FROM THE EXPERT PANEL: Advanced Automa(cid:415)c
`Collision No(cid:415)fica(cid:415)on and Triage of the Injured Pa(cid:415)ent. Atlanta (GA):
`Centers for Disease Control and Preven(cid:415)on; 2008.
`
`II | ADVANCED AUTOMATIC COLLISION NOTIFICATION AND TRIAGE OF THE INJURED PATIENT
`(cid:50)(cid:58)(cid:49)(cid:40)(cid:53)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:21)(cid:19)(cid:19)(cid:24)(cid:15)(cid:3)(cid:83)(cid:68)(cid:74)(cid:72)(cid:3)(cid:23)
`
`

`

`CONTENTS
`CONTENTS
`
`BACKGROUND .............................................................................................................. 1
`BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
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`DEVELOPMENT OF THE FIELD TRIAGE DECISION SCHEME:
` DEVELOPMENT OF THE FIELD TRIAGE DECISION SCHEME:
`THE NATIONAL TRAUMA TRIAGE PROTOCOL ................................................................. 1
` THE NATIONAL TRAUMA TRIAGE PROTOCOL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
`
`VEHICLE TELEMATICS AND ADVANCED AUTOMATIC COLLISION NOTIFICATION ...................... 2
` VEHICLE TELEMATICS AND ADVANCED AUTOMATIC COLLISION NOTIFICATION . . . . . . . . . . . . . . . . . . . . . .2
`
`INCORPORATION OF “VEHICLE TELEMATICS CONSISTENT WITH HIGH RISK FOR INJURY”
` INCORPORATION OF “VEHICLE TELEMATICS CONSISTENT WITH HIGH RISK FOR INJURY”
`INTO THE DECISION SCHEME .................................................................................... 2
` INTO THE DECISION SCHEME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
`
`EXPERT PANEL ON ADVANCED AUTOMATIC COLLISION NOTIFICATION
` EXPERT PANEL ON ADVANCED AUTOMATIC COLLISION NOTIFICATION
`AND TRIAGE OF THE INJURED PATIENT ........................................................................ 3
` AND TRIAGE OF THE INJURED PATIENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
`
`RECOMMENDATIONS FROM THE EXPERT PANEL ON ADVANCED AUTOMATIC
`RECOMMENDATIONS FROM THE EXPERT PANEL ON ADVANCED AUTOMATIC
`COLLISION NOTIFICATION AND TRIAGE OF THE INJURED PATIENT ........................................... 5-6
`COLLISION NOTIFICATION AND TRIAGE OF THE INJURED PATIENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5(cid:883)6
`
`REFERENCES ................................................................................................................ 7
`REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
`
`APPENDIX A: FIELD TRIAGE DECISION SCHEME: THE NATIONAL TRAUMA TRIAGE PROTOCOL ............ 8
`APPENDIX A: FIELD TRIAGE DECISION SCHEME: THE NATIONAL TRAUMA TRIAGE PROTOCOL . . . . . . . . . . . .8
`
`APPENDIX B: ADVANCED AUTOMATIC COLLISION NOTIFICATION AND TRIAGE EXPERT PANEL ....... 9-11
`APPENDIX B: ADVANCED AUTOMATIC COLLISION NOTIFICATION AND TRIAGE EXPERT PANEL . . . . . . . 9(cid:883)11
`
`APPENDIX C: ADVANCED AUTOMATIC COLLISION NOTIFICATION PROTOCOL .............................. 12
`APPENDIX C: ADVANCED AUTOMATIC COLLISION NOTIFICATION PROTOCOL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
`
`NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL, DIVISION OF INJURY RESPONSE | III
`NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL, DIVISION OF INJURY RESPONSE L III
`(cid:50)(cid:58)(cid:49)(cid:40)(cid:53)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:21)(cid:19)(cid:19)(cid:24)(cid:15)(cid:3)(cid:83)(cid:68)(cid:74)(cid:72)(cid:3)(cid:24)
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`OWNER EX. 2005, page 6
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`BACKGROUND
`
`The optimal way to reduce the morbidity, mortality, and socioeconomic consequences of injuries is to prevent
`their occurrence.1,2 When an injury does occur, however, emergency medical service (EMS) providers must
`ensure that patients receive prompt emergency care at the scene and are transported to an appropriate health
`care facility for further evaluation and treatment. Determining the facility to which an injured patient should
`be transported can have a profound impact on subsequent morbidity and mortality. Although basic emergency
`services are generally consistent across emergency departments, certain hospitals known as “trauma centers”
`have additional expertise and equipment for treating severely injured patients. Trauma centers are classified
`by state or local authorities depending on the scope of resources and services available, ranging from Level I,
`which provides the highest level of care, to Level IV.
`
`Not all injured patients can or should be transported to a Level I trauma center. Patients with less severe
`injuries might be served better by transport to the nearest emergency department. Transporting all injured
`patients to Level I trauma centers, when many do not require that high a level of resources and expertise,
`unnecessarily burdens those facilities and makes them less available for the most severely injured patients.
`
`Research has shown that the level of care an injured patient receives can also have a significant impact on
`health outcome. The National Study on the Costs and Outcomes of Trauma (NSCOT) evaluated the effect
`of trauma center care on mortality in moderately to severely injured patients and identified a 25% reduction
`in mortality for severely injured patients who received care at a Level I trauma center rather
`than at a nontrauma center.3
`
`DEVELOPMENT OF THE FIELD TRIAGE DECISION SCHEME:
`THE NATIONAL TRAUMA TRIAGE PROTOCOL
`
`The Centers for Disease Control and Prevention (CDC) has taken an increasingly active role in the
`intersection between public health and acute injury care, including the publication of the Acute Injury
`Care Research Agenda: Guiding Research for the Future.4 Building on these activities, CDC and the American
`College of Surgeons-Committee on Trauma (ACS-COT), with additional financial support from the National
`Highway Traffic Safety Administration (NHTSA), convened a series of meetings of the National Expert Panel
`on Field Triage to guide the 2006 revision of the Triage Decision Scheme. The expert panel was assembled to
`bring additional expertise to the revision process (e.g., EMS, emergency medicine, public health, the automo-
`tive industry, other federal agencies) in order to provide:
`
`•
`•
`
`•
`•
`
`a vigorous review of the available evidence;
`assist with the dissemination of the revised scheme, and the rationale behind it,
`to a larger public health and acute injury care community;
`emphasize the need for additional research in field triage; and
`establish the foundation for future revisions.
`
`The major outcome of these meetings was the creation of the Field Triage Decision Scheme: The National
`Trauma Triage Protocol (Decision Scheme)(see Appendix A).5
`
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`VEHICLE TELEMATICS AND ADVANCED AUTOMATIC COLLISION NOTIFICATION
`
`During the National Expert Panel on Field Triage meetings, members discussed the potential for vehicle telem-
`atics to more accurately guide trauma triage decisions. Telematics is defined as the combination of telecommu-
`nications and computing.6 Vehicle telematics systems combine and integrate directly into the vehicle’s electrical
`architecture, cellular communications technology, Global Positioning System (GPS) satellite location capability,
`and sophisticated voice recognition.7
`
`While vehicle telematics provide a wide array of services, Advanced Automatic Collision Notification (AACN)
`was the telematics service that was of particular interest to the National Expert Panel members. AACN is the
`successor to Automatic Crash Notification (ACN) and is found on a number of motor vehicles. (AACN is
`now installed in approximately 5 million vehicles in the United States and Canada.) AACN alerts emergency
`services that a vehicle crash has occurred and automatically summons assistance.7
`
`When a crash has occurred (as determined by various sensors, airbag deployment, or seatbelt pretensioners),
`the AACN system initiates an emergency wireless call to a telematics service provider (OnStar, ATX, etc.) to
`deliver the vehicle’s GPS location and crash-related data, and opens a voice communications channel to the
`emergency call center. AACN improves the data sent from the ACN version by including crash severity data
`collected by in-vehicle sensors.
`
`INCORPORATION OF “VEHICLE TELEMATICS CONSISTENT WITH
`HIGH RISK FOR INJURY” INTO THE DECISION SCHEME
`
`In earlier versions of the Decision Scheme, a number of vehicle crash characteristics were incorporated into the
`prehospital triage decision evaluation. These included, among others, high vehicle speed, vehicle deformity >20
`inches, and intrusion >12 inches for unbelted occupants as mechanism of injury criteria. National Automotive
`Sampling System Crashworthiness Data System (NASS-CDS) data indicate that risk for injury, impact direction,
`and increasing crash severity are linked.8 An analysis of 621 Australian motor vehicle crashes indicated that
`high-speed impacts (>60 km/hr [>35 mph]) were associated with major injury, defined as Injury Severity Score
`[ISS >15], ICU admission >24 hours requiring mechanical ventilation, urgent surgery, or death (OR = 1.5;
`CI: 1.1–2.2).9 Previously, the usefulness of vehicle speed had been limited because of the challenges to EMS
`personnel in estimating impact speed accurately. New AACN technology installed in some automobiles can,
`however, identify vehicle location, measure change in velocity (“delta V”), and detect the crash’s principal
`direction of force, airbag deployment, rollover, and the occurrence of multiple collisions.8 As a result, and in
`recognition that this information might become more available in the future, vehicle telemetry data consis-
`tent with a high risk for injury (e.g., change in velocity and principal direction of force) was added as a triage
`criterion.
`
`2 | ADVANCED AUTOMATIC COLLISION NOTIFICATION AND TRIAGE OF THE INJURED PATIENT
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`EXPERT PANEL ON ADVANCED AUTOMATIC COLLISION NOTIFICATION
`AND TRIAGE OF THE INJURED PATIENT
`
`In follow up to the need to explore further how AACN could improve triage, CDC selected and convened
`an expert panel (see Appendix B). The purpose of the panel was to develop a medical protocol for utilization
`of AACN data from crashes to better predict severity of injury and use this information to improve the
`ability to respond to crashes and appropriately triage crash victims. This panel included representation from
`the following disciplines: public safety answering points (911 call centers), EMS, emergency medicine, trauma
`surgery, engineering, public health, vehicle telematics providers, NHTSA, and the Health Resources and
`Services Administration’s EMS for Children program.
`
`The expert panel met three times from 2007 to 2008, with the second meeting serving as a subset of the entire
`panel to deliberate on available data. Key discussion points included:
`
`•
`
`•
`•
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`
`
`•
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`Crash characteristics that predicted a 20% or greater likelihood of having a serious injury were
`considered significant and warranted special recognition and action.
`Severe injury was defined as having an ISS of 15 or greater.
`If additional data was available from direct verbal contact with vehicle occupants, this should
`be used to refine or alter the prediction of vehicle crash telematic data. Specifically, knowing the
`number of occupants, age, gender, and level of consciousness would be important additional data
`elements in predicting severity of injury.
`More work needs to be done, but the available information strongly supports immediate
`utilization of vehicle telemetric data in field triage decision guidelines.
`
`
`
`The following section, “Recommendations from the Expert Panel on Advanced Automatic Collision
`Notification and Triage of the Injured Patient” summarizes the expert panel’s conclusions.
`
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`RECOMMENDATIONS FROM THE EXPERT PANEL ON ADVANCED AUTOMATIC
`COLLISION NOTIFICATION AND TRIAGE OF THE INJURED PATIENT
`•
`
`
`Advanced Automatic Collision Notification (AACN) shows promise in improving outcomes
`in severely injured crash patients by:
`° Predicting the likelihood of serious injury in vehicle occupants.
`° Decreasing response times by prehospital care providers.
`° Assisting with field triage destination and transportation decisions.
`° Decreasing time to definitive trauma care.
`° Decreasing death and disability from motor vehicle crashes.
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`•
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`•
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`•
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`•
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`•
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`Current AACN data transmitted from the vehicle to the telematics provider can improve accuracy
`in triage of the injured patient.
`
`Seatbelt use by an occupant significantly influences injury severity. Information regarding belt use
`should be included in AACN data transmission.
`
`AACN providers should obtain specific occupant information that is known to alter or influence
`injury severity and to significantly influence response to injury, including age and gender.
`
`Further refinement of the best data to obtain will require further investigations and data analyses.
`
`Because AACN data have not been previously used in clinical decision-making, pilot studies
`should be implemented as soon as possible using the following protocol (See Appendix C):
`
`
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`1.
`
`
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`
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`In the event of a crash, the following electronic information will be transmitted by the vehicle
`to the AACN providers:
`
`- Delta V
`
`- Principal direction of force (PDOF)
`
`- Seatbelt usage/or without
`
`- Crash with multiple impacts
`
`- Vehicle type
`
` This information is received by the AACN provider and analyzed to identify those patients
`
`who, based upon the data alone, have a > 20% risk of having a severe injury (defined as an
`
`[ISS] > 15). If the analysis indicates that the risk of severe injury is
`
`< 20%, then the AACN provider proceeds per standard protocol.
`
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`
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`2.
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`
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`> 20% risk of severe injury, then the AACN provider
`If the AACN data analysis indicates a
`directly contacts the vehicle occupant to obtain more information. During the communication
`with the occupant, the AACN provider will inquire about:
`
`- Age (> 55 years old have increased risk of severe injury)
`
`- Injuries to vehicle occupants
`
`- Number of patients
`
`- Number of vehicles involved in the crash
`
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`

` This information may help refine the AACN data; in effect, moving the 20% value either up
`
`or down as the occupant information increases or decreases the likelihood that a severe injury
`
`has occurred. For example, if the occupant is able to communicate clearly that he or she is
`
`
`uninjured and < 55 years of age, then the risk of severe injury is lessened. Similarly, if there
`
`is no (or inappropriate) voice response from the occupant, if the occupant is over or equal to
`
`age 55 years, or if he or she indicates an injury, then the risk of severe injury remains at least 20%
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`(based upon the AACN data alone) and is potentially greater.
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`3.
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`4.
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`5.
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`>20% risk of severe injury, then
`If the AACN provider determines that the occupant is at
`communication should be made with the relevant Public Safety Answering Point (PSAP)
`that AACN data obtained from the vehicle indicates that the occupant is at risk for a severe
`injury, and that the PSAP should dispatch resources as appropriate according to local protocol
`and consistent with the Field Triage Decision Scheme: The National Trauma Triage Protocol.
`
`
`
`If the AACN data indicate that the risk of injury is <20% and the AACN provider subsequently
`obtains occupant information that raises concern for a severe injury (e.g., injuries, age), then
`this specific information can be communicated to the PSAP.
`
`AACN providers will also communicate the following information to the PSAP,
`when available:
`
`- Age of occupant(s)
`
`- Presence or absence of injury(ies) based on voice communication
`
`- Number of other vehicles involved, if any
`
`- Location confirmation or disparity between electronic and voice communication
`
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`•
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`•
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`•
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`There should be a national system to collect and analyze AACN and injury data. This should
`be integrated as much as possible into current national data systems, e.g. the National Accident
`Sampling System (NASS), the National Emergency Medical Services Information System
`(NEMSIS), and the National Trauma Data Bank (NTDB).
`
`The feasibility of AACN providers acquiring components of the Glasgow Coma Scale through
`voice communication with vehicle occupants and transmitting that information to PSAPs
`(or 911 call centers), emergency medical services (EMS), and receiving hospitals should be
`investigated further.
`
`A study should investigate what AACN data best predicts a need for extrication.
`
`•
`A system of real-time communications should be established between all components of the
`trauma system, including: AACN providers, PSAPs (or 911 call centers), EMS, emergency
`
` medicine, and trauma surgery.
`
`6 | ADVANCED AUTOMATIC COLLISION NOTIFICATION AND TRIAGE OF THE INJURED PATIENT
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`REFERENCES
`1.
`
`Sasser S, Varghese M, Kellermann A, Lormand JD, editors. Prehospital trauma care systems.
`Geneva: World Health Organization; 2005.
`
`2.
`
`3.
`
`4.
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`5.
`
`6.
`
`7.
`
`8.
`
`9.
`
`
`
`Sasser S, Varghese M, Joshipura M, Kellermann A. Preventing death and disability through the timely
`provision of prehospital trauma care. WHO Bulletin [serial on the Internet]. 2006 Jul;84(7):
`Available from: http://www.who.int/bulletin/volumes/84/7/editorial20706html/en/print.html.
`[Accessed: September 19, 2008]
`
`MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national
`evaluation of the effect of trauma-center care on mortality. New England Journal of Medicine
`2006;354(4):366-78.
`
`Centers for Disease Control and Prevention; National Center for Injury Prevention and Control.
`CDC Acute Injury Care Research Agenda: Guiding Research for the Future [monograph on the
`Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2005. Available from:
`http://www.cdc.gov/ncipc/pub-res/research_agenda/agneda.htm. [Accessed: August 8, 2008]
`
`American College of Surgeons. Resources for the Optimal Care of the Injured Patient. Chicago, IL:
`ACS; 2006.
`
`The Free On-line Dictionary of Computing. Denis Howe.
`Telematics. Dictionary.com.
`http://dictionary.reference.com/browse/telematics. [Accessed: May 13, 2008]
`
`Ball W. Telematics.
`
`Prehospital Emergency Care 2006; 10(3):320-321.
`
`Hunt RC. Emerging communication technologies in emergency medical services.
`Prehospital Emergency Care 2002;6(1):131-6.
`
`Palanca S, Taylor DM, Bailey M, Cameron PA. Mechanisms of motor vehicle accidents that predict
`major injury. Emergency Medicine (Fremantle) 2003;15(5-6):423-8.
`
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`
`

`

`APPENDIX A:
`APPENDIX A:
`
`FIELD TRIAGE DECISION SCHEME:
`
`THE NATIONAL TRAUMA TRIAGE PROTOCOL
`
`Measure vital signs and level of consciousness
`Glasgow Coma Scale
`< 14 or
`Systolic blood pressure
`< 90 or
`Respiratory rate
`< 10 or > 29 (< 20 in intent < one year)
`
`Take to a trauma center. Steps 1 and 2 attempt to identify
`the most seriously lIlJIJlEtI patients. These patients should be
`transported preferentially to the highest level of care Within
`the trauma system.
`
`Assess anatomy of injury
`
`All penetrating injuries to head, neck, torso, and extremities
`proximal to elbow and knee
`Flail chest
`Two or more proximal long—bone fractures
`Crushed, degloved, or mangled extremity
`Amputation proximal to wrist and ankle
`Pelvic fractures
`Open or depressed skull fracture
`Paralysis
`
`Take to a trauma center. Steps 1 and 2 attempt to identity
`the most seriously injured patients. These patients should be
`transported preferentially to the highest level of care Within
`the trauma system.
`
`Assess mechanism of injuryand
`evidence of high-energy impact
`
`Falls
`0 Adults: > 20 ft. (one story is equal to 10 ft.)
`0 Children: > 10 ft. or 2-3 times the height of the child
`High-Risk Auto Crash
`0 Intrusion: > 12 in. occupant site; > 13 in. any site
`- Ejection (partial orcomplete) 1mm automobile
`0 Death in same passenger compartment
`0 Vehicle telemetry data consistent with high risk of iniuiy
`Auto v. Pedestrian/Bicyclist thrown, Run liver, or with
`Significant (> le MPH) Impact
`Motorcycle Crash > 2|] MPH
`
`lSEASE cuumm mm F‘RE
`
`Transport to closest appropriate trauma center, which
`depending on the trauma system, need not be the highest
`level trauma center.
`
`.
`,
`ASSESS special PaIIQHI I"
`SYSIBm Eflnslfletatlflns
`
`Age
`- Older Adults: Risk of injury death increases after age 55
`0 children: Should be triaged preterentially to pediatric-capable
`trauma centers
`Antlcoagulation and Bleeding Disorders
`Burns
`c Without other trauma mechanism: Triage to burn facility
`0 With trauma mechanism: Triage to trauma center
`Time Sensitive Extremity Iniury
`End-Stage Renal Disease Requiring Dialysis
`Pregnancy > 20 Weeks
`EMS Provider Judgment
`
`N0
`
`Contact medicalcontrol and consider transport to a trauma
`center or a specific resource hospital.
`
`Transpm according [u mmnl
`
`When in doubt, transport to a trauma center.
`For more information, visit: www.cdc.gov/Fie|dTriaqe
`
`LI 2 DEPARTMENT w HEALTH AND Huum
`sauna;
`
`THIS FIELD TRIAGE DECISION SCHEME, ORIGINALLY DEVELOPED BY THE AMERIMN COLLEGE OF SURGEONS COMMITTEE ON TRAUMA, WAS REVISED BY AN
`THIS FIELD TRIAGE DECISION SCHEME, ORIGINALLY DEVELOPED BY THE AMERICAN COLLEGE OF SURGEONS COMMITTEE ON TRAUMA, WAS REVISED BY AN
`EXPERT PANEL REPRESENTING EMERGENCY MEDICAL SERVICES, EMERGENCY MEDICINE, TRAUMA SURGERY, AND PUBLIC HEALTH. THE PANEL WAS CONVENED
`EXPERT PANEL REPRESENTING EMERGENCY MEDICAL SERVICES, EMERGENCY MEDICINE, TRAUMA SURGERY, AND PUBLIC HEALTH. THE PANEL WAS CONVENED
`BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), WITH SUPPORT FROM THE NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION
`BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (cid:904)CDC(cid:905), WITH SUPPORT FROM THE NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION
`(NHTSA). ITS CONTENTS ARE THOSE OF THE EXPERT PANEL AND DO NOT NECESSARILY REPRESENT THE OFFICIAL VIEWS OF CDC AND NHTSA.
`(cid:904)NHTSA(cid:905). ITS CONTENTS ARE THOSE OF THE EXPERT PANEL AND DO NOT NECESSARILY REPRESENT THE OFFICIAL VIEWS OF CDC AND NHTSA.
`
`8 | ADVANCED AUTOMATIC COLLISION NOTIFICATION AND TRIAGE OF THE INJURED PATIENT
`8 I ADVANCED AUTOMATIC COLLISION NOTIFICATION AND TRIAGE OF THE INJURED PATIENT
`(cid:50)(cid:58)(cid:49)(cid:40)(cid:53)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:21)(cid:19)(cid:19)(cid:24)(cid:15)(cid:3)(cid:83)(cid:68)(cid:74)(cid:72)(cid:3)(cid:20)(cid:23)
`OWNER EX. 2005, page 14
`
`

`

`APPENDIX B:
`ADVANCED AUTOMATIC COLLISION NOTIFICATION
`AND TRIAGE EXPERT PANEL
`J. LEE ANNEST, PhD | Director, Office of Statistics and Programming, National Center for Injury
`Prevention and Control, Centers for Disease Control and Prevention; Atlanta, Georgia
`
`JEFFREY S. AUGENSTEIN MD, PHD, FACS | Professor of Surgery, Director, Ryder Trauma Center and
`Director, William Lehman Injury Research Center, Ryder Trauma Center at the University of Miami/
`Jackson Medical Center; Miami, Florida
`
`GEORGE BAHOUTH, DSc | Transportation Safety Engineering, Senior Research Scientist, Pacific Institute for
`Research and Evaluation; Calverton, Maryland
`
`WILLIAM L. BALL | Vice President, Public Policy, General Motors OnStar; Detroit, Michigan
`ROBERT R. BASS, MD, FACEP | Executive Director, Maryland Institute for Emergency Medical Services
`Systems; Baltimore, Maryland
`
`PETER BAUR | Manager, Product Analysis, BMW of North America, LLC; Woodcliff Lake, New Jersey
`BOB BAILEY, MA | Principal Investigator, Field Triage Medical Protocol, Committee for Vehicle
`Telematics, and CDC Foundation Contractor for Division of Injury Response, National Center for
`Injury Prevention and Control, Centers for Disease Control and Prevention; Atlanta, Georgia
`
`ALAN BLATT | Director, Center for Transportation Injury Research, CUBRC (Calspan-University
`at Buffalo Research Center); Buffalo, New York
`
`ALASDAIR K.T. CONN, MD, FACS | Chief of Emergency Services, Massachusetts General Hospital
`and Associate Professor of Surgery, Harvard Medical School; Boston, Massachusetts
`
`ARTHUR COOPER, MD, FACS, FAAP, FCCM (cid:904)ACS(cid:905) | Professor of Surgery at the Columbia University
`College of Physicians and Surgeons, and Medical Director, Harlem Hospital Injury Prevention Program;
`New York, New York
`
`PAUL R. G. CUNNINGHAM, MD, FACS | Professor and Chair, Department of Surgery, State University
`of New York, Upstate Medical University; Syracuse, New York
`
`THEODORE DELBRIDGE, MD, MPH, FACEP | Professor and Chair, Department of Emergency Medicine,
`Brody School of Medicine, East Carolina University; Greenville, North Carolina
`
`KENNERLY H. DIGGES, PhD, PE | Research Professor of Engineering, The George Washington University;
`Washington, DC
`
`ROBERT M. DOMEIER, MD, FACEP | EMS Medical Director, St. Josephs Mercy Hospital;
`Ann Arbor, Michigan
`
`LAURIE FLAHERTY, RN, MS | Program Analyst, Office of Emergency Medical Services, National Highway
`Traffic Safety Administration, U.S. Department of Transportation; Washington, DC
`
`NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL, DIVISION OF INJURY RESPONSE | 9
`(cid:50)(cid:58)(cid:49)(cid:40)(cid:53)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:21)(cid:19)(cid:19)(cid:24)(cid:15)(cid:3)(cid:83)(cid:68)(cid:74)(cid:72)(cid:3)(cid:20)(cid:24)
`
`

`

`ROBERT L. GALLI, MD, FACEP | Professor and Chair, Emergency Medicine/Medical Toxiology/TelEmergency,
`University of Mississippi Healthcare; Jackson, Mississippi
`
`DANIEL G. HANKINS, MD, FACEP | Consultant, Department of Emergency Medicine, Mayo Clinic and
`Co-Medical Director, Mayo Clinic Medical Transport; Rochester, Minnesota
`
`MARK C. HENRY, MD | Professor and Chair, Department of Emergency Medicine, School of Medicine,
`Stony Brook University; Stony Brook, New York
`
`RICHARD C. HUNT, MD, FACEP | Director, Division of Injury Response, National Center for Injury
`Prevention and Control, Centers for Disease Control and Prevention; Atlanta, Georgia
`
`RAMON W. JOHNSON, MD, FACEP, FAAP | Board of Directors, American College of Emergency
`Physicians; Mission Viejo, California
`
`GREGORY J. JURKOVICH, MD, FACS | Professor of Surgery, University of Washington, and Chief of Trauma,
`Harborview Medical Center; Seattle, Washington
`
`VIKAS KAPIL, DO, MPH, FACOEM | Associate Director for Science, Division of Injury Response, National
`Center for Injury Prevention and Control, Centers for Disease Control and Prevention; Atlanta, Georgia
`
`SCOTT KEBSCHULL | Principal Engineer, Dynamic Research Inc.; Torrance, California
`CARLA KOHOYDA(cid:883)INGLIS, MPA | Program Manager, University of Michigan Program for Injury Research
`and Education (UMPIRE); Ann Arbor, Michigan
`
`ROBERT (cid:904)BOB(cid:905) C. LANGE, MSME | Executive Director, Structure & Safety Integration, General Motors
`Corporation; Warren, Michigan
`
`BROOKE LERNER, PhD | Associate Professor, Departments of Emergency Medicine and Population Health,
`Medical College of Wisconsin; Milwaukee, Wisconsin
`
`DAN MANZ | Emergency Medical Services Division Director, Vermont Department of Health; Burlington,
`Vermont
`
`DAVID "MARCO" MARCOZZI, MD, MHS(cid:883)CL, FACEP | Director, Emergency Care Coordination Center,
`OPEO, Office of the Assistant Secretary for Preparedness and Response, Department of Health and
`Human Services, MAJ, USAR-MC; Washington, DC
`
`BRENT MYERS, MD, MPH, FACEP | Medical Director, Wake County EMS and Wake Medical Health and
`Hospitals Emergency Services Institute; Raleigh, North Carolina
`
`AVERY B. NATHENS, MD, PhD, FACS | Canada Research Chair in Systems of Trauma Care, Division Head
`General Surgery and Director of Trauma, St. Michael's Hospital, University of Toronto; Toronto, Canada
`
`ROBERT O’CONNOR, MD, MPH, FACEP | Professor and Chair, Department of Emergency Medicine,
`University of Virginia Health System, and Immediate Past President, National Association of EMS
`Physicians; Charlottesville, Virginia
`
`NANCY POLLOCK | Public Safety professional and former Executive Director of the Minneapolis-St. Paul
`Minnesota Metropolitan Emergency Services Board; Minneapolis-St. Paul, Minnesota
`
`10 | ADVANCED AUTOMATIC COLLISION NOTIFICATION AND TRIAGE OF THE INJURED PATIENT
`(cid:50)(cid:58)(cid:49)(cid:40)(cid:53)(cid:3)(cid:40)(cid:91)(cid:17)(cid:3)(cid:21)(cid:19)(cid:19)(cid:24)(cid:15)(cid:3)(cid:83)(cid:68)(cid:74)(cid:72)(cid:3)(cid:20)(cid:25)
`