A smart phone app being developed at the University of Iowa may one day help save lives.

That’s the word from a team of researchers who have developed a prototype app that sends photos from the scene of a motor vehicle crash to providers at hospital emergency rooms long before the victims arrive at the hospital.

Early access to photographs of the crush of a vehicle can do a number of things. It can help improve triage and transportation of the victims, assist the trauma center staff in better predicting injuries and treatment options, and even aid the implementation of remote treatment, according to Daniel V. McGehee, PhD, project principal investigator and director of the Human Factors and Vehicle Safety Research Division at the UI Public Policy Center and adjunct professor of emergency medicine and mechanical/industrial engineering at the UI.

“This is the first time we are beaming vehicle crush imagery from the field into the emergency room,” McGehee says. “Based upon how a vehicle is crumpled, we can begin to predict what the injuries might be to the crash victims.

“For example, for a car sustaining a severe low side impact, the probability of the driver sustaining a pelvic fracture is high,” he says.

The goal of the project is to help law enforcement and first responders to collect a half-dozen photos of very specific photos of the crashed vehicle, then automatically send the photos to hospital emergency personnel within 30 seconds.

At present, hospital trauma teams often learn that patients are in transit to the hospital only minutes before arrival, and information may or may not be exchanged between the medical team and the very busy paramedic team.

“Such carefully taken photos will help our trauma team develop a mental model of how and what injuries may have occurred,” says Dr. Chris Buresh, MD, associate professor of emergency medicine at the University of Iowa Roy J. and Lucille A. Carver College of Medicine.

McGehee notes that unlike earlier similar studies that focused on information technology, the current project develops on-the-scene training for recording photographic evidence and training of emergency personnel in how to interpret the information collected. 

 A key part of the project is that it doesn’t merely send photos—it allows trained professionals to assess patterns of injury based upon crush and intrusion patterns of the damaged vehicle, he says.

The prototype app went live for preliminary testing in October of 2013 with 15 Iowa State Troopers and Advanced Life Support paramedics surrounding the contiguous counties around Iowa City, Iowa—home of one of the largest Level I trauma centers in the Midwest.  By the end of May, 2014, 35 phones will be in use in east-central Iowa.

Selected EMS, Iowa State Troopers, charge nurse staff and attending emergency room physicians were trained in the basic principles of automotive traumatology.

Such principles can help predict injuries based on the level of crush—or intrusion into the occupant compartment. For example, if there is a high-speed side impact crash where there is more than 12 inches of intrusion into the occupant compartment, there is a high probability of a pelvic fracture—especially if there is a raised center console in the vehicle

Robert Kaufman, a senior research scientist engineer and traumatologist at the University of Washington, pioneered the real-world crash injury research that has defined these principles and is leading the training for the project. “For years we have studied how crush and intrusion directly correlates with injury patterns and severity that one can easily assess with just a few photographs.  Being able to transmit on-scene photos to the trauma bay will be very beneficial in the triage, transport, and treatment of crash victims,” Kaufman, says. Click images to enlarge.

Major intrusion into the occupant compartment (greater that 24 inches of crush). The front-seated passenger had significant pelvic fractures. 

Thin lines represent fractures, the arrowhead is a separation of the sacroiliac joint and the thick arrow is a slipping of L4 on L5 and L5 on S1 (additional released images from rib fx available).

Comminuted fracture of tibia and fibula matches intrusion into passenger side floor pan.

As part of the outcomes research, Trauma alerts and activation pages were examined for estimated time of arrival (ETA) data for a one-month period when the TraumaHawk App was first released. Timing for the TraumaHawk alerts during the same time period relative to actual ETA was also examined. For TraumaHawk cases received from October 2013–June 2014, electronic medical records, trauma alert and activation pages were examined for time of trauma alert/activation page and actual time of patient arrival. Time of the TraumaHawk alert for these cases was also recorded. Traditional paging and TraumaHawk lead-times (minutes) were calculated. A paired t-test was used to determine if the mean lead-times for the Paging and TraumaHawk alerts differed significantly.

Preliminary Results

During the study period, 35 TraumaHawk cases were identified, of which 32 met trauma alert or activation criteria. Of these 32, the actual mean time, between the trauma team page and patient arrival was 12 min; for TraumaHawk, the advanced notice was received at the trauma center 26 min before patient arrival, more than doubling notification time (p<0.001). 

Multiple outcomes analyses for this study are still underway, but the trend is clear. This novel approach gives emergency departments additional time to prepare for the arrival of trauma patients compared to non-TraumaHawk communication. This increase in alerting time allows trauma staff to assemble the most appropriate level of care, and to notify specialists earlier than conventional estimates. As a result, hospital travel time for specialists is made more efficient, as is scheduling of operating room times to prepare for severe trauma.

This project is sponsored by the Iowa DOT.

UI Faculty and Staff: Daniel V. McGehee, PhD, Chris Buresh, MD, MPH, Denise Szecsei, PhD, Cori Peek-Asa, PhD, MPH, Michelle Lilienthal, RN, MA, CEN, Kari Harland, PhD, Dieter Friton, EMT-P. University of Washington Dept of Surgery: Robert Kaufman.