Crash Scene Research Articles

Individual risk factors predictive of major trauma in pre-hospital injured older patients: a systematic review.

Older adults with major trauma are frequently under-triaged, increasing the risk of preventable morbidity and mortality. The aim of this systematic review was to identify which individual risk factors and predictors are likely to increase the risk of major trauma in elderly patients presenting to emergency medical services (EMS) following injury, to inform future elderly triage tool development. Several electronic databases (including Medline, EMBASE, CINAHL and the Cochrane Library) were searched from inception to February 2021. Prospective or retrospective diagnostic studies were eligible if they examined a prognostic factor (often termed predictor or risk factor) for, or diagnostic test to identify, major trauma. Selection of studies, data extraction and risk of bias assessments using the Quality in Prognostic Studies (QUIPS) tool were undertaken independently by at least two reviewers. Narrative synthesis was used to summarise the findings. Nine studies, all performed in US trauma networks, met review inclusion criteria. Vital signs (Glasgow Coma Scale (GCS) score, systolic blood pressure, respiratory rate and shock index with specific elderly cut-off points), EMS provider judgement, comorbidities and certain crash scene variables (other occupants injured, occupant not independently mobile and head-on collision) were identified as significant pre-hospital variables associated with major trauma in the elderly in multi-variable analyses. Heart rate and anticoagulant were not significant predictors. Included studies were at moderate or high risk of bias, with applicability concerns secondary to selected study populations. Existing pre-hospital major trauma triage tools could be optimised for elderly patients by including elderly-specific physiology thresholds. Future work should focus on more relevant reference standards and further evaluation of novel elderly relevant triage tool variables and thresholds.

An application of in-vehicle recording technologies to analyze injury severity in crashes between taxis and two-wheelers

Conventionally, the crash data used in traffic safety analysis have been collected by the police dispatched to the crash scene. Therefore, crash information inevitably includes errors that influence traffic safety analysis. Such errors can include the crash speed, crash time, crash location, and other crash characteristics. The advances in in-vehicle video recording (IVVR) technologies have recently enabled traffic safety professionals to use more accurate crash information based on crash data reconstruction methods. Although a few studies have been conducted to identify the factors affecting the crash injury severity using such detailed crash data, there was no effort to analyze the factors affecting the injury severity in crashes between taxis and two-wheelers (TWs), including bicycles and motorcycles. Therefore, this study analyzes the injury severity of TW riders in taxi-TW crashes with the accurate crash data collected by taxis equipped with IVVR devices in Incheon, Korea. Two hundred and forty-eight crash data from two years (2010–2011) were used to perform this objective. The factors affecting the injury severity to TW riders were identified based on a partial proportional odds model for these data. Seven variables were found to affect the injury severity significantly: crash speed, second collision, third collision, Delta-V, crashes that occurred with a non-helmeted motorcycle rider, crashes where the collision type was sideswipe, and crashes under rainy or snowy weather conditions. On the other hand, two variables regarding crashes, where the taxi driver behavior helped reduce visible and severe injuries, were changing lanes and the young TW riders (<18 years).

Assessing Vehicle Profiling Accuracy of Handheld LiDAR Compared to Terrestrial Laser Scanning for Crash Scene Reconstruction.

Forensic crash investigation often requires developing detailed profiles showing the location and extent of vehicle damage to identify impact areas, impact direction, deformation, and estimated vehicle speeds at impact. Traditional damage profiling techniques require extended and comprehensive setups for mapping and measurement that are quite labor- and time-intensive. Due to the time involved, this damage profiling is usually done in a remote holding area after the crash scene is cleared. Light detection and ranging (LiDAR) scanning technology in consumer handheld electronic devices, such as smartphones and tablets, holds significant potential for conducting this damage profile mapping in just a few minutes, allowing the mapping to be conducted at the scene before the vehicle(s) are moved. However, there is limited research and even scarcer published literature on field procedures and/or accuracy for these emerging smartphones and tablets with LiDAR. This paper proposes a methodology and subsequent measurement accuracy comparisons for survey-grade terrestrial laser scanning (TLS) and handheld alternatives. The maximum root mean square error (RMSE) obtained for profile distance between handheld (iPad) and survey-grade TLS LiDAR scans for a damaged vehicle was observed to be 3 cm, a level of accuracy that is likely sufficient and acceptable for most forensic studies.

The AAA Approach to Crash Investigation Reform – The Perspective from Road Policing Practitioners

Professional road crash investigation, complemented by intelligent analysis and dynamic actions provide the foundation for road safety reform. However, to date, the real potential resulting from police investigative findings have not been fully realised due to the lack of streamlined connectivity from the crash scene to the reform process. Such deficiencies include inadequate investigations, inadequate data management, convoluted processes, system delays, inadequate analysis and limited immediate and mid-term actions which should be generated following thorough and efficient investigations. A review of processes across high, medium and low-income countries has identified a more effective approach to achieving results in road safety reform across all road safety disciplines. The simple AAA framework to ‘Acquire, Analyse and Action’ is presented as a contemporary model to ensure an evidence-based foundation drives road safety reform to identify root cause analysis locally, nationally and globally. This provides structure, discipline and purpose as well as technical skill and competence to achieve practical recommendations as preventative measures for crash reduction. A multi-disciplined expert review team to validate/assess/modify these recommendations in serious crashes ensures constructive countermeasures are prioritised and actioned. This facilitates a paradigm shift in thinking and analysis to achieve a continuous improvement process designed to reduce road trauma and save lives.

Simulation and Characterization of Wind Impacts on sUAS Flight Performance for Crash Scene Reconstruction

Small unmanned aircraft systems (sUASs) have emerged as promising platforms for the purpose of crash scene reconstruction through structure-from-motion (SfM) photogrammetry. However, auto crashes tend to occur under adverse weather conditions that usually pose increased risks of sUAS operation in the sky. Wind is a typical environmental factor that can cause adverse weather, and sUAS responses to various wind conditions have been understudied in the past. To bridge this gap, commercial and open source sUAS flight simulation software is employed in this study to analyze the impacts of wind speed, direction, and turbulence on the ability of sUAS to track the pre-planned path and endurance of the flight mission. This simulation uses typical flight capabilities of quadcopter sUAS platforms that have been increasingly used for traffic incident management. Incremental increases in wind speed, direction, and turbulence are conducted. Average 3D error, standard deviation, battery use, and flight time are used as statistical metrics to characterize the wind impacts on flight stability and endurance. Both statistical and visual analytics are performed. Simulation results suggest operating the simulated quadcopter type when wind speed is less than 11 m/s under light to moderate turbulence levels for optimal flight performance in crash scene reconstruction missions, measured in terms of positional accuracy, required flight time, and battery use. Major lessons learned for real-world quadcopter sUAS flight design in windy conditions for crash scene mapping are also documented.

Two-Lane Highway Crash Severities: Correlated Random Parameters Modeling Versus Incorporating Interaction Effects

Two-lane highways represent the majority of highways in the U.S. and their safety is of crucial concern. Even though road safety researchers intensively evaluated two-lane highway safety, past studies were challenged by a methodological hindrance, namely that of correlated random parameters (CRP) modeling methods. Random parameters models capture unobserved heterogeneity effects of crash contributing factors, while CRP models offer the additional benefit of capturing correlations among variables inducing such unobserved heterogeneity effects. However, CRP models do not permit specifying pairs of regressors, with statistically insignificant correlations, to be uncorrelated. In this research, it was demonstrated that the conventional uncorrelated random parameters ordinal probit (URPOP) structure with interaction effects outperformed the correlated random parameters ordinal probit (CRPOP) structure when modeling injury severity risks of two-lane highway crashes in Wyoming. As per the former model’s results, speeding, head-on collisions, sideswipe opposite-direction collisions, intersecting-direction collisions, motorcycle involvement, impaired driving, distracted driving, the interaction effect of speeding with motorcycle involvement, that of head-on collisions with impaired driving, and that of head-on collisions with commercial vehicle involvement all raised the likelihood of sustaining severe injuries. Conversely, leaving the crash scene, proper seat belt use, wet road surfaces, and the interaction effect of impaired driving with motorcycle involvement alleviated the risk of incurring severe injuries. The superiority of the proposed model and its reduced computation time warrant its recommendation for implementation in future studies. Also, from a practical perspective, safety mitigation measures are suggested based on this research’s findings.

Exploring digital evidence recognition among front-line law enforcement officers at fatal crash scenes

Digital forensic evidence has become an essential component of criminal investigations across the United States. The amplified integration of technology with society, however, continues to present new challenges for law enforcement officers. This issue is evident in one of the key responsibilities of police agencies involves the enforcement of traffic laws and regulations on surface streets and highways. It is unclear how well first responders recognize the need to seize digital evidence associated with fatal vehicles accidents in the field. This study addressed this gap in the literature by examining a comparative population of respondents from the state police agencies in a large Midwestern and large Southern state. Using a vignette design, the findings demonstrated that respondents recognized the need to recover mobile devices and telematics from the vehicles involved in fatal crashes. A substantive number of officers remained unsure of the potential digital evidentiary value of other objects on-scene (e.g., fast food, makeup). Further, regional differences were observed in respondents’ responses. The implications for our understanding of police capacity and training needs were explored in detail.

How automated vehicles should operate to avoid fatal crashes with cyclists?

The study assesses what kind of features would allow highly automated vehicles’ (HAVs) safe operation in encounters with cyclists and allow avoiding fatal crashes between cyclists and passenger cars. Five features of HAVs’ capabilities are formed based on previous studies and evaluated qualitatively using data from fatal crashes between driver-managed passenger cars and cyclist in Finland. By analysing these crashes, it is assessed which features HAVs should have in order to avoid each crash in a hypothetical setting, in which driver-managed cars would be replaced by HAVs. The necessary features of HAVs for crash avoidance are analysed crash-by-crash by considering the obligation to yield, visual obstacles at the crash scene and driver’s behaviour prior to the crash. In order to avoid different types of fatal crashes with cyclists, the HAVs should be able to recognize nearby cyclists (feature 1), be aware of the priority rules in various intersections and traffic situations (2), indicate its intentions to cyclists (3), maintain safe driving patterns and anticipate future situations (4), and assess cyclists’ intentions (5). Albeit the number of different features to allow crash avoidance is only five, implementing these features is a considerable challenge for HAVs’ programming and design, as these should function in various and complex traffic situations. The study discloses the complexity in the encounters between HAVs and cyclists, which are to be considered in further studies and real-world implementations.

The application of geographic information system as an intelligent system towards emergency responses in road traffic accident in Ibadan

Background: The high influx of private and public vehicles within global cities (including Ibadan) has resulted in traffic congestion within the city centre. Ibadan North-East, an urban local government area (LGA) within the metropolitan land area of Ibadan, has been experiencing automobile accidents and traffic congestion which in turn limits emergency responders. Objectives: The broad objective of the study was to develop a digital road network database for emergency response to road traffic accident, Ibadan North East, Nigeria. Methods: This study made use of primary and secondary data to generate spatial and non-spatial data. ArcGIS 10.3 was used to create the database, analyse data and display the results. Spatial search and network analysis were carried out using a kernel density estimated tool to generate a black-spot area within Ibadan North-East. Dijkstra’s shortest path algorithm in the ArcGIS Network Analysis was utilised to identify the closest health facility to the road traffic crash scene. Results: The most cost-effective haven introduced route impedance and is defined as the best route. Study findings show that dynamic distance varies from the best route to an alternative route. Also, kernel density estimation reveals that crashes widely occur in the northeastern and southwestern parts of Ibadan North-East (Iwo Road and Orita-Aperin). Incorporating live traffic data using GPS technology and traffic cameras was identified to enhance road traffic data documentation and safety. Conclusion: The study identifies GIS as a decision support system that is useful in the area of planning, mitigation, preparedness, response and recovery for decision-making in road traffic-related emergency management and emergency planning services in Ibadan.

Autopsy findings in drivers and passengers from fatal motor vehicle collisions: limited differences in injury patterns and toxicological test results

We performed a retrospective study of the injuries and characteristics of occupant fatalities in motor vehicle collisions in southeast Norway. The goal was to provide updated knowledge of injuries sustained in modern vehicles and detect possible differences in injury pattern between drivers and passengers. Forensic autopsy reports, police, and collision investigation reports from 2000 to 2014 were studied, data extracted and analyzed.A total of 284 drivers, 80 front-seat passengers, and 37 rear-seat passengers were included, of which 67.3% died in front collisions, 13.7% in near-side impacts, 13.5% in rollovers and 5.5% in other/combined collisions. Overall, 80.5% died within one hour after the crash. The presence of fatal injuries to the head, neck, thorax and abdomen were observed in 63.6%, 10.7%, 61.6% and 27.4% respectively. All occupants with severe injuries to the head or neck had signs of direct impact with contact point injuries to the skin or skull. Injuries to the heart and spleen were less common in front-seat passengers compared to drivers. Seat belt abrasions were more common and lower extremity fractures less common in both front-seat and rear-seat passengers compared to drivers. Blood alcohol and/or drug concentrations suggestive of impairment were present in 30% of all occupants, with alcohol more often detected among front-seat passengers compared to drivers.Few driver-specific and passenger-specific patterns of injury could be identified. When attempting to assess an occupant’s seating position within a vehicle, autopsy findings should be interpreted with caution and only in conjunction with documentation from the crash scene.

A skewed logistic model of two-unit bicycle-vehicle hit-and-run crashes

Objective Hit-and-run behavior in crashes is a severe offense worldwide because the identification and emergency rescue of any injured road user is delayed. A motorist’s run from the crash scene is especially serious for a cyclist who would be more prone to be physically injured in a bicycle-vehicle (BV) crash. The objective of this paper is to explore potential risk factors that contribute to the hit-and-run (HR) behavior of a driver after a two-unit BV collision. Methods The data used in this study are extracted from traffic crash records in the city of Durham, North Carolina in 2007–2014. This study uses the skewed logistic (Scobit) model to account for the skewness of the dependent variable (i.e., HR) in the dataset. Results The Likelihood ratio test, AIC and BIC results show that the Scobit model is preferred to the standard binary logistic model for modeling a driver’s decision to run from a two-unit BV crash scene. Estimation results indicate that, the driver’s tendency to run from a crash scene without reporting it in Durham increases if the bicyclist is a teenager or an adult, a drunk-driving or a speeding driver is involved, when the crash happens at night (19:00–6:59), on a local street, or when the automobile overtakes the bicycle. HR behavior will decrease if the cyclist is drunk, an SUV is involved, or the bicyclist fails to yield. Conclusions The findings of this study are important and useful when developing countermeasures to prevent BV-HR crashes and to improve cycling safety.

Examining the underlying exposures of hit-and-run and non-hit-and-run crashes

IntroductionHit-and-run crashes occur when the driver at fault leaves the scene without reporting, which could delay emergency response for the victims who are left. For this reason, it is assumed that hit-and-run crashes lead to more serious injuries; however, the research in this area is limited. The objectives of the study are to examine the differences in hit-and-run and non-hit-and-run victim injury severities and to identify the factors that may influence any differences. MethodsQuasi-induced exposure technique, an indirect method, is employed to measure the relative crash exposures between hit-and-run and non-hit-and-run crashes using Michigan two-vehicle injury crashes 2012–2014. Random parameter ordered logit model is used to reveal the discrepancy of the factors contributing to victim injury severity. ResultsWe found that the injuries sustained by the drivers left at the scene (victims) of hit-and-run crashes were generally less severe compared to non-hit-and-run driver victims, which may be attributed to the differential crash factors in terms of driver age and vehicle type. The injury-severity contributing factors of hit-and-run crashes differed considerably from the non-hit-and-run crashes. Characteristics such as occurring in rural areas, at nighttime, at intersections, crash type, and alcohol involvement significantly increased the injury severities of the driver victims. ConclusionWe inform the hit-and-run literature to suggest a contradiction to the assumption that leaving the crash scene may lead to more serious injuries. This example emphasizes the importance of distinguishing different types of crashes and their contributing factors. We offer an indirect approach that can help to identify underlying factors and reduce bias, which can inform traffic safety methods and serve to propose effective safety countermeasures.

Designing a Guideline for Emergency Medical Communication Center Staff to Help Road Traffic Crash Patients: A Delphi Study

Background: Injuries and deaths from RTC are critical health problems of societies and one of the main causes of death especially among the young. Objective: This study aimed to design and compile a guideline for emergency medical communication centers (EMCC) staff to provide direct assistance offered by road traffic crash (RTC) bystanders. Methods: Based on prior literature, the RTC bystanders' initial draft guideline contained 20 domains and 28 items. As a validation step, the draft guideline was reviewed by content experts (one emergency medicine and two disaster specialists) and modified based on their recommendations. The subsequent draft guideline was then reviewed in three Delphi rounds by 67 participants, including health professionals in emergencies and disasters, emergency medicine, nurses, emergency medical experts, and EMCC staff. The accepted agreement coefficient was set at ≥70%. As the final step, an expert consensus meeting was held to review the guideline. Results: The participants agreed on 56 items regarding 20 domains, including scene safety, hand precautions, and personal protection, alertness assessment, respiration, cardiopulmonary resuscitation (CPR), bleeding control, recovery position, splinting, rapid evacuation, scene management, patient transfer, triage, spinal cord injury prevention and immobilization, injured transportation, psychological support, hypothermia prevention, water and food, amputated limb protection, and support of deceased people. Two items in relation to airway opening maneuvers were added to the guideline during the expert consensus meeting. Conclusion: Compared to other RTC bystander guidelines for EMCC staff, more comprehensive guidelines can be served as a basis for directing RTC bystanders to provide assistance. Important areas of hand care and personal protection, breathing, airway, splinting, scene management, mental and psychological support, and support of deceased people were included in this guideline. EMCC staff can provide guidance to be performed by RTC bystanders. RTC bystanders can play important roles at crash scenes, including preventing secondary injury, supporting scene management, and providing first aid for the injured people. This guideline can be used to help direct appropriate care and behavior by RTC bystanders.

Injury Severity of Ambulatory Patients Following Motor Vehicle Crash.

On-scene ambulatory status following a motor vehicle crash (MVC) serves as an informal marker of physiologic stability. The influence of ambulatory status after an MVC on trauma team activation and injury severity is infrequently studied, yet may alter the clinician's index of suspicion for injury. The purpose of this study is to describe the injury burden of ambulatory on-scene patients following an MVC. This is a prospective descriptive study of MVC patients arriving by emergency medical services (EMS), with trauma team activation, to a Midwestern Level I trauma center from July through December 2018. The EMS records were reviewed for wording that indicated the patient's ambulatory status following an MVC. Those denoted as "ambulatory on-scene" were included in this study. Of this subset, Injury Severity Score (ISS), hospital admission status, safety mechanisms utilized, crash scene description, and demographics were collected. A total of 648 MVC patients with trauma activations were reviewed, of which 308 met criteria for study inclusion. The average ISS was 2.8, with a range of 0 to 30. The cohort was 51.3% male, with a hospital admission rate of 25.9%. Of the 308 trauma activations, six were total, and 302 were partial. This study of MVC patients with documented on-scene ambulation found that, although the average ISS was low, injuries and hospital admission were present in up to one-quarter of patients. Ambulatory status following an MVC while informative should not be used as a triage mechanism.

The role of augmented reality in air accident investigation and practitioner training

The aim of this paper is to describe the application of digital visualization tools to assist air accident investigators, including both their investigation activities and as a training resource. Augmented Reality technology is used to re-create a real aircraft crash scene, both in terms of wreckage distribution and features of the surroundings, in a full-scale 3D representation. A case study shows both potentials and limitations of the approach, and recommendations on how to improve the methodology are also proposed. Overall, it is concluded that Augmented Reality has achieved a maturity stage sufficient to consider it as an effective tool for training of air accident investigators and, to some extent, to support the investigation process itself, although more developments are required to address some current limitations and fully exploit the capabilities of this technology.

Analysis of Emergency Department Presentations due to Injuries From Motor Vehicle Crashes and Pedestrian Strikes.

ObjectiveThe objective of this study was to analyze the causes and outcomes of presentations to the emergency department (ED) due to injuries from motor vehicle crashes and pedestrian strikes along several parameters.MethodsData from 798 patients who were injured due to motor vehicle crashes or pedestrian strikes that occurred in Canakkale Province were retrospectively analyzed. Patient demographic data such as age and gender, emergency service outcomes, and the consulted clinics were also recorded. Distributions of the crashes by weekdays or weekends, national and religious holidays, official holidays, and Ramadan month were comparatively analyzed.ResultsA total of 253 people injured in motor vehicle crashes and 395 people injured in pedestrian strikes were directly brought to the ED from the crash or strike scene. While 656 patients were discharged from the ED, 142 patients were referred to other clinics for surgery. A total of 538 crashes occurred on weekdays and 206 on weekends, and 54 crashes occurred during official and religious holidays. Most crashes occurred in summer, and the second most occurred in autumn. The rate of pedestrian strikes that occurred in summer and autumn was statistically significantly higher than the rate of injuries from motor vehicle crashes observed in the same seasons. The majority of the weekend crashes were caused by persons who had not consumed alcohol.ConclusionTraffic crashes occur more commonly among young men and in the summer season, while national, official, and religious holidays do not seem to play a role in the frequency of traffic crashes.

Motor Vehicle Crash Characteristics That Are Predictive of High Acuity Patients: An Analysis of Linked Ambulance and Crash Data

Background Motor vehicle crashes (MVCs) comprise a significant component of emergency medical service workload. Due to the potential for life-threatening injuries, ambulances are often dispatched at the highest priority to MVCs. However, previous research has shown that only a small proportion of high-priority ambulance responses to MVCs encounter high acuity patients. Alternative methods for triaging patients over the phone are required to reduce the burden of over-triage. One method is to use information readily available at the scene (e.g. whether a person was a motorcyclist, ejection status or whether an airbag deployed) as potential predictors of high acuity. Methods: A retrospective cohort study was conducted of all MVC patients in Perth attended by St John Western Australia between 2014 and 2016. Ambulance data was linked with Police crash data. The outcome variable of interest was patient acuity, where high acuity was defined as where a patient (1) died on-scene or (2) was transported by ambulance on priority one (lights & sirens) from the scene to hospital. Crash characteristics that are predictive of high acuity patients were identified by estimating crude odds ratios and 95% confidence intervals. Results: Of the 18,917 MVC patients attended by SJ-WA paramedics, 6.4% were classified as high acuity patients. The odds of being a high acuity patient was greater for vulnerable road users (motorcyclists, pedestrians and cyclists) than for motor vehicle occupants (OR 3.19, 95% CI, 2.80–3.64). A ‘not ambulant patient’ (one identified by paramedics as unable to walk or having an injury incompatible with being able to walk) had 15 times the odds of being high acuity than ambulant patients (OR 15.34, 95% CI, 11.48–20.49). Those who were trapped in a vehicle compared to those not trapped (OR 4.68, 95% CI, 3.95–5.54); and those who were ejected (both partial and full) from the vehicle compared to those not ejected (OR 6.49, 95% CI, 4.62–9.12) had higher odds of being high acuity patients. Discussion: There were two important findings from this study: (1) few MVC patients were deemed to be high acuity; and (2) several crash scene characteristics were strong predictors of high acuity patients.

Applying hierarchical logistic models to compare urban and rural roadway modeling of severity of rear-end vehicular crashes

A rear-end crash is a widely studied type of road accident. The road area at the crash scene is a factor that significantly affects the crash severity from rear-end collisions. These road areas may be classified as urban or rural and evince obvious differences such as speed limits, number of intersections, vehicle types, etc. However, no study comparing rear-end crashes occurring in urban and rural areas has yet been conducted. Therefore, the present investigation focused on the comparison of diverse factors affecting the likelihood of rear-end crash severities in the two types of roadways. Additionally, hierarchical logistic models grounded in a spatial basis concept were applied by determining varying parameter estimations with regard to road segments. Additionally, the study compared coefficients with multilevel correlation model and those without multilevel correlation. Four models were established as a result. The data used for the study pertained to rear-end crashes occurring on Thai highways between 2011 and 2015. The results of the data analysis revealed that the model parameters for both urban and rural areas are in the same direction with the larger number of significant parameter values present in the rural rear-end crash model. The significant variables in both the urban and rural road segment models are the seat belt use, and the time of the incident. To conclude, the present study is useful because it provides another perspective of rear-end crashes to encourage policy makers to apply decisions that favor rules that assure safety.

Traffic police officers\u2019 experience of post-crash care to road traffic injury victims: a qualitative study in Tanzania\u201d

BackgroundRecently, road traffic injuries (RTIs) have become a major health problem affecting health systems in many low- and middle-income countries. Regardless of whether an ambulance is available for evacuation, police officers have been shown to arrive at the crash scene first, becoming, in effect, the first responders to RTI victims. Therefore, the study aimed to explore the experiences of traffic police officers in regard to the provision of care to RTI victims in the prehospital environment, including the role of traffic police upon arriving at the crash scene, the challenges they face, and their opinions about how to improve care to RTI victims.MethodThe study used a qualitative approach in which data were obtained from 10 individual interviews and three focus group discussions. There were 41 participants, 27 of them were male and 14 were female. About half (48.7%) of the study participants were aged between 30 to 39 years. Qualitative content analysis was used to analyse all the materials.ResultsThree themes emerged from the analysis. The theme “Maintain safety while saving injured victims’ lives and facilitating access to a health facility” was comprised of safety, sorting, initial help, and assisting access to hospital care. “Overwhelmed working with limited resources and support” included limited care and transport resources, police fatigue, and little or no support. “Improving supportive system and empowering frontline personnel” included the need for an emergency care system, availability of resources and an emergency medical support system, and training for police and drivers regarding victims’ first-aid care, and road safety.ConclusionThe study findings characterize an environment in which the police first responders have no knowledge or skills and no equipment and supplies to provide care to RTI victims at the scene before rushing them to definitive care. The results suggest a favorable climate for training and equipping officers so that they can deliver competent postcrash care at the scene while emergency medical services are yet to be established. However, more research will be needed to determine the efficacy of such training and its acceptability in the Tanzanian context.

Management of Preventable Deaths due to Road Traffic Injuries in Prehospital Phase; a Qualitative Study.

Prehospital care plays an important role in decreasing the number of deaths due to road traffic injuries (RTIs). This study aimed to identify the challenges of preventable deaths due to RTIs in the prehospital phase based on the attitudes of stakeholders. Conventional content analysis of qualitative study was used to analyze the data. The participants were 24 RTI prevention experts from fire-fighting organization, traffic police, the Red Crescent, Emergency Medical Services staff, emergency medicine specialists, and hospital emergency nurses who were selected by means of purposive sampling. Data were collected using unstructured interviews and analyzed by means of data coding, followed by extracting sub-categories, and main categories. Six main categories were extracted as the major challenges of preventable deaths in RTIs in the prehospital phase including "poor management of the crash scene" with two subcategories of lack of rapid access to the patient and lack of scene safety, "lack of adequate rules and regulations" with two subcategories of lack of protocols and guidelines and lack of clear duties checklists, "poor management of time" with two subcategories of elongated response time at the crash scene and elongated time of victim transport, "low quality of training" with two subcategories of insufficient training of Emergency Medical Services (EMS) staff and inadequate public training, "poor communication and coordination" with two subcategories of poor communication of EMS staff and lack of uniform commandership at the crash scene, and "low quality of victim management" with two subcategories of low quality of clinical care and lack of accurate clinical assessment. The following measures are necessary to reduce preventable deaths due to RTIs in the prehospital phase: accurate clinical assessment of the victim on the scene, provision of high quality and accurate clinical care, enforcement of legal obligations and using protocols in the field of victim management, coordination of the involved organizations through identifying the duties and responsibilities of each organization, and full management of the crash scene by assigning a unique commander to each unit and creation of the highest level of safety on crash scene.