October 2016 - Page 2 of 2 - Care For Crash Victims

Journal of Trauma Publishes Paper on Time and Place of Death From Automobile Crashes

October, 2016

Dear Care for Crash Victims Community Members:

Dr. Howard R. Champion, a surgeon who has worked to improve care for crash victims since at least 1986, has a new paper out in the Journal of Trauma (attached).

Short History of Efforts To Improve Care for Crash Victims

I have had the honor to work with Dr. Champion over the years. A little background information.

1980’s – By 1980 the U.S. had lost 2.2 Million Lives to Vehicle Violence Dr. Champion was co-author of the landmark 1989 Journal of Trauma paper “Trauma Triage: Vehicle Damage as an Estimate of Injury Severity”. See https://www.ncbi.nlm.nih.gov/pubmed/2724382

At NHTSA, his work was very highly regarded and listed in CIREN Report HS 809 564 pp. 107 – 110. Available at https://www.careforcrashvictims.com/assets/CIREN2.pdf

1990’s – By 1990 the U.S. had lost 2.7 Million Lives to Vehicle Violence Dr. Champion’s work in the 1980s contributed to the American College of Surgeons’ 1990 publication “Resources for the Optimal Care of the Injured Patient.” In 1991, NHTSA faced a mystery of an air bag fatality that turned out to be an airbag success story – albeit a tragic story. NHTSA had assigned me to manage a Congressional earmark project to build a Trauma Center in Miami, FL. A small percentage of the project funding was allocated to research on crashes, injuries, treatments and outcomes. One objective was to observe how new airbags coming into the fleet were performing. As NHTSA investigated its first air bag fatality on my project, NHTSA R&D became intensely aware of the need to improve triage, transport, and treatment decision-making for saving crash victims. The Trauma Center had not yet been built and the crash victim was transported to the massive Jackson Memorial Hospital. The crash victim had been in a very high severity multiple impact crash in a 1991 Volvo traveling at an estimated 60 mph into a traffic control box and then into a concrete pole. He was unbelted and weighed 323 lbs. He was initially stable. He was later taken to the operating room for seemingly correctable problems. He deteriorated, developed severe problems, found to have massive internal injuries and died of multiple organ system failure.

At NHTSA our focus was on the engineering of the Volvo airbag. We brought together the leading bio-mechanics and airbag engineers to understand what caused the injuries. We spent a year trying to determine whether the airbag was improperly designed, did the airbag go off on the first impact or the second impact, was the victim on the airbag when it went off? Etc. It turns out that the limits the Volvo airbag was designed for was about a 60 mph barrier impact for a belted, average size male – not an unbelted 323 lb. male in a multiple impact crash with the second impact into a concrete pole.

When I told a trauma surgeon from Baltimore about our engineering mystery, he pointed out that the emergency medical system including the hospital failed to immediately recognize the presence and severity of the internal injuries. At the hospital, they did not know how severe the crash was because he lacked major facial injuries that were usually were present in severe crashes. That led to Dr. Jeffrey S. Augenstein et al describing the challenge of identifying occult injuries in air bag protected crash victims. See Case #91-002 inattached SAE paper 940714.

In 1993, NHTSA published a Research Note, that I co-authored, titled “Detection of Internal Injuries in Drivers Protected by Air Bags” See p. 37 at https://www.careforcrashvictims.com/assets/CIREN2.pdf

In 1994, NHTSA published a poster for the Emergency Medical community titled “Look Beyond the Obvious” to help detect internal injuries in air bag equipped vehicles. See CIREN Progress Report #2, Pages 37-45 at https://www.careforcrashvictims.com/assets/CIREN2.pdf

In 1996, NHTSA Administrator Ricardo Martinez, the agency’s first emergency physician to head the agency, asked me to manage a research project with Dr. Champion as Principal Investigator to examine the relationships of crash characteristics to injuries. I had the privilege of bringing together a team of high level medical and safety researchers. We met monthly for a year analyzing available NHTSA data on crashes, injuries, and outcomes.

In 1997, Dr. Champion presented findings that it was possible to estimate the probability of the presence of serious injuries from crash data to the Administrator and top NHTSA executives – including demonstration of an URGENCY 1.0 algorithm. The continued development of an URGENCY algorithm was recommended for improving post-crash injury control. See https://www.careforcrashvictims.com/assets/MartinezBriefing3-27-97.pdf And see https://www.careforcrashvictims.com/assets/Malliaris970393.pdf

Based on this work, I helped in the publication of papers by the team members on Automatic Crash Notification (ACN), URGENCY, and Air Medical Services. See https://www.careforcrashvictims.com/home/urgency

In 1998, the research team produced the paper on Automatic Crash Notification published in AirMed. See https://www.careforcrashvictims.com/assets/automatic-crash-notification.pdf

In 1999, the team’s paper on URGENCY was published in AirMed. See https://www.careforcrashvictims.com/assets/urgency.pdf

In 1999, Dr. Champion presented a paper to the NTSB titled “Reducing Highway Deaths and Disabilities with Automatic Wireless Transmission of Serious Injury Probability Ratings from Crash Recorders to Emergency Medical Services Providers.” See http://www.nhtsa.gov/cars/problems/studies/acns/champion.htm

In October 1999, the Congress, based in part on this research, enacted the Wireless Communications and Public Safety Act specifying 9-1-1 to be the “universal emergency telephone number” and finding that “emerging technologies can be a critical component…to reduce emergency response times and provide appropriate care.” In 1999, the FCC also issued rules for Enhanced 9-1-1 service to automatically provide location information to emergency dispatchers.

2000’s – By 2000 the U.S. had lost 3.1 Million Lives to Vehicle Violence

In 2001, NHTSA published an evaluation report on a limited test of Automatic Crash Notification (ACN). See https://www.careforcrashvictims.com/assets/ACNEvaluation.pdf

In 2001, NHTSA published a paper “Development and Validation of the URGENCY Algorithm to Predict Compelling Injuries” See https://www.sae.org/publications/technical-papers/content/2001-06-0051/

In 2001, NHTSA published CIREN Report #1, which I edited, that carried chapters on the continuation of work on crashes, injuries, treatments, and outcomes to reduce deaths and disabilities. See https://www.careforcrashvictims.com/assets/CIREN1.pdf

In 2003, NHTSA published a paper on the creation of the Atlas and Database of Air Medical Services (ADAMS) to help improve rescue of seriously injured crash victims to get them to definitive (timely and optimal) care at trauma centers. See http://www.adamsairmed.org/pubs/ITS_SSC.pdf

In 2003, NHTSA published CIREN Report #2, which I edited, that carried chapters on improving care for crash victims at Trauma Centers. It summarizes much of the work. See pp.37-45 at https://www.careforcrashvictims.com/assets/CIREN2.pdf

In 2005, NHTSA published a paper by Dr. Champion and the team “New Tools to Reduce Deaths and Disabilities by Improving Emergency Care: Urgency Software, Occult Injury Warnings, and Air Medical Services Database”. See https://www.careforcrashvictims.com/assets/2005-urgency.pdf

In 2005, another team of researchers I worked with produced a paper “Assessment of Air Medical Coverage Using the Atlas and Database of Air Medical Services and Correlations With Reduced Highway Fatality Rates”. This paper indicated the life saving potential for the ADAMS GIS by providing the data and software tools needed to enable users to view the air medical resources in this country on national, state, and local levels. See https://www.careforcrashvictims.com/assets/amj-paper-4.pdf

By 2006, under the Bush Administration, NHTSA had reassigned me to work that appeared to me to have less promising life saving potential. I thought that I should retire and work on improving care for crash victims.

By 2007, GM had funded work at CDC to remove “Rollover and Extrication” from new Triage Guidelines. See https://www.careforcrashvictims.com/assets/CFCV-MonthlyReport-March2014.pdf

By 2009, Dr. Champion had a paper published in the Journal of Trauma noting the importance of “Rollover and Extrication” in Triage Guidelines. See https://www.careforcrashvictims.com/assets/rollover_paper.pdf

By 2009, BMW had shown what was possible with Automatic Crash Notification, URGENCY software, and communications with trauma centers and air medical services. Watch video at https://www.youtube.com/watch?v=A30fi8-muk4

2010’s – By 2010 the U.S. had lost 3.5 Million Lives to Vehicle Violence

By 2015, the NHTSA data showed that both the number and percent of fatalities counted by NHTSA that died pre-hospital exceeded those that died in hospital. See

JS Final NHTSA Vehicle Deaths GraphData Percentages States 06-15-15-1 2015 at https://www.careforcrashvictims.com/home/urgency In 2015, Dr. Champion’s paper “Time and Place of Death from Automobile Crashes” was published by the Journal of Trauma. Copy attached. It shows that time and place of death data continue to support calls for improvements in the triage, transport, and treatment decisions of people seriously injured in crashes.

By 2016, twenty five years later, – and nearly 1 million American lives lost and nearly 4 million serious injuries later – NHTSA still has not published a federal minimum vehicle safety standard FMVSS for ACN, URGENCY software, and communications and dispatch protocols to trauma centers and air medical services when crashes have a high probability of presence of serious injuries. This despite 100 deaths per day and 400 serious injuries per day in the U.S.A. today. See

NHTSA has failed the American people. After 25 years, 56% of all deaths due to vehicle violence still occur without transport to any facility for emergency medical care. And of the 44% that are taken to “some” facility, not necessarily a trauma center for optimal care, many die for lack of timely and optimal care.

The science and safety technologies have been there for decades. The needless deaths and suffering continue.

Lou Lombardo

DOT Waffles on Ethical and Safety Issues of Autonomous Vehicles

October, 2016

Dear Care for Crash Victims Community Members:

Mike Lemov has written an Op-Ed published in The Hill.

“On Sept. 20, the Department of Transportation, by law our primary national traffic safety enforcement agency, issued its long awaited “guidelines” for the development and sale of driverless cars. The Department attempted, Solomon-like, to balance its guidance between ensuring public safety and promoting the speedy development of driverless cars (called “Highly Automated Vehicles”) for use on our roadways.

For all its fanfare, DOT’s guidance failed to achieve its primary mission of ensuring safety.

DOT and its delegate agency NHTSA did not issue any new enforceable safety regulations for driverless vehicles, at least for the present. It did not propose any premarketing standards or requirements for automated cars, except to say it will shortly ask all producers of driverless cars and component systems to answer a comprehensive questionnaire about their proposed designs and test methods. Absent was any commitment by the federal government to actually regulate the new cars before they are sold to the public for use on public roads.

The omission is discouraging and could prove dangerous, particularly in view of the current record of partially automated vehicles getting into accidents. Some of these crashes have been deadly. It seems as if the guidelines were designed to preempt states such as California which already has issued enforceable safety regulations, such as requiring a driver and a steering wheel in all vehicles.

The Department did warn producers that the current penalties for not reporting a safety related defect publicly would apply to the automated cars, despite the weakness of the current penalties and the agency’s failure to force reporting of past lethal dangers of non-driverless cars, such as Toyota’s sudden acceleration, General Motors’s ignition shut off problem and Takata’s exploding airbags. In all these cases, and many more, the lack of adequate federal civil and any criminal sanctions apparently induced manufacturers to gamble on not reporting the accidents, even while people were being injured and killed.

The ethical and safety issues raised by the Department’s waffle are troubling.” Seehttp://thehill.com/blogs/congress-blog/technology/302647-driverless-cars-ethics-and-public-safety

Hopefully, Congress will look into the ethical and safety failures of DOT officials who have allowed the rising rate of crash victims in the U.S.A. today:

* 100 deaths per day

* 400 serious injuries per day

* $2 Billion in losses per day

Lou Lombardo

Center for Auto Safety Wins For the People In Court Decision on Chrysler Secrecy

October, 2016

Dear Care for Crash Victims Community Members:

Please see the following article on important victory by Clarence Ditlow and the CAS to unseal FCA documents.

http://www.nationallawjournal.com/id=1202769118747/Chrysler-Loses-Supreme-Court-Fight-Over-Sealed-Documents?slreturn=20160904095005

Chrysler Group LLC’s battle with the Center for Auto Safety to keep sealed certain documents relating to an alleged defect in several vehicle models ended Mondaywhen the U.S. Supreme Court declined to hear the automaker’s appeal.

In FCA US v. Center for Auto Safety, the company had asked the justices whether the “good cause” necessary to place discovery documents under a protective order was sufficient to keep them sealed.

“While FCA US is disappointed that the Supreme Court declined review, we look forward to presenting our case in the district court,” a Chrysler spokesman said.

In November 2013, several car owners sued Chrysler over the alleged power-system defect. Concerned that thousands of drivers might experience power-system failures, they sought a preliminary injunction ordering Chrysler to warn customers. Almost all of the evidence submitted by the car owners in support of the motion was sealed, as was evidence in opposition offered by Chrysler.

When the district court denied the motion, the Center for Auto Safety moved to intervene in the suit to seek the unsealing of the documents associated with the preliminary injunction motion.

The district court refused again to unseal the documents, saying that the “compelling reasons” standard that ordinarily applies to court records does not apply to non-dispositive motions, so preliminary-injunction motions may be sealed under a lower “good cause” standard.

The U.S. Court of Appeals for the Ninth Circuit disagreed. The appeals court said the public’s right to access court records extends to preliminary injunctions and those records can only be sealed for compelling reasons.

In June, the Center for Auto Safety noted on its website that the Ninth Circuit’s decision was cited by U.S. District Judge Gonzalo Curiel in San Diego when he unsealed documents in the Trump University real estate school lawsuit.

Chrysler’s petition, filed by Thomas Dupree of Gibson, Dunn & Crutcher, had drawn support from the U.S. Chamber of Commerce, the Washington Legal Foundation and other business groups. The Center for Auto Safety was represented in the high court by Leslie Bailey and Jennifer Bennett of Public Justice in Oakland.

Update: This story was updated with comment from FCA Group.

Contact Marcia Coyle at mcoyle@alm.com. On Twitter: @MarciaCoyle.

Center for Auto Safety Comments on VW Diesel Scandal Settlement

October, 2016

Dear Care for Crash Victims Community Members:

“CAS Staff Attorney Michael Brooks:

“It is great news that VW diesel owners can now be reimbursed, and that Volkswagen must begin to repair the environmental damage their emissions deception caused. However, automakers will not change their illegal behavior unless the government pursues significant criminal penalties against executives who take or condone such actions. We look forward to news of federal criminal charges against the VW executives who participated in this fraud on the American public.”

Safe Climate Campaign Director Dan Becker:

“The government did a good job preventing further harm from VW’s diesel fraud. Most heavily polluting diesels will be removed from the road and cannot be resold unless fixed. Other automakers must learn from this scandal that they dare not disable pollution controls, lie to the government or fleece consumers. Those lessons will be reinforced when the government brings criminal charges against VW officals who perpetrated this fraud.”” See

http://www.autosafety.org/cas-statement-on-volkswagen-15-billion-emissions-settlement/

Marianne Karth Participates in Nader Conference On Tort Law & Breaking Through Power

October, 2016

Dear Care for Crash Victims Community Members:

Marianne Karth, mother who lost two daughters in a crash, writes an eloquent summary of what she learned at this Conference.

Marianne has a dream that all Americans can be spared her family tragedy.“Here’s to the realization of my dream of a nationwide network of mobilized traffic safety community advocacy groups to educate and empower citizens to take back their right to a day in court as one more strategy to help us realize the vision of moving toward zero preventable deaths and serious injuries from vehicle violence.”

See http://annaleahmary.com/2016/10/ralph-nader-conference-highlights-tort-law-benefits-tort-reforms-assault-on-right-to-day-in-court/

Marianne’s dream should become the dream of all Americans – before tragedy strikes their families.

Motor vehicle violence in the U.S.A. currently results in:

* 100 deaths per day

* 400 serious injuries per day i.e. brain, spinal cord, burns, amputations, etc.

* $2 Billion in losses per day in the U.S.A. today.

Before this clear and present danger happens to you and yours, adopt her dream and make it yours.

The Conference info and some video is available athttps://www.breakingthroughpower.org/

Lou Lombardo