While More than 50 Crash Victims Die Daily Without Hospital Care – NHTSA Erases Research Articles on Advances in Emergency Medical Care for Crash Victims

Dear Care for Crash Victims Community Members:
Legal Reader has kindly published an article I submitted pro bono on NHTSA’s latest travesty.
For more documentation and a back story I am adding the following information for the care for crash victims community.
26 Years After NHTSA Began New Efforts To Improve Emergency Medical Care
Today in the USA, more than 100 Americans die of vehicle injuries every average day with about 56% not being transported to any facility for emergency medical care.
For too many vehicle victims, emergency medical care resources that arrive are too often, too little, too uninformed, too ill equipped, and too late, to prevent tragic consequences of death, disability, and family devastation.   – This has gone on for far too long due to NHTSA’s failures to set safety standards.
Over the past 26 years, nearly 1 million Americans lost their lives due to vehicle injuries.  Many more suffered catastrophic injuries but survived with lifelong disabilities. Many could have been saved and disabilities ameliorated with faster and better emergency medical care.
On April 27, 2018, NHTSA issued a Federal Register Notice, not to finally propose standards, but to seek information on improving prehospital emergency medical care.  See  https://www.federalregister.gov/documents/2018/04/27/2018-08504/request-for-information-improving-prehospital-trauma-care
On July 4, 2018, I wrote an article criticizing NHTSA for more than a decade of inaction. See https://www.careforcrashvictims.com/blog/emergency-medical-care-for-crash-victims/
Within days, NHTSA acted to erase decades of research papers on the subject from the NHTSA website that showed what NHTSA knew about improving emergency care, and when they knew it.
NHTSA Cover Up Of Landmark Emergency Medical Care Research Findings
NHTSA erased the pioneering papers from the ESV Conference Proceedings on the NHTSA web site.  See  https://www.nhtsa.gov/research-data/enhanced-safety-vehicles
Now when members of the public go to the NHTSA ESV Proceedings website they cannot find the pioneering papers.
One can search for the papers and find the Title and Authors.  But click on one of papers in the Proceedings of the 18th ESV Conference, the NHTSA web site pops up with: 

ESV 18th Conference Search Result By AUTHOR
The author Howard Champion that you requested has 1 PDF report, click on the title below to select. Thank you.


No.:  Title: Authors:
1 Reducing Highway Deaths and Disabilities with Automatic Wireless Transmission of Ser Howard Champion / Jeffrey Augenstein / Alan Blatt / Brad Cushing / Kennerly Digges / Richard Hunt / Louis Lombardo / John Siegel

404 – File or directory not found.

The resource you are looking for might have been removed, had its name changed, or is temporarily unavailable.

So to restore public access to readers I have added the correct title and placed the erased paper on my web site where the public can get it and other erased papers. See

To find this particular erased paper, and others, readers can scroll down the URGENCY list on my web site and click on
Reducing Deaths with Automatic Wireless Transmission of URGENCY Injury Probability Ratings from Crashes to EMS – 2003

The Erased History: The 1991 Mystery of a Fatal Airbag Crash Began New Efforts To Improve Emergency Medical Care

The NHTSA story of URGENCY efforts and occult injuries began on one of my projects.  In 1991, after more than a decade of work on getting airbags (automatic crash protection) into motor vehicles, I was directed to manage a grant to build a new Trauma Center at the University of Miami, Jackson Memorial Hospital.  A small percentage of the grant was devoted to research to study crashes, injuries, treatments, and outcomes for restrained (airbags and/or safety belts) occupants in frontal crashes.
We were quickly shocked by an airbag crash fatality in our second case (91-002) of the study.  Initially it was a major mystery.  Since the new Trauma Center had not yet been built the victim was taken to the busy Jackson Memorial Hospital (designated as a Level 1 Trauma Center at the time).  The patient did not meet trauma center admission criteria at the scene.  He was initially stable but then deteriorated.  In the OR they found massive internal injuries and were unable to save him.
I was tasked to bring together leading airbag engineers from the auto industry, academe, and NHTSA to help us understand what happened.  From the crash investigator’s report we found:
The victim was a 39 year old, 323 pound male, unbelted, that blacked out mid day in a new Volvo that was traveling at high speed.  The vehicle crashed first into a large bolted down traffic control box (sending it 95 feet into intersection) and then the vehicle crashed into an 18 inch square concrete traffic control pole.
Back then airbag researchers expected survival limits for 95th percentile males (225 lbs in 50 mph delta V barrier crashes where the dummy is belted) to be about 50 mph in a barrier crash.   The calculated delta V in this multiple impact crash was 55 mph, and the driver was unbelted, and he weighed 323 pounds – much heavier than the 95th percentile male.
Many questions arose.  Was he on the airbag after the first impact?  Was the Volvo airbag too aggressive causing the internal injuries?  An engineering student was assigned the task of doing his Masters degree thesis to understand the biomechanics of the crash injuries.  Many engineering questions could not be answered as there was insufficient data on the occupant’s kinematics in the seconds during the multiple impacts.
As this research was going on, one day a very experienced surgeon from the Trauma Center in Baltimore, MD working on another grant was in our NHTSA offices.  I described the mystery case to him and he quickly said that this was an emergency medical system communications failure.  Again I was shocked.  He explained that the emergency medical personnel both prehospital and at the hospital should have known from the crash severity and the femur fracture that this was a severe crash and should have been alert to potential internal injuries.  See https://www.careforcrashvictims.com/wp-content/uploads/2018/07/940714.1.1.pdf

With that insight we began NHTSA efforts to educate the EMS community nationwide about using information from the crash scene to detect internal injuries.  At the time Dr. Ricardo Martinez, an Emergency Physician, was the NHTSA Administrator.  We produced and published early warnings for the emergency medical care community.  See


In later years we worked to quantify the number and types of Occult injuries that were occurring and found it was in the thousands each year.  We created an Occult Injury Database.  See it at https://www.careforcrashvictims.com/assets/Occult.pdf
Improve Emergency Medical Care with ACN, URGENCY, & ADAMS

Subsequently in the 1990s we knew we needed to do better – and that we could do better with information technologies – to improve Emergency Medical Care decisions in triage, transport and treatment.

ACN First we envisioned using wireless to transmit from the vehicle an S.O.S.call for help instantly and automatically with data on crash occurrence, location, and crash severity.  We called it Automatic Crash Notification (ACN).  See https://www.careforcrashvictims.com/assets/automatic-crash-notification.pdf
URGENCY  Then we worked on creating a software algorithm capable of instantly and automatically calculating an estimate of the “probability of serious injury being present” in the crash.  Transmission of such crash information we believed could help EMS send crash appropriate resources such as rescue teams prepared with extrication equipment, skills, and vehicle specific information such as vehicle cut points.
Thus, at NHTSA we created URGENCY software in 1997.  It took a year of detailed analyses of crash injury data by a team of experts in crash statistics, vehicle safety, and emergency medical care.  The NHTSA Briefings are now publicly available as: NHTSA Statistical Reports on URGENCY 1.0 for Dr. Howard R. Champion Project 1997 at https://www.careforcrashvictims.com/home/urgency/
A Presentation and Briefing was given to NHTSA Administrator Ricardo Martinez and to NHTSA top management in March 1997.  See it at


ADAMS  We also worked on how notification of a crash, its location, and severity could be used to improve care by instantly calculating distances from Trauma Centers, Hospitals, Fire rescue teams and air medical resources.  The goal was to be able to get seriously injured people to definitive emergency medical care facilities and surgery within the “Golden Hour.”   To accomplish this, by 2003 we had organized a national Atlas and Database of Air Medical Resources (ADAMS).  See
The Atlas and Database of Air Medical Services (ADAMS) 2003

ADAMS has now been updated yearly for the past 15 years.  It has State by State maps and coverage areas for air medical rescue resources.  See  http://www.adamsairmed.org/public_site.html

In 2001, NHTSA had a new Administrator Dr. Jeffrey W. Runge who also was an Emergency Physician.  He too recognized the importance of educating the emergency medical community about the potential of internal injuries to be fatal.  He wrote:

“As an emergency physician I personally have learned from CIREN research.  I have used the life-saving techniques developed by CIREN for the diagnosis of liver injuries in crashes with 2-point belts.  Furthermore, I have been able to teach better emergency care for crash victims because of CIREN findings.”  See Foreword at

 In the 2002 CIREN Report, the NHTSA Overview chapter summarized the work on Improving Emergency Medical Care using modern technologies of ACN, URGENCY software, and the Atlas and Database of Air Medical Services (ADAMS) for alerting Air Medical Systems.  See pp. 1-9, and pp. 37-45 at

Today, NHTSA researchers know that NHTSA still has not done its job of setting standards for ACN & URGENCY technologies to save lives.   Recent research findings continue to confirm results found more than a decade ago.

 “RESULTS:  The CIREN data showed that longer times from the collision to notification of EMS providers were associated with more frequent invasive interventions within the first three hours of hospital admission and more transfers from a regional hospital to a trauma center. The NASS CDS and FARS data showed that rural collisions with crash-notification times >30 minutes were more likely to be fatal than collisions with similar crash-notification times occurring in urban environments. The majority of a patient’s prehospital time occurred between the arrival of EMS providers on-scene and arrival at a hospital. The need for extrication increased the on-scene time segment as well as total prehospital time.” 


NHTSA’s failures to act accumulate year after year while tens of thousands of Americans suffer and die of crash injuries without transport to any facility for emergency medical care – on average about 56 American deaths per day – year after year.  Prehospital deaths in numbers and percent by State are available at
By 2002, even OnStar was citing our NHTSA research in SAE Paper 2002-21-0066 at
But today OnStar apparently has a different focus – money.

“We are at the front end of the opportunities associated with our OnStarbusiness”, said Stevens. “The 4G network has been a great addition to the portfolio, with significant data monetization opportunities on the horizon.”

The finance executive is referring to the 4G LTE network GM rolled out across nearly all vehicles in its portfolio starting in 2015. The connection enables an in-vehicle Wi-Fi hotspot, with GM being the world’s first full-line automaker to implement the feature/technology across its entire vehicle portfolio, representing the broadest and quickest deployment of the technology in history. Other automaker are still playing catch-up in the area.

Vehicles connected to OnStar 4G run on the AT&T network, and GM receives a cut of the revenue associated with data plans it sells on behalf of AT&T. GM appears to be looking to take the connection a step further by monetizing the data pipe even more, perhaps (or perhaps not) with relevant in-vehicle advertising.

“Taken together, aftersales, GM Financial, and OnStar, we believe we have a billion and a half dollar profit growth opportunity with these businesses over the next several years”, concluded Stevens.”

NHTSA today is asking for public comments on Improving Prehospital Emergency Care to be submitted by July 26, 2018.
I have repeatedly written and petitioned NHTSA for action.  See
I asked NHTSA and FICEMS in 2013 to:

 “Recommend a National Goal for Timely and Optimal Treatment for Serious Crash Injuries Within a Decade –One Hour Med Evac to Definitive Care”
Even that was too much to ask.  Having worked for decades at NHTSA, and subsequently for the last decade as an advocate, I have sadly learned that tragically it will take much more than information and petitions to move NHTSA to care for crash victims.
Lou Lombardo

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