App lets hospital see what troopers see

For victims of a high-speed automobile crash, every second counts.

Researchers at the University of Iowa were disturbed to learn a few years ago that, on average, personnel at UI Hospitals and Clinics only had seven to eight minutes of warning before an ambulance arrived at the emergency room with a crash victim.

Through a new smartphone app developed in cooperation with staff at UI's National Advanced Driving Simulator and the Iowa Department of Transportation, a pilot program has helped increase the average warning time to 31 minutes — even as long as 45 minutes in some cases.

More importantly, the new TraumaHawk app — which allows state troopers on scene to send photos of the damaged vehicles to UIHC — gives ER physicians and nurses a better sense of the severity of a patient's injuries. As a result, hospital staff can have proper rooms, equipment and personnel available even before the ambulance makes a preliminary medical report.

"It streams the crash scene into the trauma bay," said Eric Payne, one of 35 Iowa state troopers who has been outfitted with the app.

Daniel McGehee, director of UI's Human Factors and Vehicle Safety Research Program, said researchers have long known that the more crash damage intrudes into the passenger compartment of a vehicle, the more severe the injuries are likely to be. McGehee and his colleagues thought that, if first responders and emergency room personnel could be trained in some basic principles of automotive traumatology, photos of vehicle damage could give emergency rooms more time to prepare.

Dr. Christopher Buresh, associate professor of emergency medicine at UI, said that the information gleaned from the photos isn't a substitute for in-hospital evaluation of the patient, but that it does provide a general sense of the range of likely injuries.

"Some tests are better at ruling in or out the possibility of an injury," Buresh said. "But a lot of that (decision making) is based on how worried you are about that injury in the first place."

Buresh said researchers originally planned for the app to be used by paramedics at crash scenes. But the early studies found that paramedics were too busy to do anything other than tend to the victims.

The state troopers, on the other hand, are winding down their some of responsibilities after the medical responders arrive on the scene. So UI worked with the Iowa DOT and the state police to design an app that would require about a minute of a trooper's time.

"We need to be able to use it on the fly," Payne said. "The goal is for the technology to be trooper-proof."

Payne said he still needs to secure an accident site before he can document the damage to a vehicle. But once paramedics arrive, he can transmit information about the condition of the vehicle back to the emergency room.

The TraumaHawk app — which has been tweaked over time to be more trooper-friendly — requires the trooper to provide basic information about the type of vehicle and the areas of damage and then respond to a series of automatic prompts about the crash scene. Those prompts then show the officers what type of photos are required — even demonstrating the angles at which the photos should be taken.

Because of privacy and other legal concerns, the troopers participating in the pilot program have a separate iPhone dedicated only for the Trauma Hawk app. The images are sent to a secure email server — accessible by the researchers — and appears on a dedicated iPad in the hospital trauma unit.

Researchers and hospital personnel then examine the photos of the vehicle for signs of structural damage, steering wheel damage, windscreen damage, the placement of the seat belt (indicating whether or not it was fastened), presence of a raised center console (which increases the likelihood of a pelvis fracture) and a host of other data.

On a regular basis, the response team will meet to assess how well the process worked and how accurately the injuries predicted from the photos matched the actual injury.

McGehee said the data accumulated in those sessions not only will help make the Trauma Hawk app more effective, but also might provide car manufacturers with information about potential defects and provide the DOT with suggestions for road improvements.

Buresh said the sessions — especially in cases where the victims did not survive — also provide opportunities of emotional support for everyone involved, from the first responders to the hospital staff.

Steve J. Gent, traffic and safety director for the DOT, said the DOT is working toward a goal of "zero fatalities" on Iowa roads. To reach that goal, however, the department needs to "work with a lot of different people" to develop new programs in engineering, education and emergency response.

"We saw (TraumaHawk) as an opportunity to do just that," Gent said.

So far, the pilot program has been limited to areas surrounding Iowa City. Gent said expanding the program to a trauma center in the Des Moines area would be the next logical step.

Buresh said that, after the program eventually expands, UI Hospitals could continue to serve as a central point for interpreting the photos — much like the hospital already does for radiology results and emergency room consults.

"What we would like to see happen is to see this more widely employed and to roll this into our bigger telemedicine effort," Buresh said.

McGehee said the next level for the technology would include providing the designated iPhones the capability to take 360-degree images of the crash scene from inside the vehicle. And, further into the future, he said, manufacturers might be able to embed sensors in the skin of the vehicle that would automatically transmit the damage information to the nearest hospital or traumatology center.

By then, however, other technological and engineering advances could be in place to reduce the number of crashes that lead to severe passenger injury.

"The goal is not only to treat victims after the crashes," Buresh said, "but (to learn how) to help prevent the crashes in the first place."

Reach Jeff Charis-Carlson at 319-887-5435 and jcharisc@press-citizen.com. Follow him on Twitter at @jeffcharis.