Emergency Medical Services (EMS) play a critical role post-crash to reduce fatalities and serious injuries. Studies have shown that an effective emergency trauma care system can improve survival from serious injuries and decrease crash fatalities.
Data Source: National Highway Traffic Safety Administration. (2016). The Road Ahead: National Highway Traffic Safety Administration Strategic Plan, 2016-2020. (DOT HS 812 343), pp 13-14.
Effective emergency trauma care system can improve survival from serious injuries by 25 percent.
County-level coordinated systems of trauma care can reduce crash fatalities by 50 percent.
The Federal Highway Administration (FHWA) names Post-Crash Care as a key element of a Safe System. Specifically, post-crash care refers to emergency first response and transport to medical facilities, as well as forensic analysis of the crash site and traffic incident management.
The Haddon Matrix applies basic principles of public health to motor vehicle-related injuries. The matrix looks at the factors in the pre-crash, crash, and post-crash phases to see how the driver, vehicle, and environment affect the outcome. Specifically, it identifies the factors that impact the prevention, severity, and survivability of crashes. For EMS, some factors are response time, proximity to an appropriate trauma center, and access to first responders with the appropriate equipment and training.
Figure Source: Table 4, p 11. NHTSA, 2016.
In 2021, there were 42,939 people killed in motor vehicle crashes and countless more who were injured on United States roadways.
Data Source: Stewart, T. (2023). Overview of motor vehicle traffic crashes in 2021. DOT HS 813 435. NHTSA. Page 1
The national 911 system was implemented over 50 years ago to provide efficient public access to emergency assistance. While effective, the 911 system must also evolve with technological improvements, specifically upgrading from an analog to a digital system. Next Generation 911 (NG911) improves the success and reliability of the 911 system by allowing users to securely send text messages, video, and photos to 911, and in turn allows 911 dispatchers to transmit this information along with location information to first responders. NG911 will allow first responders to more accurately locate crash victims to assess their injuries, thereby improving patient outcomes.
Each crash puts motorists and first responders at risk of secondary crashes while also increasing congestion. In response, the Federal Highway Administration (FHWA) developed the National Traffic Incident Management (TIM) Responder Training to help transportation agencies and first responders establish coordinated processes to quickly:
detect,
respond to, and
remove traffic incidents to restore traffic capacity and flow as quickly and safely as possible.
TIM became the national standard of practice for law enforcement, EMS, and others responding to roadway incidents. As of 2023, over 600,000 responders were trained to clear traffic incidents.
The latest FHWA Every Day Counts 7 (EDC-7) initiative continues to promote Next-Generation TIM technologies to improve safety for crash responders, including:
smart emergency vehicle lighting,
use of unmanned aerial systems to map crash scenes, and
also features an initiative to improve nighttime visibility, via traffic control devices and lighting, to reduce traffic fatalities.
Note: a multi-county EMS agency is defined as an entity of three or more counties.
Data Source: California Emergency Medical Services Authority. (2021). California Designated & ACS Verified Trauma Centers. Accessed April 10, 2023.https://emsa.ca.gov/wp-content/uploads/sites/71/2021/04/California-Designated-ACS-Verified-Trauma-Centers_2021_4_15.xlsx
California’s EMS system management includes 34 local EMS systems that serve all 58 counties through 7 regional EMS systems and 27 single-county agencies.
The single county agencies are found in the more densely populated urban areas while regional systems usually serve more rural ones.
Of the seven regional EMS systems, six are multi-county agencies serving thirty counties in rural areas with extensive tourism.
As of April 2021, the state’s trauma center network consisted of 79 designated trauma centers (Level I, II, and III, and unspecified level) and admitted over 70,000 trauma patients per year, though not all related to motor vehicle crashes.
Almost three-quarters of the designated trauma centers (73.4 percent) offer Level I or Level II trauma services alongside other comprehensive resources needed for providing definitive care. Nearly one quarter (24.1 percent) of the designated trauma centers are designated pediatric trauma centers.Of the 58 licensed hospitals designated as a Level I or Level II trauma center, nearly one-quarter (24.1 percent)are designated as both a Level I or Level II trauma center and a Level I or Level II pediatric trauma center by the American College of Surgeons (ACS), the Local EMS Agency (LEMSA), or both.
The following counties constitute each of the regions:
Bay Area region: Alameda, Contra Costa, Marin, Monterey, San Benito, San Francisco, San Mateo, Santa Clara, Santa Cruz, & Solano counties.
North region: Mendocino, Sonoma, El Dorado, Napa, Humboldt, Del Norte, Lake, Lassen, Sacramento, San Joaquin, Siskiyou, Shasta, Tehama, Butte, Yuba, Placer, & Yolo counties.
Central region: Fresno, Tulare, Madera, Kern, Merced, Stanislaus, & Tuolumne counties.
South East region: Imperial, San Bernardino, Riverside, & San Diego counties.
South West region: Los Angeles, Orange, San Luis Obispo, Santa Barbara, & Ventura counties.
| Region | ACS Adult Designation - Level I | ACS Adult Designation - Level II | ACS Adult Designation - Level III | ACS Adult Designation - unspecified | Total |
|---|---|---|---|---|---|
| Bay Area | 4 | 6 | 1 | 1 | 12 |
| Central | 1 | 2 | 1 | 3 | 7 |
| North | 1 | 7 | 6 | 8 | 22 |
| South East | 4 | 6 | 0 | 4 | 14 |
| South West | 6 | 14 | 2 | 2 | 24 |
| Grand Total | 16 | 35 | 10 | 18 | 79 |
| Region | ACS Peds Designation - Level I | ACS Peds Designation - Level II | Total |
|---|---|---|---|
| Bay Area | 2 | 1 | 3 |
| Central | 0 | 1 | 1 |
| North | 1 | 0 | 1 |
| South East | 2 | 0 | 2 |
| South West | 1 | 9 | 10 |
| Grand Total | 6 | 11 | 17 |
Data Source: California Emergency Medical Services Authority, 2021.
Equity in access to EMS is a significant concern. Rural California faces more barriers to trauma care due to limited access to higher level trauma centers and farther distances to care. The above tables show locations of Level I to III and unspecified trauma centers in California. Six counties do not have a designated trauma center within their boundaries but have approved trauma plans. Tribal communities in California experience long EMS response times due in large part to the greater average distance of crashes from EMS responders.
Data Source: Gregory Harasym and David Ragland. (2022). EMS Response TIME in Tribal Areas. UC Berkeley SafeTREC. Pre-publication paper
In 2021, California Senate Bill 156 was passed, expanding broadband access in rural California.
This bill may reduce EMS response time in rural and Tribal communities.
Data Source: Tribal Broadband Connectivity Program, US Department of Commerce. https://www.ntia.gov/category/tribal-broadband-connectivity-program?_ga=2.214100119.1027175880.1681520433-1591529793.1681520433. Accessed April 14, 2023.
Preliminary data indicates that there were 4,285 fatal crashes and 15,421 serious injury crashes on California roadways in 2021.
Data Source: i) State Traffic Safety Information (STSI). Traffic Safety Performance (Core Outcome)Measures for California. Washington, DC: National Highway Traffic Safety Administration, C5 ii) Provisional Statewide Integrated Traffic Records System (SWITRS) 2021
In 2021, California extended “Move Over, Slow Down” provisions to apply to local streets and roads in addition to freeways. Despite this, first responders continue to be killed in the line of duty.
Data Source: National TIM Responder Training Program Implementation Training Status Report. (2021, July). Washington, DC: Federal Highway Administration. Accessed March 2022. https://transportationops.org/sites/transops/files/TIM%20Training%20Stat...
As of July 2021, California had 27,296 first responders trained in training incident management (TIM), which represented 38.3 percent of the state’s first responder workforce.
California ranked 30th based on its TIM’s percentage and made it one of the 25 states that fell below the national goal of 45 percent.
By improving TIM training, California could reduce traffic crashes related to stopped vehicles and the subsequent risk of secondary crashes.