title: EMS Provider assessment of vehicle damage compared with assessment by a professional crash reconstructionist.
abstract: OBJECTIVE
  To determine the accuracy of emergency medical services (EMS) provider assessments of motor vehicle damage when compared with measurements made by a professional crash reconstructionist.
  
  
  METHODS
  EMS providers caring for adult patients injured during a motor vehicle crash and transported to the regional trauma center in a midsized community were interviewed upon emergency department arrival. The interview collected provider estimates of crash mechanism of injury. For crashes that met a preset severity threshold, the vehicle's owner was asked to consent to having a crash reconstructionist assess the vehicle. The assessment included measuring intrusion and external automobile deformity. Vehicle damage was used to calculate change in velocity. Paired t-test, correlation, and kappa were used to compare EMS estimates and investigator-derived values.
  
  
  RESULTS
  Ninety-one vehicles were enrolled; of these, 58 were inspected and 33 were excluded because the vehicle was not accessible. Six vehicles had multiple patients. Therefore, a total of 68 EMS estimates were compared with the inspection findings. Patients were 46% male, 28% were admitted to hospital, and 1% died. The mean EMS-estimated deformity was 18 inches and the mean measured deformity was 14 inches. The mean EMS-estimated intrusion was 5 inches and the mean measured intrusion was 4 inches. The EMS providers and the reconstructionist had 68% agreement for determination of external automobile deformity (kappa 0.26) and 88% agreement for determination of intrusion (kappa 0.27) when the 1999 American College of Surgeons Field Triage Decision Scheme criteria were applied. The mean (± standard deviation) EMS-estimated speed prior to the crash was 48 ± 13 mph and the mean reconstructionist-estimated change in velocity was 18 ± 12 mph (correlation -0.45). The EMS providers determined that 19 vehicles had rolled over, whereas the investigator identified 18 (kappa 0.96). In 55 cases, EMS and the investigator agreed on seat belt use; for the remaining 13 cases, there was disagreement (five) or the investigator was unable to make a determination (eight) (kappa 0.40).
  
  
  CONCLUSIONS
  This study found that EMS providers are good at estimating rollover. Vehicle intrusion, deformity, and seat belt use appear to be more difficult for EMS to estimate, with only fair agreement with the crash reconstructionist. As expected, the EMS provider -estimated speed prior to the crash does not appear to be a reasonable proxy for change in velocity.
authors.affiliation: Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. eblerner@mcw.edu
authors.forename: E Brooke
authors.initials: EB
authors.lastname: Lerner
authors.forename: Jeremy T
authors.initials: JT
authors.lastname: Cushman
authors.forename: Alan
authors.initials: A
authors.lastname: Blatt
authors.forename: Richard D
authors.initials: RD
authors.lastname: Lawrence
authors.forename: Manish N
authors.initials: MN
authors.lastname: Shah
authors.forename: Robert A
authors.initials: RA
authors.lastname: Swor
authors.forename: Karen
authors.initials: K
authors.lastname: Brasel
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
mesh_terms: D000063:Accidents, Traffic / Q000145:classification*; D000328:Adult; D001336:Automobiles; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D014193:Trauma Centers; D000078329:Workforce