Redefining Preventable Death—Potentially Survivable Motorcycle Scene Fatalities as a New Frontier

• Published in: The Journal of surgical research 2020-12, Vol.256, p.70-75
• Main Authors: Lu, Ning, Butler, Caroline Choi, Gogineni, Avinash, Sarmiento, Julissa Marie, Lineen, Edward B., Yeh, Daniel Dante, Babu, Maya, Byers, Patricia Marie
• Format: Article
• Language: English
• Subjects: Accidents, Traffic - mortality; Adolescent; Adult; Airway; Blunt trauma; Cause of Death; Emergency Medical Services - organization & administration; Emergency Responders - education; Female; First Aid; Humans; Injury Severity Score; Male; Middle Aged; Motorcycle; Motorcycles; Police - education; Preventable deaths; Retrospective Studies; Time-to-Treatment; Transportation of Patients - organization & administration; Trauma; Trauma Centers - organization & administration; Trauma Centers - statistics & numerical data; Treatment Outcome; United States; Wounds and Injuries - diagnosis; Wounds and Injuries - etiology; Wounds and Injuries - mortality; Wounds and Injuries - therapy; Young Adult
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2020.06.014

The National Academies of Science, Engineering, and Medicine defined a roadmap to achieve zero preventable trauma deaths. In the United States, there are over 5000 motorcycle fatalities annually. Florida leads the nation in annual motorcycle crash (MCC) deaths and injuries. It is unknown how many are potentially preventable. We hypothesize that certain patterns of injuries in on-scene fatalities that are potentially survivable and aim to make recommendations to achieve the National Academies of Science, Engineering, and Medicine objective. Miami-Dade County medical examiner reports of MCC deaths pronounced on scene, and emergency medical service or law enforcement reports from 2010 to 2012 were reviewed by board-certified trauma surgeons. Causes of death were categorized into exsanguination, traumatic brain injury or decapitation, crushed chest, or airway complications. Determination of potentially survivable versus nonsurvivable injuries was based upon whether the riders had potentially survivable injuries and had they been transported immediately to a trauma center. Traumatic brain injury cases were reviewed by a board-certified neurosurgeon. Sixty MCC scene deaths were analyzed. Ninety-five percent were men, 55% were helmeted, and 42% had positive toxicology. The median Injury Severity Score was 41 (Range 14-75, IQR 31-75). Nineteen (32%) deaths were potentially survivable, with death due to airway in 14 (23%) and exsanguination in 4 (7%) patients. One-third of on-scene urban motorcycle deaths are potentially survivable in a young patient population. ISS score comparison demonstrates the lower injury burden in those deemed potentially survivable. Automatic alert systems in motorcycles and first responder training to police are recommended to improve trauma system efficacy in reducing preventable deaths from MCCs.