magine an automobile that automatically alerts police and fire-rescue teams the instant it is involved in a serious crash. Not only does it report the exact location of the vehicle (as some luxury models already do using built-in Global Positioning System), it reports the possible cause and severity of the crash and the likelihood of serious injury. Simultaneously, a computer chip-imbedded “smart key” identifies the driver as a 45-year-old female allergic to penicillin. Rushing to the accident, emergency medical personnel review injuries commonly associated with that type of crash. On the scene, both crash data and patient symptoms are entered into a pocket PC, helping medical professionals detect hidden injuries. The data are transmitted to physicians at the nearest trauma care facility, saving a few crucial minutes that could be the difference between life and death.
    Science fiction? Not to Jeffrey Augenstein (B.S. ’69, Ph.D. ’74, M.D. ’74), director of the University of Miami/Jackson Memorial Medical Center’s William Lehman Injury Research Center. Augenstein, professor of surgery in the School of Medicine and one of the early visionaries behind Miami-Dade’s Ryder Trauma Center, says the technology behind such a system is already here. Making it work, and getting it into automobiles and in the hands of medical professionals around the nation, is one of the goals of Augenstein’s team at the Lehman Center. “The more information physicians have, and the quicker they can get it, the greater the chances that car crash victims will get the medical care they need,” says Augenstein. “If we can say, ‘this crash pattern is predictive of a certain injury,’ then trauma centers will have a head start on treating their patients. The benefits could be immeasurable.”

The William Lehman Injury Research Center, named after the former U.S. congressman from Florida who championed its cause, is one of only a handful in the United States that study injury patterns of car crash victims. Investigators at the ten-year-old center were the first to recognize that front-seat air bags could be dangerous to young children. Those findings have helped save countless lives. Other research has identified “occult” injuries—those hidden or difficult to diagnose—commonly associated with car crashes, even fender benders. Many trauma care protocols now are based on that research. Automakers also take notice of the center’s work. Better understanding of crash-related injuries, Augenstein says, leads to safer designs. “We look at the relationship between how cars are built and driven and the injuries that result from accidents,” he explains. “We want to improve treatment of injuries, but prevention is always the ultimate goal.”

o that end, the Lehman Center has developed a nationally recognized model for research on the prevention and treatment of automobile-related death and injury. This model, know as Crash C.A.R.E. (Care Administration-Research Education), allows investigators to analyze crash and injury data using an integrated information management system. Crash and patient photos, medical information, X rays and other diagnostic records, and computer animated crash sequences are combined into a computer-based crash record. The center exchanges data with the nine other injury research centers across the nation that make up CIREN—the Crash Injury Research and Engineering Network.

The Lehman Center’s database contains more than 500 cases, each including crash information and patients’ clinical outcome. About once per week on average the center’s Crash Study Team is alerted by local authorities to a crash in the Miami area. After obtaining permission from drivers or their families, team members rush to the scene to photograph the vehicles, interview victims and witnesses, reconstruct the crash, and gather other key data.

“We’re looking at every little clue, trying to create a complete picture of what happened and the consequences of what happened,” explains James Stratton, director of Crash Analysis at the William Lehman Injury Research Center. When injuries are severe, team members follow victims throughout hospitalization and rehabilitation—a process that can take months—to evaluate the success rate of treatment options. Afterwards, researchers check the database of other CIREN centers for crashes with similar characteristics to identify patterns in cause, injury, and clinical outcome.

Much of the Lehman Center’s research has focused on occult injuries. In the days before air bags and widespread seat belt use, injuries were severe and easily recognizable. Today, air bags and seat belts save lives but also can cause a multitude of hard-to-detect internal injuries. Augenstein’s team, for example, found that drivers who use a shoulder harness without a lap belt have a much higher risk of liver injury even during moderate crashes. As a result, new cars do not allow harness-only operation. Another study found that injuries to the aorta are not uncommon during side-impact crashes.

Other research has led the federal government to modify its requirements for air bags. Following the discovery of air bag risks to small children, Augenstein testified before Congress and White House officials, suggesting a change in design and testing. In another such example, Lehman Center investigators found that air bags in vehicles that strike trees or light poles do not register the impact as quickly as during a crash with another vehicle or other large surface. “An entire crash may take a tenth of a second,” says Augenstein. “When a car hits a pole or other narrow object [the air bag computer] does not recognize it as a bad accident until too late.” Automakers are now studying new detection systems to avoid that problem.

The Lehman Center’s most ambitious program is the development of a computer algorithm to predict the likelihood of crash-related injuries. The algorithm, known as URGENCY, is based on the findings of hundreds of crash pattern studies. By entering characteristics observed at a crash scene, emergency medical personnel will be alerted to injuries most commonly associated with crashes of that type and intensity. After testing is complete, URGENCY will be used by emergency workers throughout Miami-Dade County. The next step is to integrate the algorithm with automobile-based automatic crash notification (ACN) systems that alert rescue workers of a crash via wireless telephone. The Lehman Center is working with automaker BMW to develop such a system. “We’re now asking the question, ‘If a car were in a crash, what kind of information would we want it to send us?’” Augenstein says.

But technology alone cannot eliminate crash-related injury. Indeed, most injuries can be avoided with a very low-tech approach to safety: buckle up. Although the rate is improving slightly, only 65 percent of Americans regularly use seat belts, compared to over 95 percent in Canada and 97 percent in Australia. “I think we’re improving but we’ve still got a long way to go,” says Elana Perdeck, executive director of the Lehman Center, which is engaged in a comprehensive program of driver awareness. “Air bags alone are not always going to save a crash victim’s life.” Among the center’s educational programs are a speaker series that places crash survivors in high schools to warn students of the dangers of driving without seat belts and a successful child car seat program. According to Perdeck, more than 90 percent of all child car seats are incorrectly installed. In the five years it was funded, the program provided more than 5,000 child seats free to low-income families.

“There are ways that automobiles can be designed to be safer, and there are ways in which we can better identify the risks of certain injuries,” Augenstein says. “But driver safety really is the best answer. As simple as it sounds, that’s a message we still need to get across.”

Ryder Trauma Center: A Decade of Critical Care

In the late 1980s, Miami-Dade County’s rising crime rate and automobile traffic left trauma care workers at Jackson Memorial Hospital (JMH), the county’s only public hospital, unable to cope with a booming patient load. About the same time, an effort by eight area hospitals to form a trauma network failed. By 1992, JMH was again the only hospital offering advanced trauma care, with more than 3,000 critically injured people at its door each year.

Celebrating its tenth anniversary this year, the University of Miami/Jackson Memorial Medical Center’s Ryder Trauma Center—named for its principal corporate benefactor, Ryder System—dwarfed the hospital’s old trauma unit. Newer and larger facilities translated into fewer delays in treating patients. Mortality rates declined sharply. “Of all the diseases we know, trauma is the only one we are capable of fully preventing, every time, right now,” says Jeffrey Augenstein (B.S. ’69, Ph.D. ’74, M.D. ’74), professor of surgery at the University of Miami School of Medicine and one of the visionaries behind the Ryder Trauma Center.

Today the center is recognized as one of the most advanced in the country. The U.S. Army and some foreign military services send their surgeons here for trauma care training. The Ryder Trauma Center also stands out in its commitment to research of injury cause and prevention, key to which is the William Lehman Injury Research Center.

“Just being part of a research effort gives any trauma center an advantage,” says Stephen Cohn, chief of UM’s Division of Trauma and Surgical Critical Care and medical director of the Ryder Trauma Center. Having access to current knowledge, he says, “provides the right environment for patients to get optimal care.”