BACKGROUND 

With optimal emergency medical service (EMS) and trauma care it has been estimated that 20 percent of overall trauma deaths in the United States are preventable. Using data from the Fatality Analysis Reporting System (FARS), it is estimated that 40 percent of motor vehicle fatality victims were alive at the scene, indicating an opportunity to save lives through enhanced pre-hospital care interventions. Specifically, it is hypothesized that administering pre-hospital blood products to patients experiencing hemorrhagic shock can reduce motor vehicle crash mortality. While the administration of pre-hospital blood products has been shown in military applications to substantially reduce morbidity and mortality, less is known about the potential impact of pre-hospital blood products in U.S. motor vehicle trauma. 

Pre-hospital blood programs represent an invaluable resuscitation capability that directly addresses hemorrhagic shock and mitigates subsequent multiple organ dysfunction syndrome. With wider use, this intervention has the potential to reduce mortality among motor vehicle crash victims. Research is needed to develop a better understanding of the potential impact of pre-hospital blood products in U.S. motor vehicle trauma.

OBJECTIVES 

The objectives of this research are to: 

1. Assess pre-hospital hemorrhage management and mortality in U.S. motor vehicle crashes. 
2. Develop recommendations that state highway safety offices (SHSOs) and other stakeholders can use to reduce pre-hospital mortality through enhanced trauma response activities.

RESEARCH PLAN 

The BTSCRP is seeking the insights of proposers on how best to achieve the research objectives. Proposers are expected to describe research plans that can realistically be accomplished within the constraints of available funds and subaward time. Proposals must represent the proposers’ current thinking described in sufficient detail to demonstrate their understanding of the issues and the soundness of their approach in meeting the research objectives. The work proposed must be divided into tasks and/or phases. Proposers must describe the work proposed in each phase and task in detail. 

The research plan should build in appropriate checkpoints with the BTSCRP project panel including, at a minimum, (1) a kick-off teleconference meeting to be held within 1 month of the subaward’s execution date, and (2) at least one face-to-face interim deliverable review meeting and web-enabled teleconferences tied to panel review and/or BTSCRP approval of interim deliverables. Interim Report No. 1 shall include (1) a data archiving and sharing plan and (2) an annotated outline for the final report. 

Costs for the face-to-face meeting venue and travel costs for BTSCRP panel members to attend the meetings will be paid by BTSCRP. Costs for research team members to attend interim meeting(s) should be included in the detailed budget. 

It is anticipated the research plan will include (but not be limited to) the following activities: 

1. Review and summarize literature relevant to the use of pre-hospital blood products in motor vehicle trauma. 
2. Propose one or more jurisdictions for inclusion in this study that have required data accessible to the research team and capabilities (e.g., data linkages) to accomplish the research objectives. 
3. Estimate the extent motor vehicle trauma patients meet criteria for the administration of pre-hospital blood products.
4. Estimate the impact of administering pre-hospital blood products on motor vehicle trauma mortality outcomes. 
5. Determine the distribution of elapsed time between motor vehicle crash and death for victims alive at the scene to collect a large, representative sample of motor vehicle fatalities. 
6. Review a sample of motor vehicle fatality victims who did not die at the scene to determine the potential impact of administering pre-hospital blood products on survivability. 
7. Using available literature and evidence-based practices, propose standardized criteria for reporting whether a motor vehicle fatality victim was alive at the scene. 
8. Identify and evaluate barriers to implementation of pre-hospital blood programs (logistics, training, and regulatory, and measurement biases). 

At a minimum, the final deliverables shall include:    

1. A conduct of research report that documents the entire research effort and findings;
2. A standalone executive summary that emphasizes implications of the research findings for SHSOs;
3. A PowerPoint presentation with speaker notes summarizing the research findings;
4. A technical memorandum that identifies priorities for additional research; and
5. A technical memorandum on implementation (see item IV below). 

Note: Following receipt of the draft final deliverables, the remaining 3 months shall be for BTSCRP review and comment and for research agency preparation of the final deliverables.

< < < IMPORTANT > > > 

I.      The brochure Information and Instructions for Preparing Proposals for the Transportation Research Board’s Cooperative Research Programs includes extensive guidance on the preparation of proposals for submission to CRP. Revisions to these instructions are highlighted in yellow within that document.

II.    Proposals will be rejected if any of the proposed research team members work for organizations represented on the project panel. The panel roster for this project can be found at https://www.mytrb.org/OnlineDirectory/Committee/Details/7379. Proposers may not contact panel members directly; this roster is provided solely for the purpose of avoiding potential conflicts of interest.

III.   The text of the final deliverable is expected to be publication ready when it is submitted. It is strongly recommended that the research team include the expertise of a technical editor as early in the project timeline as possible. See Appendix F of the Procedural Manual for Subawardees Conducting Research in the Transportation Research Board’s Cooperative Research Programs for technical editing standards expected in final deliverables.

IV.  The required technical memorandum titled “Implementation of Research Findings and Products” should (a) provide recommendations on how to best put the research findings/products into practice; (b) identify possible institutions that might take leadership in applying the research findings/products; (c) identify issues affecting potential implementation of the findings/products and recommend possible actions to address these issues; and (d) recommend methods of identifying and measuring the impacts associated with implementation of the findings/products. Implementation of these recommendations is not part of the research project and, if warranted, details of these actions will be developed and implemented in future efforts.

V.    The National Academies have an ethical and legal obligation to provide proper attribution whenever material from other sources is included in their reports, online postings, and other publications and products. TRB will review all Cooperative Research Programs draft final deliverables using the software iThenticate for potential plagiarism. If plagiarized text appears in the draft final deliverable, the research team will be required to make revisions and the opportunity to submit future proposals may be affected.