A dispatch from the Transportation Research Board 2025
According to its organizational summary, “The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology.” The National Academy of Sciences now also has two “sister” institutions: one focused on engineering, the other on medicine.
Employees of the National Academies are committed to explaining that they are not government employees. They’re not NHTSA, the NIH, the USFA, or FEMA. They are scholars, researchers, statisticians—geeks. But they are also highly prestigious—and our profession has friends in their ranks: for example, Gregg Margolis, PhD, NRP, previously of ASPR and the University of Pittsburgh Medical Center, is now the director of Health Policy Fellowships and Leadership Programs at the National Academy of Medicine.
They are also keenly interested in transportation. Did you know that? Frankly, I barely did, and that seems like a problem when the Transportation Research Board (TRB), as the relevant division is called, is working to understand, address, and even innovation in areas of patient movement, disaster response, and public health and safety, both domestically and internationally.
And while we all know that Mobile Medicine operates at the synapse of healthcare, public health, public safety, homeland security, risk reduction, home health, and patient logistics (among other specialties that folks add to the list based on their local needs), it has been this author’s opinion that a key distinguishing characteristic—the sine qua non, as the Latin goes: “That without which we would not be.”—is that our professional uniquely goes to the patient where they are.
To the home, the crash scene, the alleyway. No matter where care is delivered, no matter whether you knew the patient ahead of time or you found them splayed out desperate and alone, you went to them. You transported yourself, if nothing else.
Therefore, this dispatch—the first of several, I anticipate, from an event that left me scratching my head, wondering “Why isn’t anyone from Fire or EMS here? Why isn’t everyone from Mobile Medicine here?”—will set the stage by explaining what TRB is and does.
I will first attempt to provide a peek at some of the conversations that have been particularly thought provoking. In later installments I will delve deeper into how and why the research that has been presented is particularly ripe for development—especially as it covers the gamut from hurricanes to wildfires to active shooter events.
Particularly poignant was to attend this conference even as my hometown burns in a dramatic and terrible way (I was born and raised in Los Angeles) and the National Association of EMS Physicians is having its annual meeting in San Diego. Food for future thought: I can only imagine a bunch of wide-eyed Mobile Medical doctors walking from presentation to presentation…maybe NAEMSP should consider co-locating with TRB in Washington, D.C. next time?
Academics
Easily hundreds of research presentations took place at the 2025 TRB meeting, and as one might expect, many are data-heavy, laden with statistics, and some presentations are more engaging than others. (Note for everyone: If you plan to post the tables from your academic paper in your presentation, do not just read them off. If it’s possible, that’s actually worse than reading the bullets off a PowerPoint).
But the committee meetings—which, one might worry, could become laden with process and Robert’s Rules and debates—turned out to be a highlight: they were conversations where a wide range of voices were heard, and the topics were centered on actionable next steps.
For example, I spoke up most about the role and unique perspectives brought by Mobile Medical professionals in a subcommittee meeting called “Artificial Intelligence Ethics and Equity.” After all, we know that the usage of ambulance services is not randomly or equally distributed: it tends to skew toward the poor and more seriously injured or ill, and these individuals face a range of other risks—but they may also have wishes worth honoring.
Thus, the role of a document like POLST (or MOLST, MOST, POST, COLST, etc., as your state may choose to call the analogous form), and to use that information to help steer the delivery of care…or, as the case may be, to let the patient pass.
The ability to leverage A.I. to know one’s patient is also an opportunity to know his or her needs in context and over time—in a community paramedicine setting, for example, even prior to an encounter. But how much information is too much? Should any data be protected and sequestered (the law seems to think so, or it did until February 2024)?
The Safety Performance & Analysis Committee meeting underscored further the need for Mobile Medical professionals to be in the room—not just reacting to what comes out of the room and turns into policy recommendations—because a list of topics for future research was presented, and it is definitely full of excellent ideas.
Several ideas are overlapping (such as access to crash data with a focus on equity, and access to crash data with a focus on underserved communities—these aren’t identical, but one can argue that they should be coordinated.
Similarly, there was a topic raised about coordinating crash and hospital data—which of course, to anyone who has attended a NEMSIS conversation in the past year or so, will sound substantially similar to the concept about matching hospital-side records and trauma registry data.
What about the clinicians who work in the space between the crash and the hospital? Well, if no one from Mobile Medicine is in the room, do we expect transportation researchers from around the country and the globe to work merely off of what they see on TV and read in articles like this one?
We know that the nuances of process and protocol—how and where care is delivered, all the things—are essential to the outcomes we all seek.
Research
Finally, the poster sessions revealed a trend worth digging into further—and, again considering that this essay is being written while California burns at the same time as an historical ice storm is barreling across the Midwest and the Southeast—namely, a focus on weather, emergency response, disaster management, and social contributors to risk, as revealed by a diligent evaluation of technology (because in interviews, people may lie).
At least three presentations considered the distinction between how municipal planners wish people would move away from storms and wildfires: one presentation, from the University of Florida, leveraged GPS to identify who actually went where, then deeply evaluated why they went where they did.
Another—this one from the University of Central Florida—did a similar study but using social media posts as the evidence: where did people say they went and did, either to avoid or to react to severe weather?
A third, from Oregon State University—notice how researchers tend to hone in on crises as they look in their own backyards—evaluated phone-based alert models for use during wildfires, asking questions like what is the optimal time ahead of the event to receive the alert?
Who actually needs to receive it (so that it avoids becoming noise to everyone else)? And what words presented in an alert are most likely to spur the intended action?
Finally, an idea that really caught me by surprise because its applicability goes far beyond the poster: scholars from China’s Central South University looked at bottlenecking traffic patterns during emergencies, and I could not help but think of the way that parents (for example) do the same thing when they get an alert that an active shooter event is occurring at a school.
Time and again, public safety and education professionals have stated that “crowd control is another level of complication for first responders and school personnel.” (At Beyond Lucid Technologies’ 2024 Mobile Medical Innovation Roundtable, Jenna Moffitt, deputy superintendent of Human Resources at the Deer Valley Unified School District in Phoenix, gave a powerful presentation that included an overview of how the school drills for emergencies large and small, including activities to keep staff and students “on their toes” because during an actual event, you never know what will deviate from the plan).
The notion of learning about human crowd control from vehicular traffic research struck me as another powerful example of why advancing Mobile Medicine to reach its potential depends on our willingness to get out of the bubble, to listen and learn about what whoever is doing over there. We win by bringing back tools, technologies, perspectives—and empathy.
Editor’s Note: This commentary reflects the opinion of the author and does not necessarily reflect the opinions of JEMS.
