You’ve been there many times. It’s 3 a.m. and the sound of your pager goes off - ‘Medic 1, respond to a motor vehicle collision on Highway 23. Three occupants. All ejected.” Whether the victims are ejected or slammed around inside of the vehicle, the massive amount of energy and trauma sustained is too often incompatible with life.
This all-too-frequent scenario is often precipitated by ingestion of mind-altering substances, falling asleep at the wheel, distracting use of a cell phone or trying to quiet down the children (or adults) in the back seat. These causative factors are preventable. If you avoided these activities, you’d be less likely to get hurt, hurt someone else or, worse, become a trauma survival failure.
If we look at the causes of death in the United States during 2003 and 2004, diseases of the heart were the number one cause of death for all ages, followed in descending order by malignant neoplasms, cerebrovascular diseases, chronic lower respiratory diseases and accidents (unintentional injury). However, if we look at a subset of the death population — ages 1 to 44 years — unintentional injury becomes the number one cause of death. And motor vehicles account for almost 50 percent of these deaths.
To grasp the significance of injury deaths, we need to understand the concept of Years Per Life Lost (YPLL). According to the 2003 United States Life Tables, provided by the Center for Disease Control, the overall life expectancy from birth is 77.4 years (compared to 40 years in 1900).
If an 86-year-old dies from heart failure, he or she beat the odds. If a 4-year-old drowns in a swimming pool, there is a loss of 73.4 years of life. Understand this is total years of life lost, not just productive or work years.
But deaths from injury in the 1 to 44 year age group do represent a significant loss of productive years of life. For 2004, the YPLL for unintentional injury was 2,219,044 years, over half from motor vehicle crashes. If we add intentional injury, it climbs to 3,606,118 years. And if we add the suffering and disability of the trauma survivors, the impact is staggering.
Injury is a disease and part of the treatment is prevention. Prevention results in less human suffering and decreased use of health care dollars. Injury prevention can be divided into three phases: primary, secondary and tertiary.
Primary injury prevention, preventing the injury from occurring in the first place, is the most effective - yet often the hardest to achieve. Two examples of prevention are educational activities, such as pool safety programs, and mechanical devices, like smoke detectors or alcohol sensors that deny an intoxicated driver access to the vehicle.
Secondary prevention is the reduction in the extent of injury when it occurs, which can be achieved by using passenger restraints, helmets or other body armor.
Tertiary prevention is preventing further damage by maximizing the treatment of injury across the entire spectrum of care, from prehospital through rehabilitation. A simple act like padding the backboard for a geriatric trauma victim can help prevent another injury that will complicate care and delay recovery.
Prevention is everyone’s responsibility; however, there are additional responsibilities for the EMT, both to the community as a public safety representative and on a personal level. EMTs have a fatality rate twice the national average. Three hundred fatal ambulance crashes occurred from 1991-2000, with 82 ambulance occupant deaths (27 of those deceased occupants were EMTs) and 275 occupant deaths in the non-ambulance vehicles involved. The majority of these crashes could have been avoided by driving the ambulance at lower speeds and stopping at all intersections.
The following comment concerning pediatric trauma deaths from former U.S. Surgeon General Dr. C. Everett Koop is relevant to all trauma deaths: “If a disease were killing our children at the rate unintentional injuries are, the public would be outraged and demand that this killer be stopped.”
EMS can help stop this killer through your commitment to all phases of injury prevention.
References
- Minino AM, Heron MP, Smith BL. Deaths: Preliminary Data for 2004. National vital statistics reports; vol 54 no 19. Hyattsville, MD: National Center for Health Statistics. 2006.
- Arias E. United States life tables, 2003. National vital statistics reports; vol 54 no14. Hyattsville, MD: National Center for Health Statistics. 2006.
- Years of Potential Life Lost Before Age 65, 2004, All Unintentional Injury Deaths. Office of Statistics and Programming, National Center for Injury Prevention and Control. Retrieved July 25, 2007 from http://webappa.cdc.gov/sasweb/ncipc/ypll.html
Years of Potential Life Lost Before Age 65, 2004, All Injury Deaths. Office of Statistics and Programming, National Center for Injury Prevention and Control. Retrieved July 25, 2007 from http://webappa.cdc.gov/sasweb/ncipc/ypll.html - Pless IB, Hagel BE. Injury prevention: a glossary of terms. J Epidemiol Community Health 2995;59:182-185. Retrieved July 25, 2007 from http://jech.bmj.com/cgi/content/abstract/59/3/182
- Ambulance Crash-Related Injuries Among Emergency Medical Services Workers – United States, 1991-2002. Morbidity and Mortality Weekly Report February 28, 2003/52(08);154-156. Retrieved July 25, 2007 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5208a3.htm