Motor vehicle safety: current concepts and challenges for emergency physicians.

Motor vehicle travel is the primary means of transportation in the United States, providing freedom in travel and enterprise for many people. Motor vehicle crashes are the leading cause of death for the young and contribute to a high degree of morbidity and mortality for all ages. Motor vehicle crashes produce an enormous burden for society in terms of suffering, disability, death, and costs. Motor vehicle crash injury prevention is developing as a focused discipline to implement proven interventions involving technology and behavior known to prevent or reduce the severity of motor vehicle crash injury. Emergency physicians have an important role in advocating motor vehicle safety and injury prevention, both in the emergency department and within the community.

Bystander Trauma Care training in Iowa.

OBJECTIVE: The Iowa Bystander Trauma Care program trained citizens to provide initial care at the scene of a motor vehicle crash. The development, implementation, and evaluation of the program are described. METHODS: The National Highway Traffic Safety Administration's curriculum was used as the basis for developing the Iowa Bystander Trauma Care program. Emergency medical technicians (EMTs) were trained to be instructors in a two-hour course offered at each of four community colleges. The EMTs, in turn, provided instructions to the general populace. Five hundred participants were given a questionnaire before the one-hour Bystander Trauma Care training session, immediately after the training and six months later. The questionnaire obtained background data and assessed attitudes regarding willingness to stop and assist, and knowledge obtained. RESULTS: One hundred twenty EMT instructors trained more than 2,000 citizen bystanders in a 17-county area in central Iowa. Immediately after the training program, participants were more likely to provide assistance (p < 0.001), and understand the sequence of actions to be performed at the scene of a crash and how to prioritize the information provided to 911 (p < 0.05). There was also evidence of retention of the knowledge six months after training. CONCLUSIONS: Citizens readily volunteered for the Bystander Trauma Care training program. Results of the questionnaire suggest citizens can be successfully trained to recognize the needs of, and provide initial care for, acutely injured persons, and the positive effects of such training are maintained over time.

Method to electronically collect emergency department data.

STUDY OBJECTIVE: To describe the development and completeness of an electronic injury-surveillance system, the Rural Injury Surveillance System (RISS). METHODS: The emergency departments of nine rural Iowa hospitals submitted information on all patients treated from May 1993 through June 1994. RESULTS: The EDs submitted information on 23,594 patients with 32,445 different injury, disease, or follow-up visits. On the basis of comparison with the handwritten ED logbook, 90% of visits were also available in the RISS. Of the visits recorded in the RISS, 99% were also recorded in the logbook. The proportion of missing diagnostic codes decreased from a high of 22.6% in May 1993 to 8.1% in June 1994. The proportion of missing external cause codes was about 25% at the end of the study period. The proportion of missing industry and occupational codes was less than 5% at the end of the study period. CONCLUSION: Our findings show that complete, computerized, ED-based injury surveillance in rural EDs is possible and should be developed further.

Motorcycle helmets and spinal injuries: dispelling the myth.

STUDY OBJECTIVE: To determine the relationship between spinal injuries and helmet use in motorcycle trauma. DESIGN: Retrospective case series. SETTING: Twenty-eight hospitals in four midwestern states--Illinois, Iowa, Nebraska and Wisconsin--representing urban, suburban, and rural settings. PATIENTS AND OTHER PARTICIPANTS: Consecutive sample of motorcyclists treated at the participating centers. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The major variables evaluated were helmet use, ethanol use, and significant head or spinal injuries. RESULTS: 1,153 cases were analyzed. Helmet use was not significantly associated with spinal injuries (odds ratio, 1.12; 95% confidence intervals, 0.79, 1.58) whereas head injury was markedly decreased with helmet use (odds ratio, 0.35; 95% confidence intervals, 0.23, 0.53). Ethanol use was a significant variable in both head (odds ratio, 3.89) and spinal (odds ratio, 2.41) injuries. CONCLUSION: In contrast to a significant protective relationship identified for head injuries, helmet use was not associated with an increased or decreased occurrence rate of spinal injuries in motorcycle trauma.

Cost savings associated with increased safety belt use in Iowa, 1987-1988.

Although safety belt use increases after passage of a safety belt law, the statewide direct and indirect cost savings associated with increased safety belt use after a belt use law has been enacted is not known. We analyzed a subset of data from the Iowa Safety Restraint Assessment consisting of 997 injured motor vehicle occupants treated at any of 11 Iowa hospitals from throughout the state between November 1987 and March 1988. We found that injuries were more serious and that more deaths and cases of permanent disability occurred among persons who did not wear safety belts. Failure to use safety belts was independently associated with higher payments to hospitals by health care insurers and individuals in nearly all age, sex, and vehicle speed categories. Lifetime direct and indirect cost savings associated with Iowa's safety belt law for persons injured in one year were estimated to be $69.5 million.

Motor vehicle crash injury: mechanisms and prevention.

Nearly 50,000 persons are killed and 5 million are injured on the nation's highways each year. Motor vehicle injuries produce enormous costs for society. The use of motor vehicle safety restraints can substantially reduce death, disabilities and expenses associated with crashes. Primary care physicians have an important role in educating patients about the benefits of correct and consistent use of safety restraints.

Prehospital pain control: nitrous oxide inhalation.

Pain control in the prehospital emergency setting is often a neglected aspect of patient care. This article reports findings from 6 months of nitrous oxide use in the field. Its safety and effectiveness in selected cases is demonstrated.