The Impact of Marijuana Legalization on Vehicular Trauma.

Background Drugged driving, or driving under the influence of any drug, is a growing public health concern, especially with the recent legislation legalizing marijuana use in certain states in the USA. We sought to gain a better understanding of the surgeons' perspective regarding marijuana (MJ) and alcohol (ETOH) and the relationship of recent laws to identification of MJ and ETOH in trauma victims. Methods Members of a national trauma surgical organization were asked to participate in an Institutional Review Board (IRB)-approved, web-based survey which centered on attitudes, knowledge, and beliefs regarding ETOH and MJ as they related to injury. Two Level I trauma center registries (located in TX and CA) were queried for the incidence of motor vehicular collision (MVC) and the presence of ETOH (defined as > 0.08 g/dL) or MJ from 2006 thru 2012. Results A total of 127 trauma surgeons participated in the survey. The majority were male (84%, n = 107) and with a median age of 52. Most were in surgical practice for greater than 11 years (78%, n = 99) and worked at a Level I trauma center (78%, n = 99) in an academic institution (65%, n = 83). MJ was illegal in the states where most of the participants were in practice (79%, n = 100), but 90% (n = 114) of respondents from states where MJ is legal stated they have not seen an increase in MVC since MJ was legalized. At the TX trauma center, only 4% of patients involved in a vehicular trauma tested positive for MJ, 21% of patients had the presence of ETOH, and 3% had both. For both MJ and also ETOH, the incidence remained the same each year. In CA, there was little yearly variation in the incidence of patients that tested positive for MJ (23%), ETOH (50%), and both (7%). In addition, the incidence of MJ was essentially unchanged after the decriminalization law was passed in 2010. Conclusion The prevalence of cannabis and alcohol varies among the states studied, TX and CA. The impact of decriminalization of marijuana did not seem to affect the incidence of drugged driving with marijuana in CA.

Fact and Fiction Regarding Motorcycle Helmet Use, Associated Injuries, and Related Costs in the United States.

Background Despite evidence that helmet use decreases motorcycle-associated injuries and mortality, the use of motorcycle helmets is not universal. As trauma surgeons are frequently the primary providers responsible for motorcycle crash victims, we sought to gain a better understanding of trauma surgeons' perspectives on helmet use with motorcycles. Methods Members of the American Association for the Surgery of Trauma (AAST) were asked to participate in a survey that centered on attitudes, knowledge, and beliefs regarding motorcycle helmet use, associated injuries, and related costs. Demographic data were analyzed. In addition, we performed a literature search to attempt to clarify the current data on this subject. Results A total of 127 surgeons participated. The majority were male (64%, n=81), in academic practice (67%, n=85), and worked at a Level I trauma center (80%, n=102). Of those that owned a motorcycle, 100% wear a helmet when riding. Seven percent (n=9) of respondents believe helmet use increases cervical spine injury, although the majority (78%, n=99) disagree. In regards to head injuries and helmet use, most (93%, n=118) believe that helmets decrease the severity of head injury, improve outcomes (98%, n=124), and impact long-term disability (93%, n=118). Ninety percent (n=114) of surgeons believe that state legislation mandating motorcycle helmet use increases helmet utilization, and 82% (n=104) believe that the decision to wear a helmet should not be a personal decision. The majority (83%, n=106) of trauma surgeons agreed that helmet use would likely lead to a major reduction in motorcycle-related health care costs. Conclusions North American trauma surgeons wear helmets when they ride motorcycles and believe that these devices are highly protective, leading to a reduction in brain injury and the subsequent health care costs.

Trauma Surgeons' Perspective on Gun Violence and a Review of the Literature.

Background In the United States, there is a constant debate between the proponents of the right to bear arms and those desiring to reduce the epidemic of gun violence. We sought to capture the trauma surgeons' perspective on gun control. Methods We presented an on-line based survey to the members of the American Association for the Surgery of Trauma (AAST). Survey questions were chosen to reflect the popular media poll questions as well as trauma-specific perspectives. We compared the trauma surgeons' perspectives to that of the general populace from a poll conducted by the New York Times (NYT). Results A total of 120 trauma surgeons responded to the survey. The age group ranged from 34 to 82 years, and the median age was 51. Most respondents were male (64%, n = 67) and worked at a Level I trauma center (80%, n = 96) in an academic setting (67%, n = 80). About half of the responding surgeons owned a household firearm (40%; n = 48 of the AAST members vs. 47%; n = 521 of the general populace). Sixty-one percent of the trauma surgeons (n = 73) and 53% (n = 588) of the NYT respondents favor stricter gun control laws. While 80% (n = 888) of the NYT respondents felt that mental health screening and treatment would decrease gun violence, only 56% (n = 67) of surgeons felt that mental health screening would be beneficial. The majority (90%, n = 999) of the NYT poll respondents favor a law restricting the sale of guns only by licensed dealers. Only (66%, n = 79) of the trauma surgeons were in agreement with the stricter gun sale legislation by licensed dealers. Conclusion Trauma surgeons appear to share similar views with the general American populace regarding gun violence and injury control.