pects of injury control that did not re- ceive full attention from EM in the. CDC's research agenda.4 Nor has in- jury c
EM and Injury Control Research, Hargarten et al.
Emergency Medicine and Injury Control Research: Past, Present, and Future Stephen W Hargarten, MD, MPH, Lenora Olson, MA, David Sklar, M D
I Thirty years have passed since the landmark publication “Accidental Death and Disability: The Neglected Disease of Modem Society”’ first documented what little progress had been made in applying the scientific aspects of injury prevention and control. Several notable publications in the 1980s, including “Injury in America: A Continuing Public Health Problem”’ and “Injury Prevention: Meeting the Challenge,”3 have reviewed the progress made in injury control and outlined future research needs. Unfortunately, many of these benchmark publications have not included the contributions of emergency medicine (EM). Perhaps there were too few to include! While the field of EM has matured and contributed substantially to the acute treatment of injuries, contributions in the area of injury prevention and EM injury research have been less clear. One of the reasons for the lack of contributions by emergency physicians (EPs) in the past may be the immediacy of emergency injury care. EM has largely focused on its role in the acute care of the injured patient. EPs are on the “front line-at the bedside” as they treat the results of unlocked guns, unused seat belts and helmets, and unsecured windows, pools, and medications. Less clear are the issues of injury prevention and rehabilitation, crucial aspects of injury control that did not receive full attention from EM in the CDC’s research agenda.4 Nor has injury control specifically received a high priority in the EM research agenda.5
This issue of Academic Emergency Medicine focuses on EM and its role as a specialty regarding injury control. Our emotional and professional reaction to these preventable injuries is finding scientific voice in the research of EPs and public health professionals as documented by this issue of Academic Emergency Medicine. These articles focusing on injury prevention add to the growing literature of injury epidemiology and prevention directly related to EM. The range and depth of the articles in this issue, from acute care to prevention, emphasize the scope of research available to EM academicians. The topics range from out-of-hospital care and trauma systems to ED peritoneal lavage, from urban to rural injury care, from E-codes and alcohol to rollerblades, and from occupational injuries to domestic violence. As this agenda broadens, so too do our collaborators. One such example of collaboration is the article by Kinnane et a].: which explores the literature of injury prevention and emergency medical services (EMS) and highlights a variety of examples of the involvement of out-of-hospital care providers with injury prevention. The University of New Mexico Injury Prevention Center, through funding from the Emergency Medical Services for Children Program, has recently implemented a curriculum for emergency medical technicians (EMTs) interested in injury prevention. The cumculum has been enthusiastically received by EMTs who use the information to design injury prevention strategies. In some rural communities,
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EMTs may be the most medically sophisticated individuals available and can provide leadership in injury prevention alongside their EM colleagues. The study by Coben et a].’ demonstrates the importance of EDs in the surveillance of injuries. Although mortality data often have been available, morbidity data, especially from the ED, have been a missing piece in injury data collection effort^.^ An accurate picture of nonfatal and fatal injuries i s important in the development, implementation, and evaluation of injury prevention programs (e.g., Kellermann et a1.8). By augmenting death certificate information with ED data, Coben et al. were able to better quantify the public health impact of firearms and their disproportional effect on blacks in Allegheny County, PA.’ EPs can play a key role in the development of public policy and prevention initiatives by performing quality research that identifies highrisk groups and risk factors. The article by Maio et a].’ describes the important contribution EPs can make in detecting alcohol abuse and dependency in motor vehicle injury victims. A similar association probably exists for patients who present with other types of injury. Identification of alcohol-related problems in the ED may lead to early intervention and begin to reduce alcohol-related trauma. Not only have EM injury control research efforts matured, as evidenced b y this dedicated injury issue of Academic Emergency Medicine, but also our leadership in the field of injury control has grown. Ricardo Martinez, MD, and Daniel Pollock, MD, are both EPs leading injury control efforts at the National Highway Traffic Safety Administration and the
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CDC, respectively. Dr. Martinez’s insights and views expressed in this issue are extremely helpful in motivating others to dedicated careers in injury control.” Other leaders include: emergency physician Jeffrey Coben, MD, at the University of Pittsburgh, who is directing a CDCfunded Injury Control Research Center complementing the other existing national centers that have been traditionally housed in schools of public health. EPs are also taking the lead in the direction and development of injury control research at Emory University, the University of New Mexico, and the East Carolina University. In addition, both Academic Emergency Medicine and the Annals of Emergency Medicine promote injury prevention research through their dedicated injury control associate editors. So, what’s the future of EM and in,jury control research? To continue the growth of injury control research and practice in EM, creative research support needs to be obtained and sustained from managed care, industry, and private foundations to complement the limited funding available from state and federal agencies. We cannot do it alone. Continued and greater collaboration with our colleagues in surgery, pediatrics, epidemiology, biomechanics, and public
ACADEMIC EMERGENCY MEDICINE
health is crucial. In addition, we need to promote injury control research scholarship among EM residents and other interested disciplines. As evidenced by this issue, our specialty’s contributions to the field have matured and increased; we can be excited about the future. We congratulate all the authors in this issue. Their dedication to highquality research can be found in each article. Of course, many other examples of EM and injury control efforts have not been mentioned here. To keep the momentum moving forward and to build on our collective experience, we recommend a consensus meeting of EM and public health to set an agenda for injury control research for the 21st century. Such a meeting should occur within the next 2 years and involve relevant govemmental agencies and key EM organizations. Dr. Hargarten is at the Medical College of Wisconsin. Milwaukee, WI. Department of Emergency Medicine; and Drs. Olson and Sklar are at the University of New Mexico, School of Medicine, Albuquerque, NM, Department of Emergency Medicine. Address for correspondence: Stephen W. Hargarten. MD, MPH. Medical College of Wisconsin. Depadment of Emergency Medicine, 9200 West Wisconsin Avenue, FMLH East, Milwaukee, WI 53226. Fax: 414-257-8040; e-mail:
[email protected]
APR 1997 VOL 4 / N O 4
Key words: injury prevention; emergency medicine; research.
REFERENCES 1. National Research Council. Accidental Death and Disability: The Neglected Disease of Modem Society. Washington, DC: National Academy of Science, National Research Council, 1966. 2. Committee on Trauma Research. Injury in America: A Continuing Public Health Problem. Washington, DC: National Academy Press. 1985. 3. National Committee for Injury Prevention and Control: Injury Prevention: Meeting the Challenge. New York: Oxford University Press, 1989. 4. Houk V, Millar JD, Rosenberg M, et al. Setting the national agenda for injury control in the 1990’s. Ann Emerg Med. 1992; 21:2016. 5. Aghababian RV, Barsan WG, Bickell WH, et al. Research directions in emergency medicine. Acad Emerg Med. 1996; 3:274-6. 6. Kinnane JM. Garrison HG. Coben JH, Alonso-Serra HM. Injury prevention: is there a role for out-of-hospital emergency medical services? Acad Emerg Med. 1997; 4:306-12. 7. Coben JH, Dearwater SR, Forjuoh SN, Dixon BW. A population-based study of fatal and nonfatal firearm-related injuries. Acad Emerg Med. 1997; 4:248-55. 8. Kellermann A, Rivara F, Lee R. et al. Injuries due to firearms in three cities. N Engl J Med. 1996; 335:1438-44. 9. Maio RF, Walker PF, Blow FC. Hill EM, Singer KM. Alcohol abuse/dependence in rnotor vehicle crash victims presenting to the emergency department. Acad Ernerg Med. 1997; 41256-62. 10. Martinez R. The view from Washington: an emergency physician in NHTSA’s court. Acad Emerg Med. 1997; 4:313-22.
