The Case for Ems in Injury Prevention

Unintentional injuries are the leading cause of death for individuals ages 1–44.1 Furthermore, unintentional injuries are the leading cause of potential years of life lost for those less than age 65.2 In the United States, deaths from unintentional injuries account for approximately two-thirds of all injury-related deaths.1 Due to this signifi cant societal impact, Healthy People 2010 calls for reductions in death rates caused by unintentional injuries from a baseline of 35.0 to 17.5 per 100,000 population1 The impact of injuries—in our personal lives as victims or near-victims and/or in our professional lives as the acquaintance of victims— cannot be overemphasized. An estimated 5.1 million people worldwide die annually as a result of injuries.2 In the United States, injuries have accounted for more than 150,000 fatalities yearly3 These deaths represent the apex of a pyramid of nonfatal cases. Hospitalized cases outnumber deaths by 19 to 1; nonhospitalized cases requiring outpatient care outnumber deaths 233 to 1.4 Another tragic pyramid demonstrates that for each non-intentional trauma death, 3 other victims are permanently disabled and 93 others are temporarily disabled.5 Historically, EMS developed as a result of and in conjunction with the nation’s growing awareness of injury’s toll on society. In the funeral hearse-asambulance era, the injured were simply scooped up and delivered to a hospital. In 1966, publication of Accidental Death and Disability: The Neglected Disease of Modern Society focused attention on prehospital care of the injured.6 The federal coordination and support phase formally began with the EMS Systems Act of 1973, which continued through block grant support of state EMS offi ces in the 1980s. Today, questions about effi cient utilization of increasingly expensive and sometimes scarce EMS resources have stimulated a wider refocus from solely the most severely injured (12% requiring level I or II trauma center treatment) to the entire spectrum of injured victims.7,8 Currently, EMS training and operations focus on maximizing survival of the most critically injured patients. Yet the majority of EMS responses and resources do not go towards treating those critically injured but rather towards the 88% of trauma victims with non-life threatening injuries. There is growing recognition of the risk factors for becoming critically injured, such as intoxication or lack of seatbelt or helmet use. Many in the EMS community view resources expended for education and injury prevention of these high-risk subgroups as a waste of time. Yet, injuries account for approximately one-third of all EMS transports, implying that a broad interface already exists between EMS and the injured. This broad interface, in combination with the potentially preventable nature of these critical injuries, begs the question of what is the most effi cient and cost-effective means to direct fi nite EMS resources.9