Doctors Attack the Disease Called Trauma
Thursday, April 2, 2009
Traumatic injury is one of the leading causes of death. But most of us don't consider it a disease. A new research center at UC San Diego is based on the notion that it is a disease. And if we treat it like one, we'll save lives and make all people safer. KPBS Health Reporter Tom Fudge has more ( Web Extra : How do you prevent being stabbed by your surfboard?)
(Photo: Raul Coimbra (right) is the founder of the Injury Epidemiology Prevention and Research Center at UCSD)
Injuries happen. In fact, they are the leading cause of death for Americans between the ages of one and 44. Yet trauma surgeon Raul Coimbra does not explain the cause of injuries by saying stuff happens. He says he regrets that most Americans do take a fatalistic view of injury.
"Trauma is something that happens to somebody else. It's viewed as accidents. Random events. Unavoidable. That's not the case. It is a disease because there is a pattern," Coimbra says.
Coimbra is chief of the division of trauma at UC San Diego hospital. He is also one of the founders of the Injury Epidemiology Prevention and Research Center, at UCSD.
Linda Hill is a clinical professor of medicine at there. She's one of the center's researchers who is looking for the patterns and causes of injury. There's no virus spreading this epidemic. Hill says the cause lies in human behavior, and the way it relates to our culture, our demographics and our environment.
"People are living in a home that is either safe or not safe. Or they're driving a car that's safe or not safe. And those are environmental influences into whether they're going to get into a motor vehicle crash. We don't call them accidents any more," says Hill.
Accidents or no, motor vehicle mishaps are a huge cause of injury and death. More than forty three thousand people died in vehicle crashes in the U.S. in 2005.
Andy Cohen, of Coronado, was riding in a car with friends when he was 16 and the car went out of control. He wasn't driving, but the accident left him paralyzed, a quadriplegic.
Andy was one of the people featured in a documentary film called "Murderball" about a rough form of wheelchair rugby he plays. Andy illustrates another aspect of the disease of traumatic injury by pointing out that he's met very few women who are quadriplegic.
"It's a compliment to all the ladies out there that they're not really as dumb as we are and don't end up in wheelchairs as often because they're not doing the stupid things that guys do," he says.
Stupid things like getting into fights, driving carelessly, or driving drunk.
The disease model of traumatic injury may seem novel. But the preventive medicine has been with us for a long time. It includes the placement of fire stations. Requirements that motorcyclists wear helmets. Learning how airplane accidents occurred by studying the black box. Dr. Kevin Patrick, another member of the Injury Research Center at UCSD, says expectations to control traumatic injury have already increased dramatically.
"One of my favorite definitions of public health is the systematic redefinition of the unacceptable. A few hundred years ago it used to be acceptable to throw your garbage into the streets, to urinate wherever you wanted, to spit on the street and whatnot. Over time, we have come to realize that there are a lot of things individuals do that have an influence on the health of others," he says.
The ultimate goal of the Injury Research Center is public outreach, and influence on public policy. Injury prevention relies on providing carrots and sticks to encourage or force people to behave more safely. For some it raises the question of whether we're becoming a nanny state. Are we? Let's go for a drive.
I'm getting into a 2006 Toyota Prius. I turn it on, and a tone tells me to buckle my seat belt. When I refuse, it becomes more adamant. Call it a nanny car if you want. But it does reflect the values of a society that recognizes serious motor vehicle injuries can be avoided. Yes, there is still back luck. There are still acts of God we can never anticipate. People still engage in risky activities and there's no cure for stupidity. But prevention has already made traumatic injury a far less dangerous disease. Tom Fudge, KPBS News.
Traumatic injury may be a disease. But is there a cure? Consider Eric Kendle’s surfing accident. Dr. Kendle is a trauma surgeon from Tucson who serves in the air national guard, and last year he was in San Diego for water survival training. After a full day of training in Coronado, he and his wife decided to go surfing.
On that day, there were steep waves breaking close to the shore. So Kendle was surfing in water that was quite shallow. During one ride, Eric’s surfboard hit the sandy bottom. He tried to kick his board out of the way. But it ended up in front of him and his momentum threw him onto the sharp end of the surfboard, which cut very deeply into his thigh. He soon saw his blood was being pumped out of him with the force of his heartbeat. He knew that rate of blood loss was life threatening.
Eric and his wife were in an isolated part of the beach. Thinking it may be the last thing he said to her, he told his wife to go find help. Eric took the leash of his surfboard and wrapped it around his leg to try to slow the bleeding. When help arrived, Eric told the paramedic to apply pressure to his leg just below the laceration. That helped get better control of the bleeding. Soon, Eric was taken to the UCSD Trauma Center. They stopped the bleeding. They saved his leg and his life.
Dr. Eric Kendle’s injury could have killed him. The fact that he was an experienced surgeon, who knew how to control the bleeding until help arrived, may have been the reason that he did not bleed to death. But could his life-threatening accident been prevented?
Eric says he is by no means an expert surfer. A more experienced surfer probably would have been more aware of the risk of surfing in shallow water and he would have known better how to react when his board hit the sand.
But does that mean California should not allow inexperienced surfers to take to the waves? Should the state require surfers to be licensed before they can surf without the supervision of a trainer? Kendle says it would be ridiculous to start mandating such things. Prevention can’t account for everything, he says, and his accident was not common or typical.