The Needle Tip: If Injury Prevention is Working, Then Why is My ER Full?

Errington C. Thompson, MD

A few years ago, my daughter, who is the mother of a very active seven-year-old, called me out of the blue, and wanted some free fatherly advice. She and her husband were considering purchasing a trampoline for their son. My first reaction was to yell, “No!” thinking only of all the serious injuries my grandson could potentially sustain.

I composed myself and thoughtfully explained to my daughter all the multiple problems and inherent dangers of trampolines even with all the latest safety features functioning properly. After the call, I even emailed her several articles on the dangers of trampolines. I felt my common sense talk about injury prevention would prevail, however, two weeks later, my son-in-law bought the trampoline anyway.

Injury prevention is tough. As my story illustrates, sometimes it is really hard getting even your own family to understand a clear message about injury prevention. Injury prevention is not for the fainthearted or the weak-willed. There are a lot of things that have to go right for your patient to get the message.

Several years ago, I took care of a mother and her six-year-old son. They were in a terrible motor vehicle crash. The mom was driving and wearing her seat belt, but her son was allowed to roam around in the car because he “didn’t like” seat belts. As you can imagine, the mother had some relatively minor injuries, but her son was severely injured. He required a chest tube, an exploratory laparotomy with repair of small bowel, diaphragm, and bladder. He was stabilized and transferred to the pediatric trauma center 90 miles away for orthopedic care. In this case, the mother understood the importance of seat belts for herself, but not for her son.

We know that getting parents to listen can be hard because parents are swamped with information: They are supposed to play Mozart to their babies in-utero. They are supposed to breastfeed (or, at least, pump) and avoid bottle-feeding. They’re supposed to make and jar their own baby food with organic, local, or home-grown organic produce. They need to read to their children. They need to read about raising their children and be in the know about all the latest parenting methods that work . . . Not to mention all the work they need to do to child-proof the house—from adding child safety locks on cabinets to installing safety gates to prevent their children from tumbling down the stairs. So they’re swamped with not just a long list of worrisome things to do that would make any parent frantic, but a lot of pressure from their communities to be the perfect parent as well—which any parent will tell you is IMPOSSIBLE.

We, the trauma community, have a lot of work to do regarding injury prevention, but we can look back proudly at all of the work that we have done, and at what we have accomplished so far when we need to gain some inspiration and strength to keep moving forward.

• Cars are much safer today because the work of those that believed you should survive your motor vehicle crash. Many child car seats are so well-designed that if properly installed, the infant/young toddler can survive most crashes without a scratch.
• In many communities, you can’t have regular windows on a patio. You now need to have special safety glass.
• That great program in New York City identified that due to a lack of safety features in the construction of high-rise apartment buildings, children were susceptible to falling out of the windows if they played with, or played too close to, the windows. Legislation was passed to place window gates on all windows except those connected to fire escapes. As a result, deaths from this type of fall decreased over 90 percent within the next year.
• Tens of thousands of buildings now have sprinkler systems.
• Playgrounds are safer because of child-friendly equipment.

But folks, the trauma community has more to do. We have serious, complex questions which need to be asked, researched, and answered.

Head injuries in football and soccer are too common. What can we do to prevent recurrent concussions?

Too many children continue to ride bikes without helmets. What can we do to get a helmet on every child?

Although many medical organizations have spoken out about the dangers of children riding and operating ATVs, the word has not gotten out. How do we fix this?

How can we better identify risks before they become a national health problem? Basically, we must continue to work together to find solutions. We must always form coalitions that will help us achieve our goal, which must always be patient safety.