Two other presentations addressed how delivery of emergency medical care can be compromised by external factors. The effect of the influenza vaccine shortage on ED patients was studied by researchers from Oregon. In Massachusetts, researchers evaluated whether ED patients with financial need might have difficulty deciding between medical care and food.
Analyzing Police Pursuits
In the period 1982 to 2004, there were 881,733 fatal crashes reported to NHTSA, leading to 987,523 fatalities. Of fatal crashes, 6336 (0.7%) were secondary to pursuits, leading to 7430 (0.8%) fatalities. Occupants of chased vehicles accounted for 5355 (72%) deaths and police for 81 (1%) deaths. Almost 2000 "uninvolved persons" died as a result of these pursuits (27% of the fatalities).
The authors reviewed the demographic data, alcohol involvement, road location and mechanism of collision leading to a pursuit fatality. Children and adolescents accounted for 28% of all fatalities. African Americans and Native Americans died at a higher proportion than their percentage of US population. Alcohol was involved in 4628 (62%) fatalities. Of police officers killed, 20 (25%) were intoxicated.
Robert M. Miller MD concludes, "Police pursuit related fatalities are an emerging public health problem that affects suspects, police officers and innocent bystanders alike. More data must be gathered by each state to fully understand the nature of pursuits with a goal of reducing preventable deaths and injuries."
These data were presented as a poster, "A Review of Police Pursuit Fatalities in the United States from 1982-2004" by Robert M Miller MD, H. Range Hutson MD, Phillip L Rice MD, Jasroop K Chana MD, Demetrios N Kyriacou MD, and Yuchiao Chang PhD. This poster will be presented at the 2006 SAEM Annual Meeting, May 18-21, 2006, San Francisco, CA on Thursday, May 18, 2006, from 3:00 PM until 5:00 PM in the Exhibit Hall of the San Francisco Marriott. Abstracts of the papers presented are published in the May issue of the official journal of the SAEM, Academic Emergency Medicine.
Identifying College Fraternity/Sorority Members At-Risk for Injury
Members or pledges of college fraternities and sororities are twice as likely as non-Greek students to get drunk at least weekly and are at higher risk of being injured or injuring someone else. Research suggests that a simple screening question - "In a typical week, how many days do you get drunk?" - may help identify students at highest risk of injury from drinking.
The question was asked of 10,635 college students chosen randomly from ten North Carolina universities. Of the 912 fraternity/sorority members and 419 pledges who answered the web-based survey on alcohol use and its consequences, 60% reported getting drunk at least weekly. Pledges who reported getting drunk at least weekly had five times the risk of falling from a height and two and a half times the risk of being burned than non-Greek students who do not get drunk. Female pledges and members who got drunk weekly had more than twice the risk of being sexually assaulted than non-Greek females who did not get drunk. Member or pledge status in a Greek organization and "getting drunk" were significant independent predictors of increased injury.
The study is "Single Question About Drunkenness to Detect College Fraternity/Sorority Members At-Risk For Injury" and will be presented by Mary Claire O'Brien MD. Her co-authors are Thomas P. McCoy MS, Heather Champion PhD, Erin Sutfin, PhD, Scott Rhodes, PhD, Mark Wolfson PhD, and Robert H. DuRant PhD. This paper will be presented at the 2006 SAEM Annual Meeting, May 18-21, 2006, San Francisco, CA on Saturday, May 20, 2006 at approximately 2:15 PM in Salons 1-3 of the San Francisco Marriott. Abstracts of the papers presented are published in the May issue of the official journal of the SAEM, Academic Emergency Medicine.
Influenza Vaccine Shortage Hits Emergency Departments Harder
For people who rely on Emergency Departments for regular care, cutbacks in preventative care or shortages of vaccines may have more adverse effects. To examine such concerns, researchers looked at the vaccination rates of ED patients both before and during the 2004 Influenza Vaccine shortage.
Researchers surveyed 802 patients older than 23 months who met CDC guidelines for vaccination. In 2004, the year of the vaccine shortage, only 45% were vaccinated and 10% reported attempts to receive vaccination that were unsuccessful or denied, compared to 57.7% who reported receiving one last year. Of 369 patients having a preexisting respiratory condition, only 25% received the vaccine, compared to 38% who reported receiving it the previous year. Uninsured patients meeting CDC guidelines had vaccination coverage of only 14%, - lower than any other insurance category.
According to Damon Kuehl MD, "Vaccines have proven benefit in improving the health of populations-but only if people receive them. It is clear from our experience that emergency department patients are vulnerable to health care shortages and that vaccination rates are far below optimal especially among people with the greatest need for preventive care."
This presentation, "The 2004 Influenza Vaccination Shortage Effect on Emergency Department Patients Who Met CDC Guidelines for Vaccination" by Damon R Kuehl MD, K. John McConnell PhD, and Heather Brooks BS, will be presented as a poster at the 2006 SAEM Annual Meeting, May 18-21, 2006, San Francisco, CA on Saturday, May 20, 2006, from 9:00 AM until 11:00 AM in the Exhibit Hall of the San Francisco Marriott. Abstracts of the papers presented are published in the May issue of the official journal of the SAEM, Academic Emergency Medicine.
Choosing Between Food and Medicine More Common Among Emergency Department Patients
In Massachusetts, about 7% of households are food insecure (FI), meaning they experienced periods when their food supplies were reduced and may have experienced periods of hunger. There is concern that the population who uses Emergency Departments for medical care might be even more food insecure. Emergency Department providers need to be aware that their patients may be more likely to forgo medicine for food, and thereby compromise health.
In a survey of approximately 500 consecutive patients in 4 Boston-area Emergency Departments, 13% or twice the Massachusetts average were found to be food insecure. FI patients were more likely to put off paying for medication to have money for food (27% vs. 4%), to take medication less often because they could not afford more (32% vs. 4%), to report needing to make a choice between buying medication and food (27% vs. 2%), and to get sick because they couldn't afford to take medication (27% vs. 1%).
Ashley F Sullivan will present the study, "Food Security and Medication Expenditures among Emergency Department Patients: A Multicenter Study" by Ashley F Sullivan MPH, Sunday Clark ScD, Uchechi Acholonu, Christina Ahn, Kristen J Lynch, Diana Saryan, Justin A Sobrino, and Carlos A Camargo MD. This paper will be presented at the 2006 SAEM Annual Meeting, May 18-21, 2006, San Francisco, CA on Saturday, May 20, 2006 at approximately 2:30 PM in Salons 1-3 of the San Francisco Marriott. Abstracts of the papers presented are published in the May issue of the official journal of the SAEM, Academic Emergency Medicine.
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