But it was an accident! A closer look at the types of accidents may help us understand how to prevent them.

But It Was an Accident!

The Emergency Room

Mercy Hospital Your Town, USA Every Day, 1991

3:30 p.m.

Rick Jones, a 40-~ear-old sheet metal worker, arrives at the registration desk, holding a bloody white handkerchief around his right hand. Examination reveals a one-inch laceration at the end of his index finger, sustained when he glanced up for an instant while molding a porch awning.

Treatment: Four stitches and a tetanus immunization.

Cost: $150 in medical bills and two hours of missed work.

4:15 p.m.

David Phillips, a 10-year-old football player, is accompanied to the examining area by another youngster and their coach. Still dressed in grass-stained white football pants, crimson jersey, and shoulder pads, David is supporting his ice-packed left wrist with his uninjured right hand. He says he heard something snap when he was tackled about a half hour ago. X-rays reveal nondisplaced fractures of the distal radius and ulna, just above the wrist.

Treatment: Application of a forearm cast, to be worn for six weeks.

Cost: $350 in medical bills.

4:35 p.m.

The emergency radio beeps at the central nursing station, and the wail of a siren is heard in the background as the voice of an ambulance driver reports: "Mercy Hospital, this is County Ambulance 189. We are en route to your facility Code 3 [lights and siren] with a female patient, age 22, victim of a head-on collision. This patient was the driver of one of the vehicles. She was not restrained--repeat, not wearing a seat belt. She sustained lacerations and abrasions to her head and face and has a large bruise over her chest and upper abdomen. The patient is breathing without assistance, but is confused and responds slowly to questions. Her vital signs: blood pressure 90/50, pulse 140 per minute, and respirations 35. We have started an intravenous in her right arm and placed her on a backboard and in a neck brace. We are prepared to assist with ventilation if necessary. Our ETA [estimated time of arrival] to your facility is seven minutes."

Treatment: Admission to the intensive-care unit; surgery for chest and abdominal injuries.

Cost: $35,000 in medical costs and two months lost from work.

4:45 p.m.

The three remaining victims of the two-car accident arrive by ambulance. Nurses, doctors, and technicians surround each gurney as the patients are rolled into the treatment area. Fred Hancock, 35-year-old driver of the second vehicle, is awake and alert. Wearing a seat belt at the time of the crash, he sustained no major injuries, but is complaining of pain in his neck.

Treatment: Examination and X-rays of the neck. Released.

Cost: $250 in medical costs.

Barb Hancock, 33-year-old female, front seat passenger, was wearing a seat belt. Emotionally distraught, she complains of neck pain and low back pain.

Treatment: Examination and X-rays of the neck and low back. Released.

Cost: $325 in medical costs.

Patty Hancock, 8-year-old female, back seat passenger, was unrestrained. She was extricated from the floor of the rear seat. She has multiple bruises, dried blood around her nose and mouth, and an obvious deformity of her left ankle, which is supported in a metal splint. X-rays reveal a broken ankle and a broken nose.

Treatment: Ankle surgery for pinning the broken bone. Realignment of fractured nose.

Cost: $2,500 in medical costs and one week out of school.

6:30 p.m.

Sarah Robertson, 85 years old, arrives via ambulance, having slipped on a throw rug and fallen at home. She complains of right hip pain and inability to stand or bear weight. X-rays reveal a fracture of the right hip.

Treatment: Surgical reduction and pinning of the right hip.

Cost: $5,000 initial medical costs and prolonged rehabilitation.

But it was an accident! Definition: an unintended, unexpected event resulting in injury.

But it was an accident! Consider these facts:

* Ten million disabling injuries in the United States each year.

* One hundred thousand deaths by accident each year.

* Fourth leading cause of death, after heart disease, cancer, and stroke.

* The leading cause of death among all persons aged 1 to 44 years.

* Four million years of lost productive life annually.

* More than $100 billion in annual cost.

But it was an accident!

Yes, but coud it have been prevented? Could we have foreseen the possibility of this unintended, unexpected event? And, having anticipated it, could we have so changed our behavior or modified our environment so as to have reduced our risk and perhaps prevented this misfortune?

Each accident involves the coming together of three elements: the host, or victim, who is vulnerable to injury; the causative agent, capable of inflicting harm; and a permissive environment, allowing host and agent to interact in a potentially harmful way.

Research and experience reveal that success in preventing accidental injury is more likely to result from changes in the host (e.g., education, behavior changes) and the environment (e.g., safety glasses, seat belts) than from efforts to get rid of the offending agents, which are often the tools and implements of our economy (e.g., automobiles, power saws).

A closer look at the types of accidents that show up at Mercy Hospital Emergency Room may help us understand better what accident prevention entails.

Motor vehicle accidents. Motor vehicle crashes, the most significant cause of accidental injury, account for almost half (4 million to 5 million) of all disabling injuries and half (40,000 to 50,000) of all accidental deaths each year. Injury rates are highest among young people ages 16 to 24, particularly young men, who experience death rates twice those of young women.

Human factors (rather than mechanical failure) are the most frequent cause of crashes. A recent article in the Journal of the American Medical Society identifies several specific human risk factors as potentially impacting upon the automobile accident rate. The most well documented and scientifically supported human risk factors are the use of alcohol when driving and the use (or lack of use) of occupant restraints.

There is strong, indisuptable association between blood alcohol concentration and the risk of crash. Alcohol impairs driving capabilities, and the more serious the crash, the more likely alcohol is to be involved. In addition, medical diagnosis and treatment may be compromised by the effects of alcohol.

The use of occupant restraints, especially lap/shoulder belts, has been remarkably effecting in reducing injuries and preventing deaths. The emerging incorporation of air bags into many new automobiles has the potential, when used in combination with lap/shoulder belts, for increased effectiveness. Child safety seats are equally important, since unrestrained children are 11 times more likely to die in a crash than those who are properly restrained. The challenge we face is to improve upon the statistics indicating that only 15 to 20 percent of Americans regularly use seat belts and that only about 35 percent of children are properly restrained when riding in automobiles. Some authorities are convinced that legislation is essential to promote the use of restraints by adults and children. They cite studies showing better than 50 percent usage of restraints in states with such laws.

Work injuries. While work-related injuries occur in virtually every industry and business, the most dangerous occupations in terms of rate and severity of injury are construction, mining, and agriculture.

Work-related injuries are primarily of two types: sudden force and overexertion. The application of sudden force results in injuries such as bruises, cuts, broken bones, amputations, and concussions. Overexertion, caused by activities such as lifting, pulling, pushing, and prolonged awkard posture, is responsible for low back pain, tendinitis, and related problems.

Prevention of work-related injuries is dependent on a multifacited approach involving safety in job design (e.g., the wearing of appropriate shoes and eye shields), employee screening and training, and aggressive medical treatment and follow-up.

Childhood injuries. Injuries are the leading cause of death in children. One million children each year require medical care for injuries, 40,000 to 50,000 of which result in permanent disability.

Injuries to children vary according to age. From the helpless baby to the vigorous adolescent, a spectrum of injuries emerges.

Birth to 6 months: babies; totally dependent upon caretakers. Automotive and crib injuries, burns, and falls are the most common accidents.

Seven to 12 months: increasing mobility; crawlers. They reach for and put everything into their mouths. They must be protected from electric cords and outlets.

One to 2 years: little investigators with no sense of danger; climbers. It is necessary to establish secure boundaries, such as playpens and fences.

Two to 3 years: same as 1 to 2 years, only faster! Close observation is essential.

Four to 5 years: preschool years; growing independence. Most frequent accidents invole motor vehicles, burns, drowning, and poisoning.

Six to 10 years: teachable youngsters--responsibility for safety shifts largely from parent to child. Pedestrain, bicycle, and pet safety must be stressed.

Eleven to 14 years: rapid physical growth and body changes, activities distinguished by strenuous physical activity. Sports injuries become more frequent.

For young people of all ages, safety requires the active involvement of parents, teachers, and other caregivers. Observation, education, and attention to detail regarding environmental dangers are essential.

Injuries to the elderly. The elderly experience 72 percent of all fatal falls, 30 percent of all pedestrian fatalities, and 29 percent of all deaths because of burns. Sensory problems such as decreased sight and hearing, uncertain euqilibrium, and slowed reaction time are felt to be partly responsible. Prevention of injury to the elderly depends to a large degree on modifying the environment to make it safer. This means, for example, stabilizing loose carpets, providing secure handrails, and installing and maintaining smoke detectors.

Conclusion. But it was an accident!

Sorry, but that's no excuse. Safety is my responsibility and yours. Only as we commit ourselves to accident prevention, through educating ourselves and others, taking inventory of our own safety habits, and practicing and supporting proven safety measures, can we hope to reduce the enormous cost in money, health, and lives that rises from accidental injury.

Ted Hamilton, M.D., in addition to serving as a senior editor for VIBRANT LIFE, is an associate professor at Loma Linda University and handles a private medical practice.