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June 28, 2002


National Trauma Awareness Month Reminder: Trauma Can Be Prevented If Proper Precautions Are Taken

According to the American Trauma Society, trauma is the leading cause of death for all individuals under the age of 40 in the United States. With June as National Trauma Awareness Month, these statistics serve as a reminder that trauma may be deadly, but it also can be prevented with proper precautions such as mandated safety belt use and the lowering of speed limits. Trauma Awareness Month is designed to raise national attention to trauma and what must be done to reduce the devastating impact of traumatic injuries.

Emory University School of Medicine trauma surgeons at Grady Memorial Hospital make every precaution to ensure that people are aware of the dangers associated with trauma. As the largest Level I trauma center in the state of Georgia, more than 85 percent of major trauma cases in the metro Atlanta area are treated at Grady Hospital. Of the trauma cases seen at Grady, one-third involve penetrating trauma of gunshot wounds and stabs; the other two-thirds include blunt trauma involving car crashes, assaults, falls, etc.

"Many people pay no attention to trauma," David V. Feliciano, M.D., Emory University School of Medicine professor and chief of surgery at Grady Hospital. "They worry about getting old and dying of cancer, heart attacks and strokes. What people need to remember is if they're young, the most likely cause of death of a friend is a car crash or shooting. If they're a parent, the most likely cause of premature death of their child is trauma. Trauma has a much bigger ripple effect on American society than people realize, because so many of the patients who die are young."

According to the National Safety Council's Injury Facts, unintentional trauma causes 95,000 deaths in the United States each year. Of this number, nearly 45 percent are attributed to motor vehicle crashes, while other causes include falls, poisoning, fire, and drownings. Intentional trauma including suicides, homicides, and police shootings accounts for another 55,0000 deaths each year. Therefore, there are 150,000 trauma deaths in the United States each year.

Dr. Feliciano says that most trauma is preventable. Much improvement has resulted from campaigns warning of the dangers of drinking and driving, as well as the lowering of speed limits on highways, and laws requiring drivers and passengers to wear seat belts. Dr. Feliciano notes that deaths related to motor vehicle crashes in the United States, for example, decreased by 23 percent from 1972 to 1996. In 1972, the National Safety Council reported 56,278 deaths involving motor vehicle crashes; in 1996, that number had dropped to 43,300.

"There's a lot more push with prevention these days with attempts to reach school children and high school kids who are starting to drive," Dr. Feliciano said. "Clearly, prevention will have a big impact if everyone focuses on it."

Grady admits as many as 3,800 trauma patients each year, and tallies twice as many admissions than the other three Level I trauma centers in Augusta, Macon, and Savannah. Level I is the designation used by the American College of Surgeons' Committee on Trauma and refers to the availability of physicians in all specialties to care for trauma patients 24 hours a day. "It puts a hospital like Grady on a special plateau. Many hospitals simply cannot produce a specialist in every specialty 24 hours a day," Dr. Feliciano noted.

There are six Emory surgeons who have been trained in both trauma and/or surgical critical care after the completion of their training in general surgery. An attending surgeon is in the hospital, for example, 24 hours a day, every day, throughout the year. The surgeons, all of whom are full-time Emory University School of Medicine faculty, have received extensive training beyond their residency training, and are board-certified by the American Board of Surgery in surgery and in surgical critical care. They are equipped to handle all major traumas, including those involving children, burns, and police. Emory surgeons care for 85 percent of all trauma patient care seen at Grady. The remaining 15 percent receive care from surgeons with Morehouse School of Medicine.

"It's unusual for a group this size in a public hospital to be as well-qualified," Dr. Feliciano said. "It's sheer dedication. You can't run a trauma center with our volume by having the attending physicians at home in bed. It just doesn't work."

In May, researchers from Emory and Morehouse began enrolling patients in the world's first clinical trial of the hormone progesterone as a treatment for moderate to severe traumatic brain injury. The three-year pilot study is called "ProTECT," which stands for Progesterone for Traumatic brain injury, Experimental Clinical Treatment. It has been approved by the U.S. Food and Drug Administration and is funded by the National Institutes of Health (NIH).

As a community, county and statewide resource for trauma care, Emory only receives a modest amount in compensated care from Fulton and DeKalb counties, yet receives no funding from the state of Georgia. In 2001, Emory physicians provided $10.6 million in uncompensated trauma care for which there was no reimbursement.

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