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Trauma and Injury Prevention Section Newsletter - Autumn 2016

Transcending Political Partisanship by Focusing on Patients and Health Outcomes

Chair-Elect's Welcome

Christopher BarsottiDear TIPS members, 

I am delighted for the opportunity to serve you and the section. As a community practice physician of 14 years and former health IT administrator, I look forward to investigating further opportunities to advance trauma and injury prevention strategies within community and academic clinical practices.

Firearm-related trauma and injury prevention have been recurrent topics within TIPS over the years, which speaks to an unmet need within our specialty to understand emergency physicians’ roles in reducing the incidence and health consequences of firearm-related violence. Conversations about firearm injury prevention have a tendency to digress into sociopolitical discussions about “gun control”, which distract us from more productive conversations about the objective issues relevant to our patients and our practices. This is not surprising: sociopolitical distractions were common to many, analogously complex, biosocial health concerns before being successfully addressed by our profession, from pediatric maltreatment in the 1960s and 1970s, to HIV in the 1980s, to opioids now. However, by maintaining our focus on the relevant medical issues, we will eventually succeed in developing comprehensive strategies to improve firearm-related health outcomes as well.

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Firearms and Suicide

September is National Suicide Prevention Awareness month, a much-needed opportunity to shed light on and reduce stigma about a leading cause of death. While violent death rates have declined overall since the 1990s, suicide rates appear to be rising, and suicide is now the 10th leading cause of death in the United States.1 Suicide prevention requires a comprehensive strategy incorporating identification and intervention across the life span, and emergency physicians know just how difficult it can be to determine an individual patient’s risk for imminent self-harm.

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ACEP SECTION GRANT AWARD – Fall Prevention for Older Adults

Shan LiuFalls among older adults are frequent;1 older adults make more than 2 million visits to the emergency department (ED) for injurious falls each year,2 and fall-related emergencies are likely to rise as the population ages. The ED is an ideal location at which to intervene as it optimizes a teachable moment.3 Implementing tactics to reduce falls in the older patient could impact care and patient injuries downstream and prevent future ED visits. We recently were awarded an ACEP Section Grant to create a brief, professionally produced video aimed at increasing awareness among older adults and their families about the risk of falls and actions they can take to reduce their fall risk.

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Imaging Patients with Chest Trauma – Using Injury Prevalence to Guide Shared Decision Making

AliRajaPatients with trauma often require imaging and for some – especially those who sustain significant trauma and obvious injuries – this decision is a simple one. However, for those patients with less significant trauma and potentially occult injuries, the decision of whether or not to image is much more complex. A number of decision instruments (DIs) regarding the use of imaging in these patients exist, with the latest focusing on chest imaging (1). The NEXUS Chest DI is a simple rule – if patients have none of its seven criteria, they do not need to be imaged. However, like many other DIs, physicians and their patients are left with the question of whether the converse is true: do patients who have one or more criteria truly need imaging?

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EP Burnout and Other Effects of Exposure to Trauma- Shameless Plug

Johnson2015There is no question that mass shootings have increased over the past few years. From the Orlando shooting of a night club to the Paris shooting of a concert hall, the effects of these horrific events are felt through local communities and globally. The effects are not only felt by those directly harmed, but by family members, friends, and various other community members. The wounds are not only physical, but also mental and emotional. 

For those who take care of these patients, the effects are also felt. It is well known that emergency physicians and nurses have higher rates of burnout than other specialties. In 2014, the burnout rates for emergency physicians (EPs) was over 70% which was higher than any other specialty measured. The burnout rate for all physicians was only 45%2. A disparity in work-life balance, as well as the level of stress while at work is largely thought to cause this burnout.

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Coming Soon: California’s Firearm Violence Research Center

Garen WintemuteIn June, California’s legislature and governor authorized and funded what will be the nation’s first publicly-chartered firearm violence research center. CalACEP, the California chapter of the American College of Emergency Physicians, played a crucial role as an initial sponsor of the authorizing legislation, along with the state’s chapter of the American Academy of Pediatrics. The center’s mission, as described in the authorizing legislation (SB 830), is “to provide the scientific evidence on which sound firearm violence prevention policies and programs can be based.”

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Yes, You Can: Physicians, Patients, and Firearms

Physicians have unique opportunities to help prevent firearm violence. Concern has developed that federal and state laws or regulations prohibit physicians from asking or counseling patients about firearms and disclosing patient information about firearms to others, even when threats to health and safety may be involved. This is not the case. In this article, the authors explain the statutes in question, emphasizing that physicians may ask about firearms (with rare exceptions), may counsel about firearms as they do about other health matters, and may disclose information to third parties when necessary. The authors then review circumstances under which questions about firearms might be most appropriate if they are not asked routinely. Such circumstances include instances when the patient provides information or exhibits behavior suggesting an acutely increased risk for violence, whether to himself or others, or when the patient possesses other individual-level risk factors for violence, such as alcohol abuse.

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