Trauma and Injury Prevention Section Newsletter - February 2007, Vol 11, #1
Letter from the Chair: Trauma Is a Team Sport
Mark Sochor, MD, MS, FACEP
Hope everyone had a great holiday season and is enjoying the new year. It is my hope that 2007 is the year the government reauthorizes the trauma system. As the trauma bill was not funded last year, it was very frustrating to see a number of trauma and injury prevention studies that never got off the ground. It is not due to lack of interest; it is because of a lack of funds. I don't understand why there is no funding; it seems to be a hot and heavy topic in all of the emergency literature and features prominently in the Institute of Medicine's June 2006 report on The Future of Emergency Care. See Fig. 1.
Figure 1: Scope of emergency care research
Please note that the circle that represents Trauma and Injury Control is as big as Emergency Medicine itself and has quite a bit of overlap with emergency medicine. That's when it occurred to me that just as the whole field of emergency medicine is an UNFUNDED mandate, congress must assume that they can get away with not funding trauma research. I mean, why not? If I can get an organization to give free care why not try and apply that to all aspects of the medical field? Emergency Medicine is a victim of its own success. Emergency Medicine always seems to come through when there are too many patients to treat and we accept your tired, your hungry, your poor, your downtrodden, and seem to be able to stay open even though the bill for this care does not get paid. If you are like me, taking care of patients other physicians refuse to see or are unable to accommodate gives a great sense of pride.
Emergency physicians can't ask or care about insurance status (as the government mandates) but when we ask for nickels on the dollar we are turned away. Why not apply the same thinking to trauma research? Just as the uninsured ED patient will be stabilized and treated for any ailment without the government having to pay a dime, the research for trauma and injury prevention will get done without funding as well. Maybe I'm not up to speed on how many trauma studies are funded by Homeland Security but after listening to the Institute of Medicine lecture at ACEP on the state of EMS, I had the impression that the money is going somewhere else. Less than 3% of the billions of dollars spent on Homeland Security is allocated to EMS programs; it was implied that these funds are then chopped up by the states and counties and rarely do they arrive intact to the community/city level where I believe they would do the most good.
As I see it, trauma and injury control makes up at least 50% of the scenarios that are plausible for a natural disaster or terrorist attack. The importance of trauma research is recognized but not funded. I quote from the IOM report "Like emergency medicine research, trauma research is concerned with the care of these patients in the pre-hospital and hospital settings. It reaches further into the inpatient setting, particularly the ICU and surgical departments, and is concerned with critical care and the operative management of traumatic patients. In addition to trauma surgeons, it involves specialists in critical care, anesthesiology, as well as collaborators in organ and disease specialties such as neurology and orthopedics. A significant branch of trauma research focuses on service delivery and the effectiveness of trauma systems. The injury control field can be thought of as a branch of trauma research that has developed a distinct, or rather several distinct, areas of focus. It is concerned principally with the prevention of injury, but also has significant overlap with the acute management of injury, and has an additional focus on long term rehabilitation following traumatic injury".
Trauma and Injury Control is a team sport and that seems to be the problem: no one owns it. It is pervasive in any field of medicine so it's assumed that it will fall into any research project, but not as the primary focus. As injury control advocates, we need to rally and continue to seek funding for our trauma and injury prevention programs and continue to solicit our public leaders for support through legislation and funding. I believe it is a big enough issue that an NIH institute needs to be formed to fund Trauma and Injury Control programs. Currently, the thinking is since trauma and injury control have such an overlap with multiple fields that they do not require their own institute. Having an Injury Control Institute is not an original idea. It was suggested twenty years ago but was not even addressed in the recent reauthorization of NIH. Injury Control deserves a dedicated NIH Institute so these issues will not be secondary or add-ons to other studies. This minimizes the focus of the trauma and injury control research which has led us to the current state of funding. I welcome your comments and suggestions on how our section can improve funding in this area and heighten the awareness of the importance of trauma and injury prevention.
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Meet the TIPS Board Liaison, Dr. Robert Solomon
Robert Solomon, MD, FACEP
Each year there is some shuffling of liaisons from the ACEP Board of Directors to the sections and committees of the College. Thus I have the privilege of succeeding Dr. David Sklar as liaison to your section.
I have spent about half of my career at a Level II trauma center, the other half at hospitals where the general surgeons have about as much interest in trauma care as I have in metallurgy. So I have a fairly broad view of the varying challenges our colleagues face in caring for trauma patients.
Injury prevention is a longstanding interest, especially from the standpoint of advocacy. Although my political philosophy, which leans heavily toward libertarian, enables me to understand the views of the opposition, I have been a staunch and outspoken proponent of primary seat belt enforcement, motorcycle helmet laws, and ATV safety legislation. West Virginia, where I have spent most of my career, has had a helmet law for more than three decades, and its opponents have attempted to repeal it during most sessions of the legislature. This while neighboring states have either never had a helmet law (Ohio) or have suffered a repeal (Pennsylvania), sure to take a tragic toll in death and disability. We have had less success with ATV legislation, and our seat belt law is secondary only, with little enforcement. And enforcement of penalties for drunk driving? Don't ask. I think that's a problem everywhere.
So I am delighted to be your new Board Liaison, and I look forward to learning much from the many experts who serve on the TCIC Committee and in the section leadership.
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The Secrets of the National Violent Death Reporting System
J A Mercy, L Barker and L Frazier
Centers for Disease Control, National Center for Injury Prevention and Control, Atlanta, GA, USA
Dr J A Mercy
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 4770 Buford Highway, NE, Mailstop K-68, Atlanta, GA 30341, USA
Accepted 3 August 2006
How the NVDRS provides a foundation for successful violence prevention
In public health, as in the rest of our lives, the value and importance of the things we do are not always readily apparent. Sometimes the things we do hold secrets that, once fully revealed, expand our appreciation of their relevance to our goals and aspirations. Such is the case with the National Violent Death Reporting System (NVDRS). On the surface, the NVDRS is a data collection system for violent deaths (that is, homicides and suicides) and in that way is similar to many other surveillance systems that we carry out as part of public health practice. But in reality the NVDRS is much more than it might appear.
Secret 1: Thej NVDRS Uses the Power of LInking Data
The NVDRS makes better use of data that are already being collected by health, law enforcement, and social service agencies.1 The NVDRS, in fact, does not require the collection of any new data. Instead it links together information that, when kept in separate compartments, is much less valuable as a tool to characterize and monitor violent deaths. For example, as part of their death investigation, medical examiners and coroners typically gather information on the presence of alcohol and drugs in the blood and tissues of homicide victims. On the other hand, law enforcement agencies, as part of their criminal investigation, gather details of the circumstances under which the homicide occurred, such as whether the homicide was precipitated by an argument or a gang fight or a robbery. By linking these types of information together, we can now determine the circumstances under which homicide victims are most likely to be intoxicated. Combined with information on the location of homicides, this may shed greater light on the relevance of, for example, alcohol serving policies and guidelines at bars where violence may erupt. It might also help us to anticipate patterns of drug use that could signal the emergence of a homicide epidemic, such as the one that occurred between 1985 and 1993 in conjunction with the distribution of crack or that may be occurring currently with the increase in use and distribution of methaamphetamines.2,3 By linking these data, the NVDRS can reveal new insights into the prevention of homicide and suicide and better prepare us for addressing why these violent deaths may be increasing or decreasing.
Secret 2: The NVDRS Is a Tool for Accountability
The NVDRS will enable federal, state, and local governments and communities to be more accountable for the impact of programs and policies intended to address the problems of homicide and suicide. Both the public and private sectors increasingly set and monitor goals for the many programs and policies that are administered across these sectors. We face the same challenge in violence prevention. This emphasis on accountability requires timely, reliable, and useful data be collected systematically and on an ongoing basis. The NVDRS will facilitate our efforts at accountability in two key ways. First, it provides a tool for goal management that is more timely and useful then other available data systems for violent death. NVDRS data can be used to establish and monitor measurable goals for reductions in homicide and suicide (for example, a goal to reduce the homicide rate among adolescents). Second, as the NVDRS is implemented in more and more states (it is currently in 17 states) and data are accumulated over time, it will become increasingly useful for directly evaluating the impact of state and local violence prevention policies and programs. For example, NVDRS data could be used in conjunction with other information to determine if temporal and geographic variations in state policies addressing welfare reform are associated with differences in rates of intimate partner homicide. The NVDRS thus provides information which enables anyone working in the field of violence prevention to be accountable and to hold others accountable for reducing violent death.
Secret 3: The NVDRS Fosters Collaborations for Prevention
The NVDRS fosters cooperation and collaboration among federal, state, and local agencies and organizations that must work together in order to successfully prevent violence. If we are to prevent violence, the cooperation and collaboration of a broad range of agencies and organizations will be required.4 State and local health departments, police departments, the media, social services, and vital statistics agencies are just a few of the entities that need to work together to develop, implement, and broadly disseminate effective prevention strategies. Many of these organizations have not worked together in the past or have worked together on a limited basis. These organizations all play a role in at least one phase of collecting and disseminating data for the NVDRS. For example, state health departments coordinate NVDRS data collection and can use NVDRS data to identify priorities for public health action and to identify appropriate prevention strategies for the communities they serve. Police departments collect data that are essential for characterizing the circumstances under which homicides occur (for example, the percentage of homicides precipitated by drug related crimes). However, police departments also play an important role in enforcing laws that might deter some forms of violence. The media can use NVDRS data as background for news stories about homicide or suicide, but might also disseminate key violence prevention messages. Child protection service agencies provide important information on child abuse related homicides to child death review teams that inform the NVDRS and also provide services to high risk children and their families that may be important in preventing homicide. State vital statistics agencies provide information from death certificates that is essential for the identification of violent deaths for the NVDRS and can also use NVDRS data to detect inconsistencies in their policies for assigning manners of deaths in death certificates.5 In the process of collecting and linking together NVDRS data, relationships and collaborations are established among key organizations as part of that process that can and do carry over into violence prevention activities. The NVDRS serves as a locus around which collaborative relationships that contribute to violence prevention are established.
Secret 4: The NVDRS Empowers People with Information
NVDRS data will facilitate the involvement of the public in violence prevention programs and activities because everyone will eventually have access to and be able to use its data. As a result, the public will gain better insight into the circumstances surrounding violent deaths and this knowledge will help them more clearly understand roles that they can play in prevention. NVDRS data are currently only available to Centers for Disease Control and Prevention and state public health researchers. Plans are underway to produce a public use data set, with some restrictions to protect confidentiality and privacy. In addition, the first steps are being taken to make the NVDRS even more accessible through a web-based system that allows anyone with access to the internet to ask basic questions of the data and get answers almost instantaneously. This system will be modeled on the Web-based Injury Statistics Query and Reporting System (WISQARS), a system currently in place that allows one to get basic data on injury related deaths.6 So, for example, in the not too distant future, if a citizen of Wisconsin wants to know how many suicides occurred in their state in 2004 among high school aged youth by means of drug overdose and how this number has changed in recent years, he or she will be able get that information in a matter of minutes. This kind of access to NVDRS data will empower people with facts they can use to become more informed about violent death and more directly involved in efforts to prevent it.
These are the secrets of the NVDRS. The NVDRS, however, will continue to reveal secrets about the nature and prevention of violent deaths as the system spreads to all states and data are accumulated. But as you can see the NVDRS is much more then just another data collection system. It provides a foundation upon which many activities and processes necessary for successful violence prevention can be built. Clearly if we are ultimately going to be successful in preventing the various forms of violence that contribute to homicide and suicide we will need much more than the NVDRS but, just as clearly, the NVDRS is a very critical piece of the puzzle. Let's not keep the NVDRS a secret any longer.
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
- Azrael D, Barber C, Mercy J. Linking data to save lives: recent progress in establishing a National Death Reporting System. Harvard Health Policy Review 2001;2:38-42.
- Blumstein A. Youth violence, guns and the illicit-drug industry. J Crim Law Criminol 1995;86:10-36.[CrossRef]
- Johnson B, Golub A, Dunlap E. The rise and decline of hard drugs, drug markets, and violence in inner-city New York. In: Blumstein A, Wall-man J (eds). The crime drop in America. New York: Cambridge University Press, 2000:164-206.
- Mercy JA, Rosenberg ML, Powell KE, et al. Public health policy for preventing violence. Health Aff 1993;12:7-29.[Abstract]
- Breiding MA, Wiersema B. Variability of undetermined manner of death classification in the US. Inj Prev 2006;12 (Suppl II) :ii49-ii54.[Abstract/Free Full Text]
- Centers for Disease Control and Prevention. WISQARS Injury Mortality Reports, 1981-2003. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2006, Available at http://www.cdc.gov/ncipc/wisqars (accessed September 2006).
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Falls Among Older Adults
Among adults 65 years and older, falls are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for trauma. Over the past decade, injury and death rates from falls have increased significantly. Given the nation's aging populations, this trend can be expected to continue unless steps are taken to prevent falls among older adults.
New Tools for Fall Prevention
CDC's Injury Center offers new tools for helping older adults-and those who care for them-prevent falls. Two popular CDC brochures have been redesigned in partnership with the CDC Foundation and the MetLife Foundation and four new posters have been created to help educate older adults about fall prevention.
Colorful and easy-to-read, the brochures and posters outline key strategies for reducing older adults' risk of falls and related injuries. The strategies include:
- Exercising regularly. Exercise programs like Tai Chi that increase strength and improve balance are especially good.
- Asking their doctor or pharmacist to review their medicines-both prescription and over-the-counter-to reduce side effects and interactions.
- Having their eyes checked by an eye doctor at least once a year.
- Making their homes safer by eliminating fall hazards and improving lighting.
The brochures and posters are available in English, Spanish, and Chinese. Download or order free copies at www.cdc.gov/ncipc/duip/fallsmaterial.htm. These materials are important resources to protect the health and independence of older adults.
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Acceptation, Evaluation and Risk Acuity Classification based on Andorra and Canadian models: Pilot Project in a Private Tertiary Hospital in Rio de Janeiro, Brazil
Neto, P.; Cavalcanti, L.; Gutierrez F.; Gavina, R.; Ferrari C.
The objective of this study was to evaluate the impact of a triage scale design based on the Andorran Model of Triage Scale Design and the Canadian Risk Acuity System. It was designed to estimate the immediate risk, to reduce waiting time to see a doctor, to avoid patients leaving without being seen by a doctor, and to encourage patients to return for future care.
This study was an observational study and was carried out in Hospital Quinta D´Or Emergency Department (ED), Rio de Janeiro, Brazil, where we have 4000 patients evaluated per month and 60-90`minute waiting times to see a doctor.
Patients were evaluated from 11th to 26th of October 2006 by the Triage Team which consisted of a social assistant, seven doctors and nurses, seven emergency technicians, and one triage-educated doctor. The Triage Team used an instrument based on the National Triage Scale. Overall 996 patients were evaluated and distributed in a 5 level triage assessment: one patient (0.1%) Level 5 (Emergency); 50.2 patients (5.5 %) Level 4 (Less Emergency); 59 patients (5.9%) Level 3 (Urgent); 281 patients (28.2%) Level 2 (Less Urgent); and 590 patients (59.2%) Level 1(Not Urgent). The medium triage period of time was 5.02 (st.3-5`).
This study confirmed the predictive validity of the scale used in the Andorran model for judgment of the urgency of patient's condition.
Submitted by: Patricia Neto, EM Doctor, Quinta D´OR Hospital, Rio de Janeiro
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QuickStats: Age-Adjusted Death Rates* for Leading Causes of Injury Death,† by Year - United States, 1979-2004
* Per 100,000 population.
† Coded according to the International Classification of Diseases, Ninth Revision, during 1979--1998 and according to the Tenth Revision during 1999--2004. Additional information regarding classification of deaths according to intent and mechanism is available at http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_10.pdf.
During 1979--2004, the three leading causes of injury death in the United States were motor-vehicle traffic, firearm, and poisoning (including drug overdose). In 2004, for the first time since 1968, when such data first became available, the number of reported poisoning deaths (30,308) and the age-adjusted poisoning death rate (10.3 per 1000,000 population) exceeded the number of firearm deaths (29,569) and the firearm death rate (10.0), respectively. During 1999--2004, the poisoning death rate increased 45%, whereas the firearm death rate declined 3%; during the same period, no change occurred in the rate (14.7) for motor-vehicle traffic deaths.
SOURCE: Mortality data from the National Vital Statistics Systems. Available at http://www.cdc.gov/nchs/deaths.htm.
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The Violence Prevention Institute
By Sampson Davis, MD, FACEP
In October of 2004, The Violence Prevention Institute (VPI), was founded by four board certified emergency medicine physicians from New Jersey: Duane J. Dyson, MD, FAAEM, Chairman & CEO; Joseph J. Calabro, DO, FACOEP,FACEP, Secretary/Treasurer; Dane E. Clarke, MD, FACEP, Vice-Chairman and Sampson Davis, MD, FACEP. The mission of this East Orange-based organization is to reduce the incidence of youth violence through education and behavior modification. VPI provides Education, Research, Prevention and Intervention programs designed to address the increasing incidence of violent youth behavior. The Institute uses evidence-based research models to assist states, cities, law enforcement, and school boards in designing strategies to address increasing societal problems associated with violent behavior in youth and young adults. Some programs offered are Gang recognition education for teachers, parents, medical personnel and the community; Training on the medical consequences of violence for law enforcement agents; Intensive violence intervention program for at risk youth; Research and assessment of violence prevention and intervention strategies; and Workshops on teenage health issues.
At risk youth are taught corrective skills to change attitudes about gun violence, gang activities and other negative social behaviors, in order to improve school performance, family relationships, reduce criminal activities, and acquire skills that maximize their ability to effectively negotiate peer relationships and other social interactions. Doctors presenting the VPI programs show students slides of real victims and their injuries, leaving nothing to the imagination. In detail, physicians explain the procedures used in treating these injuries and demonstrate how surgical instruments (rib spreaders, scalpel, thoracostomy tubes) are used in an emergency department. The doctors also explain that criminals committing crimes are often injured just as badly as the victims, frequently as a result of trying to escape from the police. A police officer is present during the presentation to address the legal ramification of poor decision making.
In order to evaluate the effectiveness of the programs, ongoing research is performed. A needs assessment survey is administered to the participants as a means of assessing the factors that place adolescents at risk for engaging in violent behaviors and gang involvement. Data generated from VPI's research and evaluation activities provide a thorough examination of the social support networks (e.g., family, friends and teachers) that protect youth from the consequences of risk-taking behavior. This information is then utilized by VPI to guide and strengthen their prevention and intervention efforts.
To date, VPI has several research studies actively ongoing conducted by Dr. Robert Reid and Dr. Pauline Garcia-Reid of Montclair State University, Department of Family and Child Studies.
For more information on VPI go to www.violencepreventioninstitute.org
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TIPS Members in the News
TIPS Chair Appointed New ACEP Liaison to the American Trauma Society
Mark D. Sochor, MD, MS, FACEP assistant professor of emergency medicine at the University of Michigan Department of Emergency Medicine and Chair of TIP Section has been appointed by ACEP President Brian F. Keaton, MD, FACEP to succeed John Sacra, MD, FACEP who has served as liaison to ATS since 1985. Dr. Sochor is currently completing a NHTSA medical fellowship, has extensive research experience in unintentional trauma through the NHTSA Crash Injury Research and Engineering Network (CIREN) program, and is working as a research scientist on a cooperative agreement with NHTSA. Additionally, he is an active member of the Society for Academic Emergency Medicine (SAEM), the Association for the Advancement of Automotive Medicine, the American Medical Association, and the University of Michigan Injury Research Center.
Long-time ACEP Trauma Leader Receives EMS Award at Scientific Assembly 2006
John C. Sacra, MD, FACEP has been a passionate supporter of trauma system development. and the integration of emergency physicians as crucial members of trauma systems. He twice chaired ACEP's Trauma Committee and has held numerous offices in ACEP. Dr. Sacra has served as the College's liaison to the American Trauma Society (ATS) for over 20 years and was the first emergency physician to be president of ATS. Dr. Sacra serves as medical director for the Medical Control Board that provides oversight for the pre-hospital care system for 1.2 million residents in and around Tulsa and Oklahoma City and he is interim chairman of the department of emergency medicine at the University of Oklahoma College of Medicine in Tulsa, where he recently secured state funding for a new emergency medicine residency program that will provide significant training on disaster response.
New NHTSA Fellow
William G. Fernandez, MD, MPH, Assistant Professor of Emergency Medicine and Social & Behavioral Sciences at Boston University has recently been selected for a National Highway Traffic Safety Administration (NHTSA) Medical Fellowship. During the fellowship, he will collaborate on motor vehicle safety research projects, provide medical testimony on crash-related injuries, and help support efforts to advance the national traffic safety agenda.
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Director Federal Affairs
Medicare Physician Pay Cut Averted
Congress passed P.L. 109-432 which contains a provision that rescinds the -5% physician pay cut due to take effect on January 1, 2007, replacing it with a freeze, or 0% update. Combined with ACEP's earlier success last year during the RUC's five-year payment review process of physician work, your Medicare payments are projected to increase by 7% on average in 2007. The bill also extends by 1 year (to 12/07) a floor of 1 in the geographic adjustment or GPCI index. This means that physicians whose payment would be adjusted downward by virtue of their location in a rural area (e.g .89) would see the average payment increase this year. While the bill maintains the current 2006 payment rate through 2007, the cost of a fix to the entire Medicare physician payment system just keeps getting more expensive, and is now estimated at over $200 b, which is why Congress keeps applying the funding "band-aids" each year instead.
In addition to the payment freeze, the legislation also provided for the establishment of a quality reporting system based on the current Physician Voluntary Reporting Program. Physicians who submit quality data from July 1, 2007 through December 31, 2007 would be eligible for an additional payment of 1.5%, which would be paid out in 2008.
New Bioterrorism Law Passes
In the final hours of the 109th, Congress also approved S. 3678, the "Pandemic and All-Hazards Preparedness Act" which will improve emergency preparedness, renew a bioterrorism law enacted after the September 11 terrorist attacks, and create the Biomedical Advanced Research and Development Authority (BARDA) to coordinate the research and development of new vaccines. ACEP worked closely with the bill's sponsor, Senator Richard Burr (R-NC), to develop provisions that will strengthen our nation's public health emergency preparedness during times of natural or man-made disaster.
ACEP will work closely with ACS and other specialty groups to support reintroduction of legislation to reauthorize and fund the trauma system again.
New TIP members for 2006
Bayan Al-Abdulbaqi, MD
Dorcas J. Atkinson, MD
Vincent L. Ball, MD
Paul Calmer, Jr.
Lara De Nonno, MD
Kathleen Houlihan, MD
Meghan B. Kelly
Marierose Mendoza, MD
Stuart L. Resch, MD
Joong Eui Rhee, MD
Carolyn Snider, MD
Kimberly P. Stone, MD
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September 2005 - October 2006
Officers for 2005-2006:
Chair: Mark R. Sochor, MD
Chair-elect: Ernie E. Sullivent, III, MD
Immediate Past Chair: Mary P. McKay, MD, MPH, FACEP
Newsletter Editor: Michelle McMahon-Downer, MD
Councilor: Peggy E. Goodman, MD, FACEP
Alternate Councillor: Fred Vaca, MD, MPH, FACEP
Board Liaison: David P. Sklar, MD, FACEP
Staff Liaison: Barbara Marone
Dr. Sochor, TIP Section Chair, welcomed the attendees to the October 17, 2006 annual meeting in New Orleans and noted that Section membership currently stands at 146.
Dr. Sklar, TIPS Board Liaison, introduced himself to the group and described his own interest regarding injury prevention and research he's conducted in pedestrian and domestic violence injuries.
Dr. Peggy Goodman, Section Councilor, gave the report from the Council meeting. Two resolutions of particular interest included: 1) supporting the development of community protocols for selective referral to centers with SANE/SART programs for victims of sexual abuse after a medical screening exam is performed, and 2) adopt strict and explicit standards regarding availability of alternative care settings when it is determined that a patient in the ED doesn't have an emergent condition.
2005-2006 Activities as Related to Section Objectives:
- Section members participated jointly with the TCIC Committee to refine approaches to injury priorities identified by both groups in past year. Completed. See below.
- Two Section newsletters were produced last year and a new co-editor, Dr. Marie-Carmelle Elie, volunteered to be co-editor with Dr. McMahon-Downer for 2006-2007.
1) In conjunction with the Trauma Care and Injury Control Committee, identified the top five priority areas in injury control for ACEP. These issues include: increased funding for research, increased funding/payment for ED-based interventions, violence and suicide prevention, improved traffic safety advocacy, and maintenance of specialty coverage in the ED. (It was determined at the TCIC meeting that the College has several ongoing efforts to address the on-call specialty crisis, so TCIC and TIPS members can be called on an as-need basis to assist with these initiatives). The attached list describes strategies for the first four priorities during 2006-2007. More TIPS members are needed to work with current TCIC volunteers.
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This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.