Janet M. Williams

Health promotion practices of emergency physicians

In this article we describe health promotion practices of emergency physicians (EPs). A survey was mailed to members of the West Virginia American College of Emergency Physicians. Main outcomes included the EPs beliefs regarding health promotion, perceived roles in health promotion, and perceived effectiveness in modifying the behavior of patients. Over 90% of respondents routinely asked about cigarette smoking and half about alcohol use. A minority routinely asked about illicit drug use, diet, exercise, domestic violence, or stress. The majority stated they were the main person responsible for patient health education in their emergency department (ED). Most felt prepared to counsel patients about smoking (68%) and alcohol (59%), although very few described themselves as successful in helping patients change their behavior. Although EPs feel responsible for promoting the health of their patients, only a minority reported routinely screening and counseling patients about prevention and most were not confident in their ability to help patients change their health-related behaviors.

Snakebite injuries: contributing factors and intentionality of exposure.

The objective was to study the intent of exposure to snakes and other factors contributing to snakebite injuries in order to develop prevention strategies. We used a retrospective chart review and a follow-up telephone interview of snakebite victims who were admitted to a tertiary care center between 1985 and 1994. The data collected included demographics, intent of exposure and host and environmental factors. I performed descriptive analysis. Twenty-four males and six females ranging in age from 2 to 93 years sustained bites from a variety of snakes including rattlesnakes, copperheads, and Egyptian cobra, and others. Sixty-seven percent (20/30) of all bites resulted from intentional exposures to snakes: professional snake handlers (7), snake hunts (8), and playing with (aggravating) snakes in the wild (5). Sixty-five percent (13/20) of intentional exposures involved novices in a recreational/home setting, and 35% (7/20) occurred in an occupational setting. Unintentional exposures occurred while victims were walking in wooded areas, fishing by streams, gardening, and washing dishes indoors. Forty percent (12/30) of all victims had consumed alcohol before the snakebite, 92% (11/12) of whom were nonprofessionals with intentional exposures. Only eight victims (seven of whom were professional handlers) were using protective equipment. I concluded that the majority of snakebite injuries resulted from intentional exposures to snakes in which a variety of factors such as the use of alcohol and lack of protective equipment likely played a role.

Boxer's fracture: An indicator of intentional and recurrent injury

The objective was to describe the population of patients presenting with a boxers fracture (BF), to determine how often BF is an intentional injury, to determine if it is a predictor of recurrent injury, and to compare the rates of intentional injury and injury recidivism between patients with BF and those with other injuries. An emergency department (ED)-based injury surveillance system (EDBISS) in a university-affiliated ED (census of 35,000) provided data on injured patients presenting between January 1, 1995 and December 31, 1996. Chart review was performed. Descriptive analyses were performed. The results showed 22,728 of 69,438 (33%) ED visits during a 2-year period were attributable to injuries. Sixty-two patients presented with BF. Mean age of BF patients was 22.1 versus 28.6 for all injured (P < .005). Ninety-two percent (57/62) of BF patients were men compared with 58% of all injured (P < .0001). Thirty-eight of 62 (61%) BF injuries were sustained after intentional punches of an object/person. Seventeen of 62 (27%) BF patients were injury recidivists. Previous studies in this same ED population showed that 6% had intentional injuries and 12% were injury recidivists. BF is usually an intentional injury and these patients are at increased risk for recurrent injury. Clinicians should focus prevention efforts on this high-risk population.

Extracorporeal circulation in the management of severe tricyclic antidepressant overdose

Extracorporeal circulation is a technique that provides precise control of circulation, oxygenation, temperature, and blood composition in patients suffering from cardiopulmonary failure. The investigators present the case of a near fatal tricyclic antidepressant overdose that failed to respond to standard therapy but was resuscitated using extracorporeal circulation.

Matched analysis of parent's and children's attitudes and practices towards motor vehicle and bicycle safety: an important information gap

The purpose of this study was to compare parents’ and children’s attitudes and habits towards use of bicycle helmets and car seat belts. We hypothesized that parental perception of their children’s safety practices did not reflect actual behavior and further, that parental practices, rather than their beliefs about a particular safety practice, have a greater affect on their child’s risk-taking behavior. The study population consisted of children in grades four and five and their parents/guardians. Participation in the cross-sectional study was voluntary and confidential anonymous questionnaires were used. In separate and independent surveys, children and parents were questioned in parallel about their knowledge, habits and attitudes toward bicycle helmet use and car safety practices. In the study, 731 students participated with 329 matched child-parent pairs. Ninety-five percent of the children own bicycles and 88% have helmets. Seventy percent of parents report their child always wears a helmet, while only 51% of children report always wearing one (p < 0.05). One-fifth of the children never wear a helmet, whereas parents think only 4% of their children never use one (p < 0.05). Parents report their children wear seat belts 92% of the time while 30% of children report not wearing one. Thirty-eight percent of children ride bicycles with their parents and wear their helmets more often than those who do not ride with their parents (p < 0.05). Parents who always wear a seat belt are more likely to have children who sit in the back seat and wear a seat belt (p < 0.05). Parents’ perceptions of their children’s safety practices may not be accurate and their actions do affect their children’s. Injury prevention programs that target both parents and children may have a greater impact on reducing risk-taking behaviors than working with each group in isolation.

Tree-stand-related Injuries: a. wIlderness emergency

Objective To determine the mechanisms and patterns of injury due to falls from tree stands associated with hunting, identify risk factors, and suggest injury prevention and control measures. Design Retrospective medical chart reviews were performed. Telephone interviews were also conducted to obtain additional information. Patients: All patients who presented to two emergency departments during a 5-year period after sustaining injury while using tree stands. Results Twenty-four male deer hunters comprised the study group. These 24 patients sustained a variety of injuries, including 7 with vertebral fractures, 6 with extremity fractures, 4 with multiple rib fractures, 3 with pelvic fractures, and 3 with head injuries. These injuries resulted in hospitalization of 16 (66.7%) of the 24 patients and prolonged disability (> 1 month) in 5 patients (20.8%). Average height of fall was 21.1 ft. In 7 (35%) of 20 cases, the fall resulted from mechanical failure of the tree stand or harness. The remaining majority of falls (13/20 or 65%) could be traced to judgment error or careless behavior on behalf of the hunter, usually during ascent or descent of the tree and in the absence of a safety belt. Conclusions A significant number of patients presented with a variety of injuries after falls from tree stands. The majority of these injured patients required hospitalization, and a significant percent had prolonged disability. Risk factors associated with these falls were identified.

Poster 019. Work-Related Injuries Among Rural West Virginia Emergency Medical Services Providers

Purpose: To examine hospital hazardous-materials preparedness. Methods: The safety officers of all acute-care hospitals in the five-county Philadelphia metropolitan region received surveys. Questions addressed the ability of EDs to safely decontaminate and treat chemically contaminated patients. Results: Thirty-six of 58 hospitals (62.1%) returned usable surveys. Of these, 25 (69.4%) have a written ED hazmat plan, and 11 (30.6%) conducted a drill of the plan in 1994. Nineteen (52.8%) EDs have a specific treatment area for chemically contaminated patients. A stock of supplies for protecting the ED from secondary contamination is maintained by 16 (44.4%). While 23 (63.9%) EDs store personal protective equipment, most of these involve only gowns, gloves, and surgical masks; only 12 provide any type of respiratory protection. Seven respondents were certain that patients brought in by local EMS would have been decontaminated adequately in the field, eight stated that they believed or felt decontamination would be adequate, and 12 were concerned that field decontamination might not be adequate. Seventeen hospitals (47.2%) reported treating one or more (mean = 2.4) chemically contaminated patients in 1994. We believe the return rate reflects reluctance to commit hospital policies to paper. This was confirmed during telephone follow-up of nonrespondents; for example, one safety officer discussed hazmat principles for 40 minutes, but refused to complete the survey.