Lenora Olson

Safe at Home? Domestic Violence and Other Homicides Among Women in New Mexico

STUDY OBJECTIVE To define the contribution of domestic violence (DV) to homicides in women in New Mexico and to examine differences in ethnicity, mechanism, previous documented injuries, incidence of sexual assault, and use of alcohol or illicit drugs between DV- and non-DV-related homicides. METHODS We carried out a retrospective analysis of reports of the state office of the medical investigator (OMI) reports from all female homicides from 1990 to 1993 in New Mexico. A homicide was defined as being related to DV if the perpetrator was a current or former male intimate partner. The chi-squared and Mann-Whitney tests were used to analyze data. RESULTS The OMI investigated 134 homicides in women for an overall fatality rate of 4.3 per 100,000. A male intimate partner was the perpetrator in 62 cases (46%). The rate of DV homicide among American Indians (4.9 per 100,000) was significantly higher than that among Hispanics (1.7) and non-Hispanic whites (1.8)(RR=2.8; 95% confidence interval (CI), 1.5 to 5.1). Firearms were almost two times as likely to be used in DV homicides as in non-DV homicides (RR=1.8; 95% CI, 1.2 to 2.6). Evidence of old injuries was found more often in DV homicide cases (35.5%) than in non-DV cases (83%) (RR=4.3; 95% CI, 1.8 to 9.8). The presence of alcohol or other drugs was higher among non-DV homicide victims (69%) than DV homicide victims (54.3%) (P=.03). CONCLUSION American Indian women are at particularly high risk of homicide, including DV homicide. Firearms were overrepresented in DV homicides, suggesting that removing firearms from the homes of previous DV perpetrators would be a useful public health strategy. Alcohol or illicit drugs were found in approximately two thirds of New Mexico women who were victims of homicide. The high prevalence of history of previous injuries among DV homicide victims indicates that early identification of DV victims in the emergency department and other health care settings is an important point of intervention.

Repeated ambulance use by patients with acute alcohol intoxication, seizure disorder, and respiratory illness☆

Three chronic conditions were examined--acute alcohol intoxication, seizure disorder, and respiratory illness--to quantify the extent of repetitive emergency medical services (EMS) use in a defined population. Urban EMS system ambulance data from 1992 to 1994 were analyzed for the three designated conditions with respect to transports by condition and individual patient. Analysis by chi2 was used for comparing proportions. Analysis of variance after square root transformation was used to evaluate differences among means. The total number of transports analyzed was 15,541: 7,488 for acute alcohol intoxication, 4,670 for respiratory illness, and 3,383 for seizure disorder. These transports involved 8,692 patients who were transported at least once for one of the three designated conditions. The mean number of transports for alcohol was 1.96 (95% confidence intervals [CI]: 1.92, 2.01), seizure 1.32 (95% CI: 1.27, 1.36), and respiratory 1.18 (95% CI: 1.15, 1.21). Of 369 patients transported five or more times during the study period, 260 (70.5%) were for alcohol, 56 (15.2%) for seizure, and 53 (14.4%) for respiratory complaints. This group comprised only 4.3% of patients, but 28.4% of all transports. Acute alcohol intoxication resulted in more repetitive ambulance transports than either seizure disorder or respiratory illness. A small number of patients were responsible for a large number of transports. Focused intervention for patients with high ambulance transport deserves further study.

Farm-related injury mortality in New Mexico, 1980-91

To compare the epidemiology of farm with non-farm occupational injury deaths, we reviewed state medical examiner data for all occupational injury deaths in New Mexico from 1980 to 1991. We identified 53 farm-related injury deaths for a rate of 21.3 per 100,000 worker-years. Farm workers were four times more likely than non-farm workers to die from occupational injury. American Indians had the highest farm injury death rate. Farm decedents were older than non-farm decedents (t498 = 6.29, p < 0.0001). Half of the farm decedents were 50 years of age or older; one-third were 60 years of age or older. Crush injuries accounted for half of all farm injury deaths including 18 of 23 motor vehicle deaths, half of these involving a tractor rollover. One in six farm injury deaths were from electrocution: one in five involved alcohol. Our study indicates that New Mexico has high farm-related injury mortality related to tractor use, alcohol intoxication, farm animals, and exposure to electricity. American Indians and older males are especially susceptible to these factors.

Injury mortality in American Indian, Hispanic, and non-Hispanic white children in new Mexico, 1958-1982

Childhood fatalities from injuries are a serious public health problem in New Mexico, a state which ranks second in the nation in injury-related mortality rates. To determine the extent of injury mortality in children in this state, and to examine time trends and differences in mortality rates in New Mexicos American Indian, Hispanic, and non-Hispanic white children aged 0-14 years, we analyzed vital records collected from 1958 to 1982. American Indian children experienced the highest mortality rates from all external causes combined. Among all three major ethnic groups, children aged 0-4 years were at the highest risk for injury fatalities. Unintentional injuries accounted for 85% of all injury-related deaths. Motor vehicle crashes and drowning were the first and second leading causes of death in all three groups, while other important causes of death included fire, choking on food or other objects, poisoning, and homicide. Although the fatality rates on most types of injuries decreased over the 25-year period, childhood fatality rates for motor vehicle crashes and homicide increased in each ethnic group. Despite the overall decrease in injury mortality rates in New Mexican children, the rates are excessively high compared to other states, especially in American Indian children.

Analysis of childhood pedestrian deaths in New Mexico, 1986-1990

STUDY OBJECTIVE To determine if the mechanism of fatal childhood pedestrian injuries correlated with location, injury pattern, and age of the pedestrian and to determine ethnic differences in fatality rates. DESIGN Retrospective review of state medical investigator reports and autopsies from 1986 to 1990. Logistic regression and chi 2 were used to test for statistically significant differences between the groups in our data set. TYPE OF PARTICIPANTS New Mexican children, 0 to 14 years old fatally injured by moving vehicles. RESULTS Sixty-four children died for an overall fatality rate of 3.8 (per 100,000). Native American children and children younger than 5 years experienced the highest fatality rates. Children younger than 5 years were more likely to be crushed under the wheels of a slow-moving vehicle in both a nontraffic and a traffic location, whereas older children were found more often to have died from injuries from a high-speed impact event in a traffic location (P < .001). Leg fractures (P = .001) and spinal fractures (P = .02) occurred more frequently in impact than crush injuries. CONCLUSION Young children are at risk for a crush injury in both the traffic and nontraffic environment.

Injury prevention and emergency medical services for children in a managed care environment

Each year, 1 in 5 US children receives medical care as a result of injury. Injuries are the leading cause of medical spending for children ages 5 to 21 years, accounting for more than 20% of hospital admissions and days spent in the hospital. Pediatric injuries become an important issue for managed care organizations because of concern for member safety and increasing medical costs related to treatment. Because effective prevention decreases health care consumption, injury prevention often costs less than treating injuries. Simple devices, such as bicycle helmets, smoke detectors, and child safety seats, help keep children safe and save money. Appropriate emergency care at the scene of an injury, poison control centers that dispense expert advice over the telephone, and triaged regional trauma systems improve the outcome and save money at the same time. This article continues the white paper series by the Emergency Medical Services for Children Managed Care Task Force.

Adequacy of EMS data collection during pediatric cardiac arrest: are EMTs getting the whole story?

OBJECTIVE To compare the initial emergency medical services (EMS) prehospital assessment of medical and traumatic cardiopulmonary arrest in the pediatric patient with that of the Office of the Medical Investigator (OMI) and assess differences and implications for EMS training and prevention. DESIGN Retrospective review of ambulance run forms with the OMI autopsy confirmations. SETTING An urban EMS system and the state Office of the Medical Investigator. PARTICIPANTS Patients 15 years of age or less who were treated by prehospital personnel from November 1, 1990, to October 31, 1991, for a medical or traumatic arrest. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Ambulance runs were reported for 2,586 pediatric patients. Of these, 42 (1.6%) had suffered arrests, with 32 (76%) medical arrests and ten (24%) traumatic arrests. Children 1 year of age or less accounted for 75% of the medical arrests, while children more than 1 year of age accounted for 80% of the traumatic arrests (p = 0.003). Overall mortality was 81%. When EMS prehospital assessments of medical and traumatic arrests were compared with autopsy reports, there was good agreement for sudden infant death syndrome (SIDS) (kappa = 0.70), but poor agreement for child abuse (kappa = 0.37). CONCLUSION The authors found good agreement between EMS prehospital assessments and autopsy diagnoses for identifying pediatric SIDS, but child abuse was not well identified prior to autopsy.

Knowledge and attitude assessment and education of prehospital personnel in child abuse and neglect: Report of a national blue ribbon panel*☆☆☆★★★

child maltreatment, is a public health concern that has reached epidemic proportions. Prehospital providers, who often witness scenes of child abuse and neglect, can fill an essential role in identifying neglect and abuse in the home, at school, and in other locations. In October 2001, a blue ribbon panel of national experts in emergency medical services (EMS), emergency medical services for children (EMSC), and child protection services (CPS) convened to discuss the prehospital provider’s role in identifying and reporting suspected child abuse and neglect. Significantly, this marked the first time national experts from the worlds of child protection and EMSC met face-to-face to address this issue. With expertise in EMS education, pediatric emergency medicine, pediatric surgery, psychiatry and psychology, social work, legal practice, law enforcement, and fire and rescue services, the participants represented the entire continuum of care for at-risk children. When all available services are used and integrated, children are kept from falling through the cracks, and the highest quality of care possible is provided for them. Guided by research findings from a national survey conducted by the Center for Pediatric Emergency Medicine (CPEM), the panel’s goals were to:

05. EMS and the Pediatric Arrest: Are EMTs Getting the Whole Story?

Purpose : Among pediatric patients, cardiopulmonary arrests account for a small, but important, percentage of responses by emergency medical services (EMS). EMS prehospital assessment of medical and traumatic arrests in the pediatric patient were compared with that of the Office of Medical Investigator (OMI) autopsy reports to assess differences and implications for EMS training and prevention in pediatric arrests. Methods : Retrospective review of ambulance run forms from an urban EMS system with OMI autopsy correlation. Patients less than fifteen years of age and younger who were treated by prehospital personnel from November 1, 1990, to October 31, 1991, for a medical or traumatic arrest. Proportions were analyzed using chi-square analysis or Fishers exact test and agreement was assessed using the Kappa statistic. Results : Ambulance runs were reported for 2,586 pediatric patients. Of these, forty-two (1.6%) suffered arrests, with thirty-two (76%) medical arrests and ten (24%) traumatic arrests. Children one year of age or less accounted for 75% of the medical arrests while children greater that one year of age accounted for 80% of the traumatic arrests ( p = 0.003). Overall mortality was 81%. When EMS prehospital assessment of medical and traumatic arrests were compared with OMI reports, there was good agreement (kappa = 0.70) for Sudden Infant Death Syndrome (SIDS), but poor agreement (kappa = 0.37) for child abuse.