Trauma has been termed the “neglected disease of modern society.” It is also now the costliest medical problem, with trauma costs nearly doubling since the mid-1990s.1 Until recently, injuries were considered to be due to “accidents,” or randomly occurring, unpredictable events. Injuries were thus regarded in a fundamentally different manner from other diseases, which are viewed as having defined and preventable causes. This viewpoint, on the part of the public, professionals, and policy makers, induced a nihilistic attitude and severely limited the development of injury prevention efforts.
Trauma, as with any other disease, should be approached from a scientific vantage point, with delineation of causative factors and with development of preventive strategies targeting such factors. This scientific approach has been successful in decreasing the toll of mortality and morbidity from most diseases. However, this same organized scientific approach has only recently been applied to the prevention of injury.2–7
The importance of injury prevention efforts is pointed out by trauma mortality patterns. One-third to one-half of trauma deaths still occur in the field,8,9 before any possibility of treatment even by the most advanced trauma treatment system. Such deaths can only be decreased by prevention efforts. In terms of severely injured persons who survive long enough to be treated by prehospital personnel, very few “preventable deaths” occur in a modern trauma system with a well-run emergency medical system and designated trauma centers. Even among those who survive to reach the hospital, a significant portion of in-hospital deaths are directly related to head injuries and occur despite optimal use of currently available therapy. Hence, injury prevention is critical to further significantly reduce the toll of death caused by trauma. Moreover, prevention efforts can also decrease the severity of injuries and thus the likelihood of disability that arises after trauma.
In the following chapter, the historical development of the scientific approach to prevention is discussed and practical considerations for implementation of prevention efforts and for assessment of their effectiveness are reviewed. The chapter will discuss how these basic principles have been successfully applied to the prevention of both unintentional and intentional injuries. Finally, the chapter will conclude with a discussion of surgeons’ roles in injury prevention programs.
Historical Development of the Science of Injury Prevention
Early attempts at injury prevention were largely based on the premise that injured individuals had been careless or were “accident prone.” Although this may be true in some circumstances, the resulting injury prevention strategies, limited to generic admonitions to be careful, were greatly limited in their scope and success.7,10 The current foundation for the scientific approach to understanding the causation of injuries and to developing rational prevention programs was laid by several pioneers.
One of the earliest developments of the science of injury prevention was the work of Hugh DeHaven in the 1930s–1940s. DeHaven demonstrated that during ...