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CDC - Injury Leading Cause of Death for Persons Ages 1 - 44

Posted by Jane Akre
Friday, January 23, 2009 5:54 PM EST
Category: On The Road, Major Medical, Protecting Your Family
Tags: Emergency Room, Trauma Center, Injury, ER, Field Triage

What to know about trauma centers before you need one.  



IMAGE SOURCE: iStockphoto/ emergency sign/ author: © BradenGunem


This week’s CDC  Morbidity and Mortality Weekly Report provides the guidelines that approximately 800,000 emergency medical service (EMS) providers should use to have a substantial impact on the care and survival of injured persons.

Injury is the leading cause of death for persons aged 1 through 44 years. And the lifetime medical costs of injuries that occurred in 2000 (the most recent year for which numbers are available), are estimated to be about $80.2 billion. So minimizing injury is good, not only for the patient, but for the nation.

This  “Guideline for Field Triage of Injured Patients,”  revised from earlier versions in 2006 with the help of national experts in EMS, offers consumers some interesting information about injury treatment they may want to know before they need the services.    

Trauma Center

In the field, emergency medical service (EMS) providers will determine the severity of an injury, initiate treatment and identify the best place to bring you.  A trauma center can be found in some hospitals providing care above the emergency room.  Trauma centers are classified from Level I to Level IV.

Level I- centers providing the highest level of trauma care. The risk of death is reported to be about 25 percent lower if a severely injured patient is taken to a Level I center, however not all patients should automatically be taken to a level I facility because it may overburden the personnel.

Level IV – centers that provide initial care that can transfer you to a higher level if necessary.

A trauma center is an acute-care facility that has resources and personnel to care for severely injured patients.  A 24-hour emergency department, access to surgeons, anesthesiologists, other specialists, nurses, and resuscitation and life support equipment should all be present. 

The different levels of trauma center do not imply a different quality of care rendered, rather the level of resources.  A level V center may be located in a remote rural setting in which a higher level of care is not available, but may have a nurse practitioner or physician’s assistant trained in trauma resuscitation. 


EMS providers work in approximately 15,000 different systems across the US and provide nearly 16.6 million transport calls per year.  About 6.5 million are attributed to injury.  EMS providers are regulated by their various states however all must operate under the license and direction of one or more licensed physicians.

Rating Scale for Injury

Worldwide the most accepted injury severity scale is the Abbreviated Injury Scale (AIS), which ranks each injury in every body region with a numerical score (one being a minor injury, 6 a probable lethal injury).

Another way of communicating injury is the Injury Severity Score (ISS), which takes into account multiple injuries.  It uses a scale of 1-75) which is assigned to each of six body regions (head/neck; face; thorax; abdomen/visceral pelvis; bony pelvis/extremities; and external structures). A patient coming into a trauma center may have an AIS score of 6 and an ISS score of 75.

ISS has been used to predict mortality and risk for possible organ failure.

The importance of making accurate decisions in the field and relaying them to an emergency or trauma center can make the difference between life and death. Patients treated at Level I trauma centers had lower hospital mortality, fewer deaths at 30 days after injury and fewer deaths 90 days after injury.

Addressing injuries beginning in the field not only saves lives but improves the national picture.  The cost of injury in the US exceeded $400 billion in 2000. The 50 million people who were taken to an emergency department in 2000, were associated with $80 billion in medical costs, and an estimated $326 billion in productivity loss. 

The best way to reduce the harm from injuries is to prevent them in the first place. However when injury prevention fails, the revised 2006 Decision Scheme is meant to assist EMS workers in making the right critical decision to save your life.    #

1 Comment

Posted by Louis Lombardo
Sunday, January 25, 2009 9:26 AM EST

This is a tragic decision by the Bush Administration CDC for the more than ten thousand people killed or seriously injured each year in rollover and other severe crashes. The amount of lives, and livelihoods that will be needlessly lost is a national tragedy and a source of great personal suffering.

In the U.S.A, since 1978 nearly 600,000 people have died from automotive crash injuries without being transported to any medical facility for treatment in time to save their lives. In 2007, NHTSA counted more than 23,000 people (57% of 41,000) that died of crash injuries without benefit of timely transport to any medical facility for treatment.

In response to this enormously tragic problem, with what may be remembered as the Dead on Arrival (DOA) Triage Guidelines, the CDC (with GM support) has issued Triage Guidelines with the following shameful language:

"Rollover Crash: Criterion Deleted

Panel members concluded that a rollover crash is not associated per se with increasing injury severity. The increased injury severity associated with rollover crashes results from an occupant of a motor vehicle being ejected either partially or completely from the vehicle, which occurs most frequently when restraints are not used. Because partial or complete ejection is already a criterion for transport to a trauma center as a mechanism of injury associated with a high-risk MVC, the Panel chose to delete rollover crash from the 2006 Decision Scheme.

Published data indicate that rollover crash is associated with a PPV for severe injury of <10% (100). A multivariate analysis of 621 crashes indicated that rollover crash was not associated with ISS of >15 (92). Further, an analysis of contemporary NASS CDS research confirmed that rollover crash (in the absence of ejection) was not associated with increasing injury severity (AIS of >3); however, rollovers with ejection were associated with increasing injury severity (105). Review of NASS CDS data also indicated that a >20% risk of ISS of >15 was not associated with the number of quarter turns in a rollover crash, the landing position of the vehicle, or maximum vertical or roof intrusion (100).
Extrication Time >20 Minutes: Criterion Deleted

The Panel discussed the value of retaining extrication time of >20 minutes as a criterion in the 2006 Decision Scheme. In its discussion, the Panel recognized potential problems with field use of this criterion. EMS personnel can experience difficulty in determining exact times while managing the scene of a crash and assessing and treating vehicle occupants. Adverse weather conditions and darkness can complicate matters further. Additionally, because the majority of EMT personnel are trained only to do light extrication and must call someone else for heavy rescue, when EMS personnel should start the clock for the 20-minute timeframe has remained unclear.

In any vehicular crash, the need for extrication is caused most often by intrusion into the passenger compartment. The Panel recognized that, although lengthy extrication time might be indicative of increasing injury severity, new crush technology in automobiles is causing an increase in the number of nonseriously injured patients who require >20 minutes for extrication. Intrusion already is contained in the 2006 Decision Scheme as a criterion for transport to a trauma center associated with a high-risk MVC. The Panel determined that the modifications made to the triage protocol for cabin intrusion adequately addressed issues relevant to extrication time and elected to delete extrication time as a criterion."


Info on GM Funding of CDC Work is at


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