This paper assesses the importance of adverse health shocks as triggers of bankruptcy filings. We view car crashes as a proxy for health shocks and draw on a large sample of police crash reports linked to hospital admission records and bankruptcy case files. We report two findings: (i) there is a strong positive correlation between an individual's pre-shock financial condition and his or her likelihood of suffering a health shock, an example of behavioral consistency; and (ii) after accounting for this simultaneity, we are unable to identify a causal effect of health shocks on bankruptcy filing rates. These findings emphasize the importance of risk heterogeneity in determining financial fragility, raise questions about prior studies of "medical bankruptcy," and point to important challenges in identifying the triggers of consumer bankruptcy.

OBJECTIVE. The goal was to assess the knowledge and confidence in recognition, management, documentation, and reporting of child maltreatment among a representative sample of emergency medical services personnel in the United States.METHODS. A questionnaire was developed and pilot-tested, with the input of experts in emergency medical services and child maltreatment, to assess knowledge, attitudes, confidence, and training needs regarding assessment and treatment of child maltreatment. The questionnaire was distributed nationally to a random sample of prehospital providers by using a previously validated sampling plan.RESULTS. Of 2863 surveys sent to prehospital providers, 1237 (43%) were returned. Most prehospital providers reported receiving <= 1 hour of continuing medical education regarding child maltreatment. Most (78%) asked for additional educational opportunities, with only 3% stating that they required no additional training. Participants lacked knowledge regarding the developmental abilities of children, management of families in which child maltreatment is suspected, key elements of the history that should be noted, and the degree of suspicion necessary for reporting.CONCLUSIONS. Prehospital providers expressed confidence in their abilities to recognize and to manage cases of child abuse and neglect; however, significant deficiencies were reported in several critical knowledge areas, including identification of child maltreatment, interviewing techniques, and appropriate documentation.

[Markenson D, Foltin G, Tunik M, Cooper A, Matza-Haughton H, Olson L, Treiber M. Knowledge and attitude assessment and education of prehospital personnel in child abuse and neglect: report of a National Blue Ribbon Panel. Ann Emerg Med. July 2002;40:89-101.]

STUDY OBJECTIVE:We identify health variables associated with a history of intimate partner violence (IPV) using self-reported and laboratory measures. METHODS:This study used a cross-sectional design. Participants were a randomized sample of English-speaking women between the ages of 18 and 50 years who presented to a large urban emergency department. Potential participants were screened in the ED for a history of physical abuse and coded as having experienced no IPV (No IPV), as having a recent history of IPV (occurring in the previous 12 months; IPVA), or as having a remote history (most recent occurrence >12 months ago; IPVHx). Participants were interviewed several days later in an outpatient setting regarding demographics, medical care use, and physical and mental health variables. Participants also received urine and blood tests and a pelvic examination. RESULTS:Self-reported health was poorest among women reporting IPVA and best among women reporting no IPVA. Women in the IPVA group differed from women with no IPV history with respect to cocaine use (odds ratio [OR] 4.8; 95% confidence interval [CI] 1.4 to 17.3), sexually transmitted diseases (OR 5.1; 95% CI 1.5 to 20.3), and nightmare frequency (OR 11.6; 95% CI 2.3 to 83.4). Women reporting IPVHx were more likely to report a history of sexually transmitted diseases than women with no IPV history (OR 4.1; 95% CI 1.6 to 11.4) and had more frequent nightmares (OR 5.0; 95% CI 1.3 to 24.9). Urine and blood tests identified only 2 variables (hemoglobin levels, mean corpuscular volume) that differed significantly between groups by IPV history; these differences were not clinically significant. CONCLUSION:Women with a recent history of IPV reported a poorer health status than women with no IPV history; laboratory testing detected few differences.

OBJECTIVE:To compare pediatric patients transported by ambulance on more than one occasion (repeat) with those transported only once.METHODS:The authors analyzed pediatric (patient < 21 years old) transports for 1992-1995 by the ambulance service that provides 99% of transports for a non-innercity metropolitan area. Repeat transports were compared with single transports with regard to patient age, gender, chief complaint, and payment source.RESULTS:There were 17,448 transports involving 15,168 patients. Nearly half (49.0%) of the repeat transports involved patients in the oldest age category, 17 to 20.9 years, contrasted with 38.0% of single transports (p < 0.00001). Females comprised 51.4% of the repeat transports and 48.5% of the single transports (p = 0.0008). Traumatic complaints accounted for one-third (33.0%) of the repeat transports and half (51.1%) of the single transports (p < 0.0001). Chief complaints of the patients with repeat transports were more likely to be seizure, assault, abdominal pain, and respiratory problems, and less likely to be falls and motor vehicle-related complaints, than chief complaints of the patients with single transports (p < 0.0001). More than one-third (39.0%) of the repeat transports were funded by Medicaid, in contrast with 19.8% of the single transports (p < 0.0001).CONCLUSIONS:Compared with single transports, repeat transports were more likely to involve patients more than 16 years of age, female, and with a chief complaint of seizure, assault, abdominal pain, or respiratory distress, and more likely to be funded by public insurance (Medicaid). Repeat pediatric transports warrant further investigation. This information may be useful in designing interventions targeted at reducing emergencies and hence ambulance use.

BACKGROUNDThere have been no population-based studies estimating the prevalence of intimate partner violence (IPV) in an insured population. There is also little information on how well routinely collected health status information predicts IPV risk. Many women now obtain health care from providers who are members of a managed care organization (MCO). To justify efforts to routinely screen for IPV, it is essential to know the prevalence of IPV in this growing population and to identify correlates of IPV among female MCO members.METHODSA telephone survey with questions on health status, behavioral risk factors, preventive services use, and the Conflict Tactics Scale was completed by 2,415 female members of a New Mexico MCO.RESULTSOverall, 13.5% of respondents reported experiencing major verbal aggression and 6.7% reported experiencing physical aggression. Younger age, degree of sadness, and inability to handle stress, and a perception of a poorer general health status were significantly associated with major verbal aggression. Race/ethnicity, degree of sadness, and average number of drinks consumed at one sitting were significantly associated with physical aggression.CONCLUSIONSThere is a low but important annual prevalence of IPV among female members of a MCO that occurs across all variables studied. This information is needed to develop appropriate screening protocols and interventions in this population.

Suicide is among the leading causes of death in the United States, and in women the second leading cause of injury death overall. Previous studies have suggested links between intimate partner violence and suicide in women. We examined female suicide deaths to identify and describe associated risk factors. We reviewed all reports from the New Mexico Office of the Medical Investigator for female suicide deaths occurring in New Mexico from 1990 to 1994. Information abstracted included demographics, mechanism of death, presence of alcohol/drugs, clinical depression, intimate partner violence, health problems, and other variables. Annual rates were calculated based on the 1990 census. The New Mexico female suicide death rate was 8.2/100,000 persons per year (n = 313), nearly twice the U. S. rate of 4.5/100,000. Non-Hispanic whites were overrepresented compared to Hispanics and American Indians. Decedents ranged in age from 14 to 93 years (median = 43 years). Firearms accounted for 45.7% of the suicide deaths, followed by ingested poisons (29.1%), hanging (10.5%), other (7.7%), and inhaled poisons (7.0%). Intimate partner violence was documented in 5.1% of female suicide deaths; in an additional 22.1% of cases, a male intimate partner fought with or separated from the decedent immediately preceding the suicide. Nearly two-thirds (65.5%) of the decedents had alcohol or drugs present in their blood at autopsy. Among decedents who had alcohol present (34.5%), blood alcohol levels were far higher among American Indians compared to Hispanics and non-Hispanic Whites (p = .01). Interpersonal conflict was documented in over 25% of cases, indicating that studies of the mortality of intimate partner violence should include victims of both suicide and homicide deaths to fully characterize the mortality patterns of intimate partner violence.

Injury prevention has been identified as a component of emergency medicine. However, involvement of emergency physicians in injury prevention has been hindered by clinical responsibilities, lack of financial support, and limited expertise In skills necessary for effective injury prevention programs. This article describes the development and content of a statewide pedestrian safety plan prepared by the Department of Emergency Medicine at the University of New Mexico, The plan included a written document, community input through focus groups, and a public information campaign, The written document included a synthesis of published literature, state-specific data, information on community interventions, and recommendations for state agencies and other groups Interested in reducing pedestrian injuries. This project can be modeled at other academic EDs with an interest in injury prevention and pedestrian safety.

Objective: To evaluate the association between ambulance transports for assault and those for alcohol intoxication.Methods: A retrospective analysis of emergency medical services (EMS) calls was performed. The authors used logistic regression models to compare patients transported for alcohol intoxication with a control group of patients transported for respiratory distress (asthma or shortness of breath) with respect to whether they had been transported on a separate occasion for a chief complaint of assault.Results: Patients transported for alcohol intoxication had 9 times the risk of transport for assault as compared with the control group (OR = 9.3; 95% CI = 6.4, 13.6). The odds of transport for assault among the alcohol patients increased 17.1% with each alcohol transport (OR = 1.17; 95% CI = 1.14, 1.20) but decreased for the control group (OR = 0.34; 95% CI = 0.26, 0.44), Repeat transports for assault were more common among the alcohol patients than among the control group (OR = 3.3; 95% CI = 1.1, 11.3). The mean number of assault transports was higher among the alcohol patients than among the patients never transported for alcohol intoxication (p < 0.0001).Conclusions: Patients transported on multiple occasions for acute alcohol intoxication are at relatively high risk for assault, This risk group should be targeted for focused assault prevention interventions that include components designed to reduce incidents of repeat alcohol intoxication.

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 χ2 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.

Academic Emergency MedicineVolume 4, Issue 4 p. 243-244 Free Access Emergency Medicine and Injury Control Research: Past, Present, and Future Stephen W. Hargarten MD, MPH, Corresponding Author Stephen W. Hargarten MD, MPH Medical College of Wisconsin, Milwaukee, WI, Department of Emergency MedicineMedical College of Wisconsin, Department of Emergency Medicine, 9200 West Wisconsin Avenue, FMLH East, Milwaukee, WI 53226. Fax: 414–257–8040; e-mail: hargart@post.its.mcw.eduSearch for more papers by this authorLenora Olson MA, Lenora Olson MA University of New Mexico, School of Medicine, Albuquerque, NM, Department of Emergency MedicineSearch for more papers by this authorDavid Sklar MD, David Sklar MD University of New Mexico, School of Medicine, Albuquerque, NM, Department of Emergency MedicineSearch for more papers by this author Stephen W. Hargarten MD, MPH, Corresponding Author Stephen W. Hargarten MD, MPH Medical College of Wisconsin, Milwaukee, WI, Department of Emergency MedicineMedical College of Wisconsin, Department of Emergency Medicine, 9200 West Wisconsin Avenue, FMLH East, Milwaukee, WI 53226. Fax: 414–257–8040; e-mail: hargart@post.its.mcw.eduSearch for more papers by this authorLenora Olson MA, Lenora Olson MA University of New Mexico, School of Medicine, Albuquerque, NM, Department of Emergency MedicineSearch for more papers by this authorDavid Sklar MD, David Sklar MD University of New Mexico, School of Medicine, Albuquerque, NM, Department of Emergency MedicineSearch for more papers by this author First published: 29 September 2008 https://doi.org/10.1111/j.1553-2712.1997.tb03542.xCitations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume4, Issue4April 1997Pages 243-244 ReferencesRelatedInformation

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.

OBJECTIVE To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data. METHODS The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978-1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults. RESULTS Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased. CONCLUSIONS Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.

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 for 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 χ2 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 (8.3%) (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. [Arbuckle J, Olson L, Howard M, Brillman J, Anctil C, Sklar D: Safe at home? Domestic violence and other homicides among women in New Mexico. Ann Emerg Med February 1996;27:210-215.]

Study objective: To determine whether recognition of domestic violence in the emergency department is affected by restructuring of the ED chart to include a specific question about domestic violence, to evaluate whether training concerning domestic violence further increases its recognition, and to develop a profile of women who present to the ED as a result of domestic violence. Methods: We collected prospective data on all females aged 15 to 70 years who presented to an urban Level I trauma center during a 3-month period. Two keywords were used to define domestic violence: (1) mechanism (eg, kicked, hit, pushed) and (2) perpetrator (eg, current/former boyfriend, spouse). We used the first month to define the baseline number of domestic violence cases. We modified charts in the second and third months (intervention months) to include, "Is the patient a victim of domestic violence?" In addition, the third month included a 1-hour educational lecture on the identification of domestic violence in the ED. Results: We identified 123 cases of domestic violence from a survey population of 4,073: 25 (2.0%) in the baseline month, 49 (3.4%) in the chart-modification month, and 49 (3.6%) in the education month. The proportion of cases identified during the intervention months was 1.8 times higher than during the control month (relative risk [RR], 1.78; 95% confidence interval [CI], 1.15 to 2.75), but did not differ between each other (RR, 1.06; 95% CI, .72 to 1.57). Women identified as domestic violence cases ranged in age from 15 to 61 years (median, 28.5 years). Most of the identified domestic violence patients presented with a triage classification of assault (54.5%), trauma (8.1%), or abdominal complaints (7.3 %). Triage complaint differed for domestic violence and non–domestic violence cases (χ2=830; P<.0001). Nearly one third of domestic violence patients (31.7%) presented between 11 PM and 6:59 AM, compared with 19.0% of non–domestic violence patients (χ2=12.4; P=.005). Conclusion: Modification of the chart significantly increased the recognition rate of domestic violence. An educational intervention did not significantly improve this rate. The profile of a woman presenting to the ED differs from those of other women with respect to chief complaint and time of presentation. [Olson L, Anctil C, Fullerton L, Brillman J, Arbuckle J, Sklar D: Increasing emergency physician recognition of domestic violence. Ann Emerg Med June 1996;27:741-746.]

Study objective: To examine specific risks for occupational injury deaths in New Mexico.Design: Retrospective review of slate medical investigator reports from 1980 through 1991 with regard to industry, agent of death, gender, ethnicity, location, and alcohol and other drug involvement.Participants: New Mexico residents who were fatally injured while on the job.Results: We identified 613 deaths: 87.1% unintentional, 10.6% homicides, and 2.3% suicides. Industries with the most fatalities were construction(11.8%), oil/gas (10.6%), and farming (8.6%). The primary agents of death were motor vehicles (41.7%), firearms (10.1%), and falling objects (10.0%). Almost all (95.6%) oi the decedents were male. However, females were overrepresented among homicide deaths (P<.0001). Most unintentional injuries occurred in rural areas (69.1%), whereas most homicides (73.4%) and suicides (71.4%)occurred in urban areas. Drug or alcohol use was evident in 19.4% of cases.Conclusion: New Mexico has a high rate of occupational injury death, which appears to be associated with rural location and use of motor vehicles and alcohol.

VioLit summary: OBJECTIVE: The intent of this article by Becker et al. was to review a gunshot injury prevention program, geared especially toward child injuries, implemented in New Mexico for four months during late 1990. METHODOLOGY: The authors implemented a non-experimental design which reviewed the history of gunshot injuries in New Mexico, identified the major elements in their $13,000 gunshot injury prevention program and identified their plans for continuing the program. FINDINGS/DISCUSION: A recent report indicated that in New Mexico during a 5 year period, 25 children aged 1-15 years were killed, with another 200 nonfatally injured due to unintentional gunshot wounds. The authors therefore implemented a statewide childhood gun safety program with the public health goal of reducing the availability of loaded guns at home. The program contained three basic components. First, the authors produced public service announcements in Spanish and English and aired them during prime time television and on the radio. In addition they obtained statewide newspaper coverage on the topic of gun safety. Second, they increased awareness of health care professionals and patients by providing information to pediatricians, family doctors, general practitioners and children's health clinics. Brochures in Spanish and English were also sent to these health care professionals for distribution among their patients. Third, the Young Hunters education program in New Mexico's Department of Game and Fish assisted by distributing information to over 5,000 teenaged hunters, and posters were displayed by the New Mexico Shooters Association and many gun stores. To monitor the progress of the program the State of New Mexico Office of the Medical Investigator would assess the firearm deaths among children for five years (presumably beginning in 1993), the database of the statewide trauma registry would be monitored, and calculations would be based on denominators collected by the US Census. To continue the program the existing efforts would be incorporated, the authors said, into the Indian Health Service injury prevention program. Guns sold would be tagged with safety messages, and a statewide gun coalition would be formed comprising the National Rifle Association, pediatricians, emergency medical professionals, parents, and injury control officers. AUTHORS' RECOMMENDATIONS: The authors encouraged all health care professionals to become involved in gun safety counseling, education programs and legislative efforts geared toward reducing the number of loaded firearms in the home. They also suggested that cooperative efforts be organized on the state or regional level. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado) KW - New Mexico KW - Firearms Injury KW - Firearms Violence KW - Child Injury KW - Child Safety KW - Child Victim KW - Injury Prevention KW - Violence Prevention KW - Prevention Program KW - Firearms Safety KW - Safety Promotion KW - Safety Program KW - Juvenile Injury KW - Juvenile Safety KW - Juvenile Victim KW - Juvenile Violence KW - Child Violence KW - Victimization Prevention