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Tue Oct 21 14:48:17 BST 2008

I forget: what's Latin for "First, blame the victim?"

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Stephen Richey
Sent: Tuesday, October 21, 2008 6:48 AM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Trauma outcomes

I wonder how much of a factor delays in access to care because of
cultural
attitudes plays in this. While working on ambulances was told numerous
times
by African Americans and Hispanics (especially men) things to the effect
of
"I ain't going to no ****ing hospital b***h! I's tough". Granted, I've
been
told the same thing (although worded differently....you haven't been
cussed
out until you've been told to go to hell by a Cajun) by every ethnic
group
I've treated and by women, but I still wonder- given that men engage as
a
group in more risky activities than women in general- how many of
those additional fatalities were caused as much by their own machismo or
the
disregard of their "associates" for the severity of the injuries as by
the
injuries themselves.

Also, I wonder what role the language barrier between Hispanics and
non-Hispanics might take in the much higher rate of mortality.  The same
degree of curiosity exists for things like differences in the use
of standard injury prevention measures such as seatbelts, helmets, etc.
I've also wondered how the "ghetto lean" a lot of urban youth set their
driver's seats to have affects the frequency and severity of injury in
the
event of a car accident....

Just my two cents worth of rambling....I could be completely missing
something here as I am about half awake....

On Tue, Oct 21, 2008 at 6:31 AM, Robert F. Smith
<rfsmithmd at comcast.net>wrote:

> Dr. Haider appears to have written several articles using trauma data
to
> look at outcomes in different populations. Several are co-authored
with Dr.
> Eddie Cornwell. This article does not yet appear on the  Pub Med
website.
>
> Rob Smith
>
> Patterns: Race and Health Coverage Affect Survival
> By NICHOLAS BAKALAR
>
> Whether you survive after a serious accident may depend on your race
and
> your health insurance, a new study concludes.
>
> Researchers examined the records of more than 310,000 trauma patients
whose
> cases were entered in a national databank that includes information on
> race,
> age, severity and type of injury, insurance status, and mortality.
>
> After controlling for severity of injury and other factors, they found
that
> compared with whites, African-Americans had a 17 percent increased
risk of
> death and Hispanics a 47 percent increased risk.
>
> When they looked at patients with health insurance, they found a
greater
> disparity. Insured African-Americans had a 20 percent increased death
risk
> compared with insured whites, and Hispanics a 51 percent increased
risk.
> The
> study appears in the October issue of The Archives of Surgery.
>
> "This study refutes the notion that racial disparities in trauma care
are
> merely a reflection of insurance status," said the lead author, Dr.
Adil H.
> Haider, an assistant professor of surgery at Johns Hopkins. "Both
insurance
> and race are independent predictors of mortality after trauma. And of
the
> two, insurance is the more important predictor."
>
> The authors acknowledge that the study was retrospective and based on
> records that did not give complete medical information on each
patient.
> Also, people with insurance may be generally healthier and have an
> increased
> ability to survive traumatic injury.
>
>
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-- 
Stephen L. Richey, CRT
Aviation Injury Research Project Leader
Saginaw Valley State University
Work E-mail: slrichey at svsu.edu
Home Office Phone: 248-366-4452

"It is the characteristic excellence of the strong man that he can bring
momentous issues to the fore and make a decision about them. The weak
are
always forced to decide between alternatives they have not chosen
themselves."- Dietrich Bonhoeffer
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