Unintentional injuries:
The high cost of accidents
It was 2:30 a.m. and Anthony Perry was driving home on Washington Street when all of a sudden, a car coming toward him made a quick left onto Townsend Street.
Perry swerved, but it was too late. His Jeep Cherokee was totaled, and worse, his life was sent spiraling down a road of physical rehabilitation and economic disaster.
Unable to work, he lost his job, his health insurance benefits and his car.
And it only took less than a minute.
“Accidents can happen so fast,” Perry said. “If the driver had waited just three seconds, this could have been avoided.”
It could have been a lot worse.
Accidents are the fifth-leading cause of death in America, right behind heart disease, cancer, strokes and chronic respiratory illnesses. While those illnesses receive the lion’s share of attention, the numbers for unintentional injuries and deaths are staggering.
Nationwide, accidents result in 26 million disabling injuries each year and roughly 120,000 deaths. That number is about the same as all deaths from prostate, breast and colon cancers combined.
Deaths are not the only tragedies. In 2005, for instance, more than 33 million people sought medical attention for an injury, the National Safety Council detailed in its Report on Injuries in America. Of those seeking medical attention, the report said, 3 million required hospitalization.
In all, the council reported 28 million emergency room visits, 5.4 million clinic visits and 41 million visits to doctors’ offices on an outpatient basis.
Despite the sheer numbers, unintentional injuries are often overlooked as one of the nation’s most deadly problems.
And one of the most expensive.
In 2006 alone, fatal and nonfatal unintentional injuries accounted for more than $652 billion in direct health care costs, as well as lost wages and productivity.
Dr. Selwyn O. Rogers Jr. knows the numbers all too well and argues that even they don’t tell the whole story, largely because the impact of accidents cannot be measured completely.
“It does not measure the impact on the families,” he explained. “Nor do [the numbers] take into account the people who are living with short- and long-term effects: the people who have lost limbs or have traumatic brain injuries and require permanent medical care.”
As chief of Brigham and Women’s Hospital’s Division of Trauma, Burns and Surgical Critical Care unit, Rogers is astounded.
“You don’t find people wearing a ribbon with a color for unintentional injuries,” Rogers said. “You can go into many cities and find people who can easily raise a half-million dollars for a particular illness. But you don’t find the same interest in injuries. There is no political force for injuries.”
The lack of political will is only part of the problem.
“People are not afraid of accidents,” Rogers explained. “People are afraid of cancer, but generally, people do not express fear of a car accident.”
The most common types of injuries suffered are fractures, open wounds and damage to internal organs. Traumatic brain injuries — caused by a blow to the head — are particularly dangerous, sometimes resulting in long-term physical and cognitive problems.
The death rates vary by age, gender and race. In 2006 in Massachusetts, unintentional injuries were the leading cause of death from age 1 to 44. By the age of 45, cancer and heart disease cause the most fatalities. But accidents remain one of the top 10 lifetime killers.
Unintentional injuries are significantly higher in males — exceeding those in females by more than 200 percent — and more deadly for black males. Their death rate is almost four times that in Asian males, and nearly 13 percent higher than white and Hispanic males.
Anthony Perry readily admits that his accident could have been worse. But it was still bad enough.
He initially thought he was not seriously injured in the crash. But he later realized that he was in a daze and didn’t realize the full extent of his injuries.
Though he had called a friend to give him a ride back to his home, Perry said he found himself in the emergency room three hours later. Doctors told him that he had a bulging disk in his spine and would have to wear a neck brace for a time to treat his case of whiplash.
But his spine was only part of the problem. He had lost sensation on his right side and his reflexes were diminished — both signs of neurological trauma. He is in physical therapy, and that has helped increase his strength and flexibility. He still cannot play basketball — one of his favorite pastimes — but is finally able to drive a car again.
The timing of the accident was another problem. Just last year, Perry had been diagnosed with diabetes. While the disease runs in his family, Perry said he had no problems until one day, he found himself constantly going to the bathroom. He also lost vision in one of his eyes.
Perry said he immediately went to a doctor, who explained “his sugar was running high.”
The same doctor urged Perry to look for a less stressful line of work. At the time, Perry was a supervisor at a treatment facility. On his doctor’s advice, he changed careers, found a new job at an information technology company and became a certified computer technician.
Three days after he received his certification, he got into the accident.
That was bad news for him, because he was just days away from passing his 90-day probation period.
Perry said he was unable to work for a month, and during that period he was told he no longer had a job. The company was downsizing, Perry said he was told, because business was slow.
Perry did have some medical coverage as part of his automobile insurance. But he is still looking for work.
“Accidents just change a life,” he said. “People are in a rush to go nowhere. If I had not swerved, it would have been a lot worse.”
Rogers has seen a lot worse.
“Ninety percent of the trauma I see is the result of motor vehicle accidents,” he said.
Prevention is the key.
Simple things like wearing seat belts are known to save lives.
According to the National Highway Traffic Safety Administration, more than half of the people who died in car crashes in Massachusetts in 2006 were not wearing seat belts. More troubling is that 40 percent of all traffic fatalities were alcohol-related and 34 percent were caused by excessive speed.
Cell phone use is also becoming a problem. The National Safety Council estimates that talking, listening and dialing reduce reaction time to that of a legally drunk person — one with a 0.08 blood alcohol content.
Members of the American College of Emergency Physicians are equally concerned. Emergency physicians are treating an increasing number of people who sustained injuries while typing text messages. Physicians advise to not text while driving, walking or engaging in any activity that requires a person’s attention.
To reduce motor vehicle deaths and injuries in children, Gov. Deval Patrick recently signed into law an enhanced Child Passenger Safety Law — the “Booster Seat Bill” — that went into effect July 10. The law requires that all children riding in passenger motor vehicles must be in a properly fastened and secured federally approved child passenger restraint until they reach 8 years old and 57 inches tall.
But simple prevention sometimes gets past even the experts.
As Rogers tells the story, he was backing out of his driveway when his now 6-year-old son started to yell something curious.
“We can’t go until everyone is buckled,” the boy exclaimed.
Rogers had forgotten to put on his own seatbelt. |
(top) Carlton Hamilton (right) is shown with his daughter, Kyra, 6, at a Child Safety Seat Check sponsored by the Boston Public Health Commission. Children up to 8 years old and 57 inches tall are now required to ride in a booster seat. (Photo courtesy of Boston Public Health Commission)
(bottom) Anthony Perry receives physical therapy from Danielle Rice at Bay State Physical Therapy for injuries he sustained in a car accident. |
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(above) Selwyn O. Rogers Jr., M.D., M.PH.
Chief, Division of Trauma, Burns and Surgical Critical Care
Brigham and Women’s Hospital
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