“Motor vehicle accident.” The emergency medicine residents in our program run for cover when they hear the unsuspecting off-service intern use that term while presenting a case to me. They know that it is the trigger for a long diatribe explaining that motor vehicle crashes are not “accidents.” The unsuspecting physician hears a well-rehearsed lecture explaining that the whole premise of injury prevention is to assume that trauma is a preventable disease. I frequently use the example of a 17-year-old male adolescent driving on a country road at night at a high rate of speed, under the influence of alcohol and without a seat belt, who loses control and is involved in a rollover motor vehicle crash. Consequently, he is ejected and dies. I then ask the physician to explain to me how this young man experienced an unavoidable act of God or how it was just “an accident.” Close evaluation of this crash with the application of Haddon’s matrix (a system for evaluating human, vehicle, and environmental factors contrasted to pre-event, event, and post-event phases) yields multiple points of intervention for prevention of this outcome. This young man was the victim of a “crash” or “collision” and the event was wholly avoidable. I firmly believe this tenet, but as emergency physicians we are well aware that in avoidable crashes there are often innocent victims. (Author/publisher)
Samenvatting