RESUMEN
BACKGROUND: The pattern of law enforcement-related injuries of police and civilians in the United States is unknown. METHODS: Data were aggregated from the Federal Bureau of Investigations, the Bureau of Justice Statistics, the Centers for Disease Control (CDC) Web-based Injury Statistics Query and Reporting System, and the Nationwide Inpatient Sample (NIS) from 2003 to 2011. Law enforcement-related injuries in the CDC Web-based Injury Statistics Query and Reporting System and the NIS were identified using E-codes 970-976, which are meant to identify "injuries inflicted by the police or other law-enforcing agents, including military on duty, in the course of arresting or attempting to arrest lawbreakers, suppressing disturbances, maintaining order, and other legal action." RESULTS: The CDC reported a total of 715,118 nonfatal injuries and 3,156 fatal injuries from 2003 to 2011. In contrast, for the same period, the NIS identified a total of 3,958 patients, ranging from 348 to 572 per year. Among the injured, 1,548 (48.0%) were white, 866 were black (26.8%), and 605 were Hispanic (18.8%); 1,011 patients (25.5%) were injured by firearms, while 2,304 (58.2%) experienced blows or manhandling. Firearm-injured hospitalized patients are more likely to be male, black or Hispanics, and in the age group of 18 years to 39 years. CONCLUSION: The majority of law enforcement-related injuries are among white or black young men. Hispanic patients are more likely to be injured by a firearm than struck. When injured by firearm, white and black patients are more likely to die compared with Hispanic patients. Unfortunately, data about these injuries are scattered across multiple data systems. A uniform national system to aggregate these data sources is needed to better understand the scope of the problem, for both law enforcement personnel and civilians. LEVEL OF EVIDENCE: Epidemiologic study, level III.
Asunto(s)
Aplicación de la Ley , Heridas y Lesiones/epidemiología , Adolescente , Adulto , Anciano , Etnicidad/estadística & datos numéricos , Femenino , Armas de Fuego , Homicidio/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Violencia/estadística & datos numéricos , Heridas y Lesiones/etnologíaAsunto(s)
Becas , Cirugía General/educación , Internacionalidad , Misiones Médicas , Haití , Humanos , Desarrollo de ProgramaRESUMEN
UNLABELLED: Little is known about pediatric surgical disease in resource-poor countries. This study documents the surgical care of children in central Haiti and demonstrates the influence of the 2010 earthquake on pediatric surgical delivery. METHODS: We conducted a retrospective review of operations performed at Partners in Health/Zanmi Lasante hospitals in central Haiti. RESULTS: Of 2,057 operations performed prior to the earthquake, 423 were pediatric (20.6%). Congenital anomalies were the most common operative indication (159/423 operations; 33.5%). Pediatric surgical volume increased significantly after the earthquake, with 670 operations performed (23.0% post-earthquake v. 20.6% pre-earthquake, p=.03). Trauma and burns became the most common surgical diagnoses after the disaster, and operations for non-traumatic conditions decreased significantly (p<.01). CONCLUSION: Congenital anomalies represent a significant proportion of baseline surgical need in Haiti. A natural disaster can change the nature of pediatric surgical practice by significantly increasing demand for operative trauma care for months afterward.
Asunto(s)
Terremotos , Hospitales Pediátricos , Servicio de Cirugía en Hospital/estadística & datos numéricos , Adolescente , Niño , Preescolar , Femenino , Haití , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: The earthquake that struck Haiti on 12 January 2010 caused significant devastation to both the country and the existing healthcare infrastructure in both urban and rural areas. Most hospital and health care facilities in Port-au-Prince and the surrounding areas were significantly damaged or destroyed. Consequently, large groups of Haitians fled Port-au-Prince for rural areas to seek emergency medical and surgical care. In partnership with the Haitian Ministry of Health, Partners in Health (PIH) and Zanmi Lasante (ZL) have developed and maintained a network of regional and district hospitals in rural Haiti for over twenty-five years. This PIH/ZL system was ideally situated to accommodate the increased need for emergent surgical care in the immediate quake aftermath. The goal of the present study was to provide a cross-sectional assessment of surgical need and care delivery across PIH/ZL facilities after the earthquake in Haiti. METHODS: We conducted a retrospective review of hospital case logs and operative records over the course of three weeks immediately following the earthquake. RESULTS: Roughly 3,000 patients were seen at PIH/ZL sites by a combination of Haitian and international surgical teams. During that period 513 emergency surgical cases were logged. Other than wound debridement, the most commonly performed procedure was fixation of long bone fractures, which constituted approximately one third of all surgical procedures. CONCLUSIONS: There was a significant demand for emergent surgical care after the earthquake in Haiti. The PIH/ZL hospital system played a critical role in addressing this acutely increased burden of surgical disease, and it allowed for large numbers of Haitians to receive needed surgical services. Our experiences reinforce that access to essential surgery is an essential pillar in public health.
Asunto(s)
Prestación Integrada de Atención de Salud , Terremotos , Servicios Médicos de Urgencia/organización & administración , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Heridas y Lesiones/cirugía , Estudios Transversales , Países en Desarrollo , Planificación en Desastres/métodos , Femenino , Haití , Humanos , Masculino , Evaluación de Necesidades , Pobreza , Estudios Retrospectivos , Medición de Riesgo , Servicios de Salud Rural , Procedimientos Quirúrgicos Operativos/métodos , Análisis de Supervivencia , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/mortalidadRESUMEN
INTRODUCTION: Prehospital emergency services are a vital public service, and consumer access to the system is an important factor in their use. The Dominican Republic recently experienced "the epidemiological transition" leading to increased morbidity and mortality secondary to traumatic and cardiac conditions--thus, increasing the need for prompt and adequate delivery of emergency medical care. METHODS: A survey was administered to 90 subjects from diverse backgrounds, all living in Santo Domingo. Survey items included questions on emergency medical services (EMS) systems knowledge (i.e., access numbers), confidence in the system, first-aid education and prior experience with the EMS system. Chi-square was used to measure statistical significance for categorical variables and Student's t-test for continuous variables (JMP 2.0 software was used for statistical processing). RESULTS: A total of 90 subjects were surveyed. The average age of respondents was 36 +/- 12 years SD. More than one-fifth (22.2%) of respondents did not know the established universal emergency number (9-1-1), and 37.8% responded that they would access a different telephone number in case of a medical emergency. CONCLUSIONS: Important deficiencies and access-to-care concerns were interpreted from the results. An adequate understanding of the current state of prehospital care could lead to creation of policies by system administrators to further improve the delivery of emergency medical care. This study will assist system administrators in future design and policy issues.