"It's Just An Accident"

New Medical College of Wisconsin Research Center Pulls Talents Together to Address Injury as a Health Problem

It’s just an accident; you really can’t do much about it..." has been a common response to injury for a long time. Individually and collectively, we repeat the refrain out of habit, perhaps under our breath when we hear of a particularly compelling, fatal injury.

But when serious injuries affect families, with their disproportionate impact on children and young adults, "It’s just an accident" is a viewpoint that offers nothing to those injured and the many others who face a different life after the trauma has struck.

The new Injury Research Center at the Medical College of Wisconsin (IRC-MCW) has set about to change that old way of thinking about injuries, with an ultimate goal of reducing fatalities and disabilities statewide, regionally and across the nation. The IRC-MCW was recently awarded a $4.5 million grant from the National Center for Injury Prevention and Control at the U.S. Centers for Disease Control and Prevention (CDC), making it the 11th IRC in the U.S. and the fifth to be located at a medical college.

Wisconsin, Illinois, Michigan, Minnesota, Indiana and Ohio will be served by the IRC-MCW in Region V of the federal program. Children ages 5 to 14 in this region are at exceptional risk, facing a 24% greater injury rate than the nation as a whole. In Wisconsin alone, more than 2,700 residents of all ages die of injuries each year, and unintentional injury is the leading cause of death among children ages 1-17 years and young adults ages 18-34 years.

IRC-MCW Director Stephen W. Hargarten, MD, MPH, Professor and Chairman of Emergency Medicine, recently discussed the center’s role with HealthLink. "My wife and I were just talking about going to the Heart Ball," said Dr. Hargarten, offering an example of a popular event focused on supporting a cure for a well-known health problem. He noted that there is little similar perception of injuries as a "major" health problem.

"There’s been coordination of research (to address heart disease), there are clinicians who are taking care of patients with heart disease, and there’s a concerted effort to impact the problem with donations and so forth. They even have the Heart Ball," said Dr. Hargarten. "And when you think about injuries as a health problem, which I do, it affects people’s lives. There is not a commensurate, coordinated research effort to address this health problem."

Focus on Prevention, Acute Care, Rehab
Injury prevention, acute care and rehabilitation will be the cornerstones of the multidisciplinary approach the IRC-MCW will use to "treat" injury as a health problem. The center will serve as a resource for injury research, facilitate education and training in injury prevention and control, and also serve as a regional resource for professionals, public agencies, private organizations and individuals concerned about injury and its human and community costs.

"There are talents for doing this that were scattered throughout this campus and throughout this state and region," said Dr. Hargarten. "This center is a great opportunity to pull these talented people together in a much more explicit collaborative effort and thus, hopefully, increase their effectiveness and increase their impact."

IRC-MCW staff and others working in collaboration with the center will study the number and types of injuries the public knows as "serious", ways to treat those injuries in acute care settings, and rehabilitation after the injury, all with an eye toward lasting, systematic methods to prevent them in the first place. (See accompanying article "Injury Facts Reveal the Extent of the Problem.")

"An injury is an energy exchange," said Dr. Hargarten in explaining the broad range of injuries to be addressed by the IRC-MCW. "Typically that energy is kinetic energy that you amass as you are traveling at 60 miles an hour in a car, or falling from a height and achieving some velocity. When you’re abruptly stopped, that energy exchange is transmitted to the body and organ systems may not be able to tolerate that."

Low-level, cumulative chronic conditions such as carpal tunnel disease will not fall under the IRC-MCW umbrella, Dr. Hargarten said. "So what we’re looking at is acute exposure to kinetic energy, chemical energy, thermal energy, and other injuries that are in the absence of energy." Falls, motor vehicle accidents, severe exposure to heat or cold, shootings, drowning, suffocation, deep cuts, fractures, sledding accidents and bicycle accidents are all among the types of injuries identified as acute and settings in which they occur.

"This research effort that was recently supported by the CDC here at the medical college is a step towards better understanding the disease, using tools of medicine and public health to better understand it, and to hopefully impact the problem by lowering the incidence, decreasing its effect on an individual if an individual does get injured, in a way that is as effective and no different than heart disease, cancer or HIV," said Dr. Hargarten.

Projects Reflect Multidisciplinary Approach
Six major areas make up the agenda of the new Injury Research Center at the Medical College of Wisconsin. The multidisciplinary approach the center will use throughout its work is shown by the project areas and directors listed below.

• Quality of Life After Trauma
  Project Director: Karen J. Brasel, MD, MPH, Associate Professor of Surgery (Trauma and Critical Care)
  
• Risk Factors for Medical Injury
  Project Director: Peter M. Layde, MD, MSc , Professor and Director of Research in Family and Community Medicine
  
• Clinical Biomechanics of Penetrating Brain Injury
  Project Director: Thomas Gennarelli, MD, Chairman and Professor of Neurosurgery
• An Analysis of Violence Related Fatalities and Injuries in Wisconsin
  Project Director: Stephen W. Hargarten, MD, MPH, Professor and Chairman of Emergency Medicine
• Psychological Factors Associated with Effective Adjustment Following Traumatic Injury Psychological Treatment of Acute Stress Disorder
  Project Director: Mark D. Rusch, PhD, Associate Professor of Surgery, Department of Plastic and Reconstructive Surgery
• Injury Fatalities of U.S. International Travelers
  Project Director: Halim M. Hennes, MD, MS, Professor of Pediatrics (Emergency Medicine)