Thinking Globally, Driving Locally: A New Traffic Safety Agenda

When the World Health Organization dedicated World Health Day (April 7, 2004) to traffic safety, it was the first time that motor vehicle injuries and deaths were designated as its annual focus. Maybe WHO didn't have Wisconsin in mind; but with state traffic fatalities reaching a 23-year high of 840 in 2003, the emphasis on traffic safety as a global health issue came at a good time for local efforts to reduce the toll taken on our roads and highways.

Area physicians joined others who observed World Health Day locally by introducing a traffic safety agenda developed by the Medical College of Wisconsin Injury Research Center (IRC). The agenda offered recommendations to state policymakers and the public on four specific priorities that IRC researchers believe would help bring the number of traffic injuries and deaths down.

"World Health Day was helpful because it's got a global audience involved, said Stephen W. Hargarten, MD, MPH, Medical College Professor and Chair of Emergency Medicine, who also serves as IRC Director. "It's put car crashes in the same perspective as other health problems, and indicates that if we don't do something about it it's going to get worse. The state agenda that we want to see realized is getting a primary enforcement seat belt law and a booster seat law, also a comprehensive approach to addressing alcohol-related injuries, and securing adequate and stable funding for the state's trauma system."

The Injury Research Center serves Wisconsin, Indiana, Illinois, Michigan, Minnesota and Ohio and is one of eleven such federally funded centers nationwide that compiles data and studies traumatic injury to help develop and promote advances in injury prevention, patient safety and well-being, better care for the injured and improved outcomes.

Broad Support for New Policies
Injury Research Center representatives were joined at a news conference announcing the traffic safety agenda by T. Michael Bolger, JD, President and CEO of the Medical College; Michael Witter, Deputy Regional Administrator of the National Highway Traffic Safety Administration (NHTSA); Frank Busalacchi, Secretary of the Wisconsin Department of Transportation; Andrea Winthrop, MD, Medical College Associate Professor of Pediatric Surgery (Trauma) and Medical Director of the Children's Hospital of Wisconsin Level One Trauma Center Program; John Weigelt, MD, DVM, Medical College Professor, Chief of Trauma and Critical Care Surgery, and Medical Director of Froedtert's Level One Trauma Center Program; and Lisa Heinz, RN, Froedtert Hospital Flight for Life Nurse.

Attendees voiced clear support for new policies and changes in current law. Specifically, the traffic safety agenda introduced by the Medical College physicians called on public policy makers and organizations to:

• Pass "primary" safety belt legislation that would allow law officers to enforce Wisconsin's mandatory seat belt law differently. Current law makes seat belt use a "secondary" enforcement matter. For example, a motorist stopped for speeding may also be ticketed for not wearing a safety belt, but the motorist will not be stopped solely for not wearing a seat belt.
  States with primary seat belt enforcement have had belt usage rate increases ranging from 5% to 15%. NHTSA data indicates that a primary safety belt law could save as many as 76 lives in Wisconsin each year, prevent nearly 2,000 injuries and save almost $200 million annually in medical and lost time costs.

• Pass a booster seat law to require that children ages 4 to 8 years be properly restrained in a child restraint system or booster seat to reduce the risk of injury resulting from poor-fitting belts. Traffic crashes remain the number one cause of death among children in the US, in part because younger children are too small to be properly restrained by standard lap belts and shoulder harnesses.
  The use of belt-positioning booster seats lowers the risk of injury to children in crashes by 59% compared to the use of adult safety belts only, according to the National SAFE KIDS Campaign.

• Develop and implement a protocol for at-risk alcohol use and abuse screening and referral of patients entering Wisconsin hospital emergency departments. According to the IRC, alcohol is a factor in 45% of all traffic-related deaths in the state. Studies have indicated that screening and brief intervention programs in emergency departments reduce alcohol-related injuries.

• Secure adequate funding to maintain and enhance the Trauma Care System in Wisconsin. This newly established statewide system represents a continuum of care from initial injury through rehabilitation and provides a comprehensive approach to the triage, treatment, transport and ultimate care of major trauma victims. The system requires adequate funding to be effective.

Will Interest Turn to Action?
Policymakers will have a chance to consider the initiatives soon, Dr. Hargarten said, adding that it is unclear how quickly they will move on the issues. "Primary enforcement will come back up," he said. "It may even be inserted into next year's state budget. There's a lot of interest now since Wisconsin experienced its worst fatality record in decades. I think folks are going to want to rethink this legislatively and at the executive level. The state Secretary of Transportation was here, so there's a lot of genuine interest to reexamine this, and I'm encouraged by that.

"And we'll do some advocacy to look for funding for trauma system. One dollar added to the registration and license fee would do it. Many states do it that way; Wisconsin seems to have stalled on that approach. Right now the system is fragmented. It's held together by dedicated people. It needs real funding."

SAFE KIDS Wisconsin is promoting clearer child booster seat regulations. (The Children's Health Education Center, a member of Children's Hospital and Health System, is the lead SAFE KIDS agency in the state.)

The alcohol-abuse screening segment of the traffic safety agenda is getting a push from the Injury Research Center, which Dr. Hargarten said is putting together a model program with Medical College leadership and Froedtert Hospital.

New International Research
Dr. Hargarten also noted the longstanding IRC interest in international injury, especially as it affects US citizens traveling or living abroad.

One research project within the Injury Research Center is looking at US Passport Office data to look at how US citizens are dying while traveling or living abroad. The first cause is cardiovascular disease, and the second is injury, notes Dr. Hargarten. "And the most common injury event is a car crash."

"We've had a long history of being interested in international injury. We have the interest and excitement, and now with leadership from WHO the global report has come out. Many US-based agencies are taking a critical look at this issue from the standpoint of asking 'what can we provide in leadership?' and realizing 'this is a US citizen problem, too.' There's a keen interest in becoming a genuine global partner to address this problem."

Dan Ullrich
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.