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Prevention: The magic bullet for the 21st century
EDITORS’ NOTES
Prevention: The Magic Bullet for the 21 st Century Renec.5 Holleran, RN, PhD, CEN, CCRN, CFRN, and David J. Dries, MD, MSE, FACS, FCCP, FCCM
During the past century, health care and the way it is provided have experienced major changes. Science and technology have produced a level of care not comprehended in previous centuries. They also have left health care providers at a serious crossroads. Because this issue is the first journal of the last year of the 26th century, we thought we would take a critical look at where we are. We also will describe a framework that suggests another place we may want to go as we enter the next century. An article titled “Systemic Inflammatory Response Syndrome (SIRS), Multiple Organ Dysfunction Syndrome (MODS), and Multiple Organ Failure (MOF): Are We Winning the Battle?“’ was published in Shocklast year. The article reviewed the current research related to the problems that occur after major injury. The authors staged the effects of major injury as sick (SIRS),sicker (severe SIRS), very sick (MODS), and dying (MOF). One of their primary assertions was * .. .better intensive care is help ing, and the secret to MOF is prevention. Once it happens, the mortality remains high, and other problems occur.” Another problem many of us are confronting is severely injured patients with preexisting diseases, such a diabetic patient with a serious bum or a patient with pulmonary disease who sustains a flail chest. Advanced lie support at the scene of injury and rapid transport have allowed these patients to reach the hospital, the operating room, or the intensive care unit, only to develop such complications as SIRS or MOF and death.’ Better science, better health care, and longer life expectancy will continue to give rise to injured patients with preexisting
Air Medlcal Journal
18:l
January-March
health problems. The authors conclude that “ . . *major advances with reduced mortality will come with injury and disease prevention.” Prevention is the key word. What does this mean to those of us in air medical transport? We have spent a great deal of effort and time ascertaining how to manage our patients once injury has occurred. Yet have we evaluated what role we may play in preventing illness and injury? The U.S. Department of Health and Human Services has developed an initiative to improve the health of all Americans. The Objectives for Healthy People 2000 was first published in 1979. The newest edition, Healthy People 2010,’ has been developed during the past 2 years with input from multiple organizations. These new national objectives will differ from the previous set as a result of a broadened prevention science base, improved surveillance and data systems, a heightened awareness and demand for preventive health services and quality health care, and changes in demographics, science, technology, and disease spread that will affect public health in the 21st century.2 One pertinent objective to air medical professionals is Injury/Violence Prevention, which has been broken down into a multitude of specitic objectives with data sources that can be used to monitor implementation. Some applicableobjectives:2 l Reduce nonfatal head injuries so that hospitalizations for this condition are no more than 74 per 100,000 people l Reduce firearms-related deaths to fewer than 11.6 per 100,000 people l Reduce deaths caused by motor ve hicle crashes to no more than 11.4
1999
per 100,000 people and 1.1 per 100 million vehicle miles traveled The complete objectives of Healthy People 2010 will be introduced in 2000. They will provide not only an organized outline that identities national health ob jectives but also a prescribed way of de termining where limited research funds may go. As Baue, Durham, and Faist’ point out in their article, we have made a great deal of progress in our care of the critically injured and ill patient. Patients who, not too long ago, would have died before reaching the hospital now are able to ob tain critical care at the scene of injury or very quickly thereafter. Yet as health care providers, we have made little progress toward decreasing overall mortality. Preexisting diseases, limited use of safety devices (eg, seatbelts), and high-risk behaviors (eg, drinking and driving) continue to hinder our efforts to prevent injury. Prevention is the magic bullet of the future. As air medical care providers, we need to decide what role we can play in health education and prevention. For some practitioners, it will be a different challenge, but it is one we must face so that we remain an essential part of the future of health care.
References 1. Baue A, Durham R, Faist E. Systemic inflamnw tory response syndrome, multiple organ dysfunction syndrome, and multiple organ failure: are we winning the battle? Shock 1998;10:79-89. 2. U.S. Department of Health and Human Services. Healthy People 2010 objectives [draft for the public]. Washington (DC): The Department; 1998.
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Prevention: The Magic Bullet for the 21 st Century Renec.5 Holleran, RN, PhD, CEN, CCRN, CFRN, and David J. Dries, MD, MSE, FACS, FCCP, FCCM
During the past century, health care and the way it is provided have experienced major changes. Science and technology have produced a level of care not comprehended in previous centuries. They also have left health care providers at a serious crossroads. Because this issue is the first journal of the last year of the 26th century, we thought we would take a critical look at where we are. We also will describe a framework that suggests another place we may want to go as we enter the next century. An article titled “Systemic Inflammatory Response Syndrome (SIRS), Multiple Organ Dysfunction Syndrome (MODS), and Multiple Organ Failure (MOF): Are We Winning the Battle?“’ was published in Shocklast year. The article reviewed the current research related to the problems that occur after major injury. The authors staged the effects of major injury as sick (SIRS),sicker (severe SIRS), very sick (MODS), and dying (MOF). One of their primary assertions was * .. .better intensive care is help ing, and the secret to MOF is prevention. Once it happens, the mortality remains high, and other problems occur.” Another problem many of us are confronting is severely injured patients with preexisting diseases, such a diabetic patient with a serious bum or a patient with pulmonary disease who sustains a flail chest. Advanced lie support at the scene of injury and rapid transport have allowed these patients to reach the hospital, the operating room, or the intensive care unit, only to develop such complications as SIRS or MOF and death.’ Better science, better health care, and longer life expectancy will continue to give rise to injured patients with preexisting
Air Medlcal Journal
18:l
January-March
health problems. The authors conclude that “ . . *major advances with reduced mortality will come with injury and disease prevention.” Prevention is the key word. What does this mean to those of us in air medical transport? We have spent a great deal of effort and time ascertaining how to manage our patients once injury has occurred. Yet have we evaluated what role we may play in preventing illness and injury? The U.S. Department of Health and Human Services has developed an initiative to improve the health of all Americans. The Objectives for Healthy People 2000 was first published in 1979. The newest edition, Healthy People 2010,’ has been developed during the past 2 years with input from multiple organizations. These new national objectives will differ from the previous set as a result of a broadened prevention science base, improved surveillance and data systems, a heightened awareness and demand for preventive health services and quality health care, and changes in demographics, science, technology, and disease spread that will affect public health in the 21st century.2 One pertinent objective to air medical professionals is Injury/Violence Prevention, which has been broken down into a multitude of specitic objectives with data sources that can be used to monitor implementation. Some applicableobjectives:2 l Reduce nonfatal head injuries so that hospitalizations for this condition are no more than 74 per 100,000 people l Reduce firearms-related deaths to fewer than 11.6 per 100,000 people l Reduce deaths caused by motor ve hicle crashes to no more than 11.4
1999
per 100,000 people and 1.1 per 100 million vehicle miles traveled The complete objectives of Healthy People 2010 will be introduced in 2000. They will provide not only an organized outline that identities national health ob jectives but also a prescribed way of de termining where limited research funds may go. As Baue, Durham, and Faist’ point out in their article, we have made a great deal of progress in our care of the critically injured and ill patient. Patients who, not too long ago, would have died before reaching the hospital now are able to ob tain critical care at the scene of injury or very quickly thereafter. Yet as health care providers, we have made little progress toward decreasing overall mortality. Preexisting diseases, limited use of safety devices (eg, seatbelts), and high-risk behaviors (eg, drinking and driving) continue to hinder our efforts to prevent injury. Prevention is the magic bullet of the future. As air medical care providers, we need to decide what role we can play in health education and prevention. For some practitioners, it will be a different challenge, but it is one we must face so that we remain an essential part of the future of health care.
References 1. Baue A, Durham R, Faist E. Systemic inflamnw tory response syndrome, multiple organ dysfunction syndrome, and multiple organ failure: are we winning the battle? Shock 1998;10:79-89. 2. U.S. Department of Health and Human Services. Healthy People 2010 objectives [draft for the public]. Washington (DC): The Department; 1998.
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