Faculty Bibliography

BACKGROUND: Both children and older adults are thought to sustain burns serious enough to warrant hospitalization disproportionately more often than other age groups, but the incidence, injury characteristics, and outcome have not been precisely defined. METHODS: Patients hospitalized with a burn diagnosis were identified from hospital discharge data from California, Florida, New Jersey, and New York for the 5-year period 2000-2004. RESULTS: In those states, 60,024 residents were hospitalized with a diagnosis of burn and/or inhalation injury according to the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. Using population data from the United States Census 2000, we found that the average annual incidence of hospitalization with a burn diagnosis in these 4 states was 155 per million (per M) (95% confidence interval,153-158). There were 13,453 children under 15 years of age: incidence, 163 per M (range, 157-169). Of these 9508 (70%) were under 5 years of age: incidence, 363 per M (range, 347-379). In contrast, there were 10,686 patients 65 years of age or older: incidence, 214 per M (range, 205-224), of whom 2091 were at least 85 years old: incidence, 347 per M (range, 314-380). The incidence of hospitalization with a burn diagnosis for patients 15 to 64 years of age was 141 per M (range, 138-145). Compared with children younger than 15 years, patients aged 65 years and older more often had flame burns (odds ratio [OR], 2.12), burns of 20% or more of body surface area (OR, 2.41), inhalation injury (OR, 2.88), respiratory failure (OR, 4.48), and death (OR, 16.53), all P < .0001. CONCLUSIONS: Older individuals are the most vulnerable to the morbidity and mortality of burn injury. Prevention strategies targeted to those older than 65 years should be developed.

The hypothesis that relative to cars, light trucks and vans (including sports utility vehicles) are more likely to result in fatal paediatric pedestrian injury was investigated. It was further hypothesized that this increased risk is a result of head injuries. The study sample consisted of 18 117 police records of motor vehicles involved in crashes in which one or more pedestrians aged 5 to 19 years old was injured or killed. Frequencies and case fatality ratios for each vehicle body type were calculated. A logistic regression analysis was conducted, with light truck or van vs. car as the exposure variable and fatal/non-fatal pedestrian injury as the outcome variable. After controlling for driver age, driver gender, vehicle weight, road surface condition and presence of head injury, 5 to 19 year-olds struck by light trucks or vans were more than twice as likely to die than those struck by cars (odds ratio (OR) 2.3; 95% CI 1.4, 3.9). For the 5 to 9 year-old age group, light trucks and vans were four times as likely to be associated with fatal injury (OR 4.2; 95% CI 1.9, 9.5). There was an association between head injury and light trucks and vans (OR 1.2; 95% CI 1.1, 1.3). It was concluded that vehicle body type characteristics play an important role in paediatric pedestrian injury severity and may offer engineering-based opportunities for injury control.

Effective postterrorism public health interventions require the recognition that behavioral consequences are, in fact, the intent of terrorists. The authors searched published and unpublished post-1980 studies that documented population-level behavioral and psychological consequences of terrorist incidents, focusing on posttraumatic stress disorder (PTSD). Results were tabulated, and random effects models were used to calculate overall effect sizes. The analysis indicates that in the year following terrorist incidents, the prevalence of PTSD in directly affected populations varies between 12% and 16%. The review also shows that this prevalence can be expected to decline 25% over the course of that year. These prevalence estimates mask great variability, depending on who is being studied, who is conducting the study, and where the event occurred. Higher rates of disease are reported for survivors and rescue workers, and higher overall rates are also reported from studies conducted in Western Europe compared with studies conducted in North America. Prior psychiatric diagnoses are strongly associated with subsequent PTSD and may be a useful triage factor, particularly when considered together with factors such as female gender and direct exposure to events as either a survivor or rescuer. The review indicates that these associations are consistent across study types and environments and represent important variables to consider when developing triage, outreach, and treatment programs.

The New York City Department of Health and Mental Hygiene and the Columbia University Mailman School of Public Health's National Center for Disaster Preparedness undertook a collaborative project to establish a model academic health department. The goals were to increase student participation at the health department, increase faculty participation in health department activities, and facilitate health department faculty appointments at the school. As a result, 17 students were placed in full-time summer research projects designed by health department staff specifically for the project, 154 health department staff attended a series of six lectures presented by faculty, and five health department professionals applied for academic appointments at the school. The benefits of the efforts toward establishing an academic health department extend to all areas of public health practice, including those of preparedness.

HYPOTHESIS: The public health system has a specialized body of knowledge and expertise in bioterrorism and public health emergency management that can assist in the development and delivery of continuing medical education programs to meet the needs of emergency medical service providers. METHODS: A nationally representative sample of the basic and paramedic emergency medical service providers in the United States was surveyed to assess whether they had received training in weapons of mass destruction, bioterrorism, chemical terrorism, radiological terrorism, and/or public health emergencies, and how the training was provided. RESULTS: Local health departments provided little in the way of training in biologic, chemical, or radiological terrorism to responders (7.4%-14.9%). State health departments provided even less training (6.3%-17.3%) on all topics to emergency medical services providers. Training that was provided by the health department in bioterrorism and public health emergency response was associated with responder comfort in responding to a bioterrorism event (OR = 2.74, 95% CI = 2.68, 2.81). CONCLUSIONS: Local and state public health agencies should work with the emergency medical services systems to develop and deliver training with an all-hazards approach to disasters and other public health emergencies.

The recent increased threat of terrorism, coupled with the ever-present dangers posed by natural disasters and public health emergencies, clearly support the need to incorporate bioterrorism preparedness and emergency response material into the curricula of every health professions school in the nation. A main barrier to health care preparedness in this country is a lack of coordination across the spectrum of public health and health care communities and disciplines. Ensuring a unified and coordinated approach to preparedness requires that benchmarks and standards be consistent across health care disciplines and public health, with the most basic level being education of health professions students. Educational competencies establish the foundation that enables graduates to meet occupational competencies. However, educational needs for students differ from the needs of practitioners. In addition, there must be a clear connection between departments of public health and all other health care entities to ensure proper preparedness. The authors describe both a process and a list of core competencies for teaching emergency preparedness to students in the health care professions, developed in 2003 and 2004 by a team of experts from the four health professions schools of Columbia University in New York City. These competencies are directly applicable to medical, dental, nursing, and public health students. They can also easily be adapted to other health care disciplines, so long as differences in levels of proficiency and the need for clinical competency are taken into consideration.