In the past columns have been directed to various disease states such as the number one killer in our society which is heart disease.  More than 600,000 deaths per year out of the two million that happen annually in the United States result from heart disease.  Number two on the list is cancer accounting for three hundred thousand deaths per year.  Number three on the list is strokes which cause about two hundred thousand deaths per year and number four on the list is chronic obstructive disease which was recently discussed as causing one hundred twenty thousand deaths per year.

     The fifth leading cause of death in the United States is accidents and injuries.  These cause more than a hundred thousand deaths per year.  As tragic as heart disease, cancer, strokes, and lung disease are, as a group they tend to be afflictions of people later in life.  Twenty-five year old individuals rarely have any of the above four problems.  But accidents and injuries are different.  They are clearly an affliction of the young and are the leading cause of death for individuals thirty years of age or younger.  The tragedy in this group is compounded by the many years of happy, mature, productive life that is snuffed out in an instant.  In addition to the more than 100,000 individuals per year that die from accidents and injuries, more than 300,000 individuals a year have some permanent deformity or residual from their accident.  Examples include those with spinal injuries who never walk again, those with head injuries who can no longer care for themselves, and those with accidental amputations.

     There is no pill or shot that reverses an injury once it has occurred. There are only two effective treatments for the injured individual.  One treatment involves surgical repair of injured parts to restore function as can be done.  The second and by far more important treatment is not to have the accident in the first place.
     I am reminded of one of the Karate Kid movies in which the young apprentice, Daniel,  asked his karate teacher, Mr. Miage, about how to defend against a certain type of attack.  In broken but very clear English, Mr. Miage replies, “Daniel san. Best defense. When blow comes, don’t be there.”  The clear message is that avoidance of the accident or the injury is not to encounter it in the first place.

     To put that message in perspective, the first and most important safety step for our population is the use of safety belts in cars.  Our state government has finally passed a seat belt law based on the overwhelming statistics favoring the use of seat belts. South Dakotans as a group are a willful independent bunch.  When I advocate seat belts, individuals offer stories about how a seat belt killed this, that or the other person.  The real truth is as below:

 1.  Eighty percent of all automobile accidents happen within six miles of home or work place at speeds less than 35 miles per hour.  This is a situation in which seat belts provide the greatest protection.
 2. The use of a seat belt would have prevented three out of four fatalities that did occur from automobile accidents.
 3.  Fifty percent of head injuries are prevented through the use of seat belts.
 4.  True to Mr. Miage’s advice, statistics have shown that individuals who wear seat belts have fewer accidents than those who do not.
 5.  For those individuals who think they can brace themselves with their arms at the time of an accident, forget it.  In order to brace yourself from a collision with the dashboard at the instant of an automobile accident at 35 miles per hour, the person would have to be able to bench press 17,000 pounds in order to prevent the collision with dashboard.
 6.  The majority of fatal vehicle accidents occur on a dry, straight, rural road.
 7.  The vast majority of fatal motor vehicle accidents result from alcohol intoxication, the non-use of seat belts and the sudden stop.  Most of the time, you read that speed is the contributing factor for an automobile accident.  It is not the speed that kills; it’s the sudden stop.  Obviously, the faster you are going when that sudden stop comes, the worse your chances are for survival.

     Moving vehicle accidents cause approximately sixty thousand deaths per year in the United States, half of which are alcohol related.  The very clear message from this column is don’t drink alcohol and drive, wear a seat belt in the car, and avoid those sudden stops.

     While moving vehicle accidents cause most of the mortalities from injuries and accidents, sports and recreational activities are the leading cause of minor injuries such as sprains and broken bones.  Gun control remains a controversial topic in the United States and an anthema in South Dakota.  Be that as it may, keeping firearms out of the hands of curious children would go a long way in preventing the eight thousand deaths a year that result from gun accidents.

     Lastly, the following two points are offered as food for thought.  Dr. Fred Harris is a trauma surgeon in Sioux Falls, South Dakota.  He supervises the Advanced Trauma Life Support educational course for physicians that I recently attended.  He commented that in past years the most dangerous situation in Minnehaha County was a 25 year old driver behind the wheel of a car.  He said in the past few years, the most dangerous thing in Minnehaha County is a person more than 60 years old on a ladder.  The second point to make has to do with keeping perspective of what the real dangers are.  Remember from above that that more than one hundred thousand people per year die from injuries and accidents.  This gets no where near the TV time that SARS does.  Yet there is yet to be a recorded death from SARS in the United States.  Please be careful and try not to do all those dumb things that kids do; traumatic fatalities are a terrible tragedy.