Q & A with Raul Coimbra: Treating Trauma as a Disease
Trauma. The word itself invokes images of an emergency: a car accident, heart attack, or bad fall. Something that cannot be anticipated but requires immediate action.
However, many causes of trauma can be prevented, and therefore fit the criteria for disease, according to Raul Coimbra, MD, PhD, chief of Trauma, Surgical Care, and Burns for UC San Health System and co-director of the Injury Epidemiology, Prevention and Research Center. We’ve asked Coimbra several questions about how people can prevent trauma and why trauma needs to be treated as a preventable disease.
Question: It’s trauma awareness month – why is it important for the community to recognize this and understand their role in prevention?
Answer: Trauma is a disease that kills more people between one and 45 years of age than any other disease in the world. In addition, trauma leads to more years of life lost than any other disease, including cardiovascular diseases and cancer. Productive individuals are being taken away from their families, their jobs, and their environment because of injuries. Many die, and for every death, six individuals will be forever disabled. However, this is a completely preventable disease. The public has a responsibility in preventing injuries, as in most circumstances, it is human behavior that leads to injury.
Q: What are some simple prevention tips people can implement in their homes, yards, etc. that could save them a trip to the trauma center or even their lives?
A: For children at home, the most frequent causes of injury are drowning and burns. Therefore, the use of fences with alarms around swimming pools and constantly watching kids in the kitchen so they cannot reach out to frying pans or boiling liquids on the stove is very important. For the adult population, drinking and driving is a very common cause of injury. Avoiding driving after drinking, finding a designated driver, or catching a cab would be examples of preventive strategies. In the elderly population, securing rugs and furniture on the floor, as an example, will decrease the risk of injury at home. For all ages, wearing a seat belt while driving is key.
Q: Most people don’t think of trauma as a disease. Please explain this philosophy.
A: Trauma is a disease like any other. We know how to define it, we know how to treat it, and more importantly, we know how to prevent it, therefore, it is a disease like any other. Unfortunately, the public’s perception is that trauma is an accident that only happens to somebody else, but that is not the case.
Q: San Diego’s trauma system is used as a model worldwide. What makes it successful and what are your goals for future trauma systems?
A: San Diego has one of the most organized trauma systems in the world. The commitment of six trauma centers and the county EMS has been the same for the last 28 years. This is a model trauma system, and I would go even further to say that our system is a model for regionalized care applicable to any disease. Competing healthcare systems work together, in a very collegial way, to provide the best care possible to trauma patients. As a result, the San Diego trauma system has one of the lowest preventable death rates in the world. In our system, we do not compete with each other; we work together on behalf of the injured patient.
The trauma program at UCSD has provided guidance and help to many other systems in the world, and we plan to continue with those activities. We have received healthcare providers from several countries who spend three weeks with us learning the intricacies of the system and how to build an effective trauma center. This international outreach is very important in disseminating the concept of trauma as a disease. Just as an example, in August 2012, we will be presiding the first World Trauma Congress in Rio de Janeiro, Brazil, where we will be discussing a global agenda for trauma care, particularly focusing in middle and low income countries, where trauma is the most important health care problem.
Coimbra discussing state-wide trauma system