Work-related injuries seen in the emergency department continue a long-term decrease. This is reflected in the payer mix of patients. Worker’s compensation was the payor source for 3.9 percent of ED visits in 1995 (3.8 million visits), and that has decreased steadily over the last 20 years to 0.8 percent in 2015 (1.1 million visits). Work injury reductions are a huge public health success!

Multiple or system-wide injuries were the outcome in an estimated 8.4 million visits. Where there were isolated injuries, the count was highest for the upper extremity, with an estimated 6.2 million injury visits related to that area. Next was the lower extremity at 5 million visits, the head at 4.6 million, the torso at 1.6 million, and the spinal column at 1.5 million.

There is a continuing decrease in the prevalence of injuries presenting to the ED. This success story has continued for at least 23 years, and has been one important factor in the changing mix of ED patients.

Emergency physicians are important contributors to injury prevention programs of all types, and should consider this change in patient mix a tremendous success. There is always more work to be done. There is an opportunity to ask your emergency medicine and EMS colleagues to look at regional data and further efforts at injury prevention for the patient populations being served.

• Can the emergency department identify trends that would lead to improved public health programs targeted to the service community?
• Does the ED staff talk to elderly patients, particularly female patients, about reducing injuries?
• Where are the injury programs that can further target the parents and members of the pediatric population? This is the group that has life-long repercussions from significant injuries. Educational efforts that start with uniform application of child safety seats, use of safety helmets in appropriate activities, safe sports and recreational programs, and even the reduction in distracted walking and texting will continue the public health benefits of injury reduction.

In the ED, the bottom line is to expect more illnesses than injuries in the “patients to be seen” column of the tracking board.

Reference

1. National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables. Centers for Disease Control and Prevention website. Available at
   https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf. Accessed July 22, 2018.