What Is on the Horizon: The Physiatrist's Role in Injury Prevention

As the focus on the spiraling cost of health care in the United States continues to draw the attention of the public, politicians, and lawmakers, it is vital that, as health care providers, we continue to contribute to the broad discussion about how the escalation of these costs can be controlled. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) continues to be active in promoting the importance of the physiatrist’s value in treating individuals with disabling injuries and medical conditions, guiding their rehabilitation to regain their functional independence, facilitating return to work or school, and promoting a greater understanding of the complexities of their medical conditions and disabilities, with the intent of minimizing future medical complications and, therefore, decreased health care costs. Nowhere has this been more evident than through the inspiring story of former U.S. Representative Gabrielle Giffords’ recovery from the traumatic brain injury that she sustained in the senseless mass shooting that took place in January 2011 in Tucson, Arizona. The vital roles that physiatry and rehabilitation have played in her recovery from these injuries have been put on public display and are clearly recognized. But there is more that we can and must do as physiatrists on the front end to address the underlying cause of Representative Giffords’ disability, one of the largest contributors to health care costs today, injuries. Injuries continue to be the leading cause of death in persons younger than 44 years of age. Of even greater significance, nonfatal injuries account for more than 29 million visits annually to U.S. hospitals, and more than 2.8 million individuals are hospitalized each year for an injury. In economic terms, in 2005, injuries accounted for $406 billion in medical and work-loss costs [1]. Our specialty is keenly aware of these patients: they make up one of the larger diagnostic groups cared for by physiatrists in our rehabilitation programs and practices, including but certainly not limited to traumatic brain injuries, spinal cord injuries, burns, and other orthopedic and traumatic injuries. Physiatrists are frequently introduced to these individuals shortly after their injuries, often while they are still in acute care, and we guide them through their recovery, manage their unique medical issues, and facilitate their functional progress as they navigate their way through the rehabilitation process from inpatients to outpatients. It is this long-term relationship with these patients, which frequently span months, years, and often decades, that provides us the perspective of understanding the impact that these types of injuries have on these individuals, not only medically and functionally but also on their relationships with family and friends, in their work and school environments, and in society as a whole. It is this unique perspective that inspires us to provide compassionate, quality medical care to optimize functional recovery, but it should also obligate each one of us to take a more active role in injury prevention. Presently, injuries and violence are unfortunately widespread in society and are so commonplace that people often accept them as just a part of life or fate. However, it is well known that most events that result in death, injury, or disability are predictable and, therefore, preventable. Accidents imply randomness, but injuries are frequently predictable, and the situations and circumstances in which they take place are known. The daily act of obtaining medical histories from these injured patients adds data and details of circumstances that led to the events. For example, national data have shown that 1 in 3 deaths from motor vehicle crashes involved an alcohol-impaired driver. Data have also shown that the