M. Meyer1, M. C. Spalding1, M. S. O’Mara1 1Grant Medical Center/Ohio University Heritage College Of Medicine,Trauma Surgery,Columbus, OH, USA
Introduction:
Seatbelt and helmet use have been well established as effective primary prevention measures. A collision increases post-collision use of prevention, but knowing why those in a crash were not using the prevention in the first place could lead to better intervention strategies. We hypothesized that patients admitted to a level one trauma center after a motor vehicle or motorcycle crash will have noncompliance with primary prevention measures (seatbelts and helmets), and the reasons for noncompliance will not align with the benefits of prevention.
Methods:
208 consecutive patients over a two month period at a level one trauma center. All patients had been involved in a motor vehicle or motorcycle collision. Each patient gave consent and answered a 17 question survey on the circumstances of their collision, focusing on primary prevention measures use. Demographic and injury information were also collected from the patient medical record. 43 patients were excluded, due to inability to communicate, early discharge, or being less than 18 years of age.
Results:
Seatbelt users (92/129, 71.3%) were older (46 vs. 39 years, p = 0.038), had more people in the vehicle (2.0 vs. 1.5, p = 0.004), and admitted to speeding more often (11.5% vs. 0%, p = 0.04). Helmet wearers (11/36, 30.6%) varied only in gender, with women more likely to wear their helmets (OR 9.6, p = 0.009). Stated reasons for seatbelt use were “habit” (43), safety (26), and required by law (24). Most patients who were not wearing their seatbelt could not state a reason or felt it had been a bad choice (21), were not in the habit of wearing one (4), or were a backseat passenger (4). Reasons for wearing a helmet were primarily safety (7) and habit (4). Patients not wearing helmets could not state a reason (10) or did not like wearing helmets (7). Two patients stated that helmets were unsafe to wear and three stated they would wear them if a law was in place to do so (p < 0.0001). Veracity was assessed by comparing patient report of alcohol use to blood alcohol screening. 11% reported alcohol use before operating their vehicle, while 22% had a positive alcohol level (p = 0.007). 12% denied their proven alcohol consumption. 32% not wearing their helmets denied proven consumption.
Conclusion:
Consistent use of primary prevention devices relies upon establishing them as a habit. Education and mandated laws are good ways of establishing this habit. We saw this consistent pattern across our patients who had just been injured in a crash. Laws can overcome individual dislike of a device, eventually establishing a habit. Intervention at the time of injury may be useful in improving compliance, as many patients could state that not using prevention was a bad choice. More important is the group of patients that still maintained their choice to not put on a helmet was the right one. For them, education might save their life.