Introduction
and epidemiology
Injury is the leading cause of death and disability in the first four
decades of life and is the third most common cause of death overall. This holds
true even in acquired immunodeficiency syndrome (AIDS)-prevalent areas of the
world. Yet, the National Academy of Science in the United States has labelled
injury as the ‘neglected disease of modern society’. A similar view prevails
in the UK, where a leading emergency surgeon has referred to ‘trauma as the
neglected stepchild of modern medicine’. Public health officials world-wide
concede that there is a global epidemic of violence with an increasing trend
towards penetrating injury caused by knives, guns and terrorist devices. This
has led to injury as a subject of study undergoing a renaissance over the last
10 years.
In
the UK accidental and deliberate injury results in more than 18 000 deaths
annually, with 60 000 hospital admissions costing £2.2 billion, which
represents 1 per cent of gross national product (GNP). For every injury-related
death there are 10 other survivors with serious injury, two of whom will have
permanent disabilities. A staggering 120 000 people die from trauma each year in
the USA. Ballistic trauma accounts for more than 30 000 of these, most of them
in the prime of life. The cost to the USA is between $75 and $100 billion
— more than the cost of the Gulf war in