Chest trauma in Far North Queensland: alcohol management can make a difference
Chest trauma in Far North Queensland: alcohol management can make a difference Journal Article
Australian and New Zealand Journal of Public Health
- Author(s): Jennings, Scott, Whitaker, Richard, Turner, Richard
- Published: 2012
- Publisher: Blackwell Publishing Ltd
- Volume: 36
- ISBN: 1753-6405
Abstract: My colleagues and I wish to convey the findings of a research project recently conducted in Far North Queensland (FNQ), Australia. Alcohol-related violence in FNQ Indigenous communities has been an issue for some time. This has prompted the Queensland Government in consultation with affected Indigenous communities to introduce the Making Choices, Meeting Challenges (MCMC) initiative. Specifically, the MCMC initiative introduced alcohol-management policies (AMPs) within these communities imposing certain restrictions on the sale, quantity and type of alcohol permitted in each community. AMPs and similar strategies have proven successful in other Indigenous communities, both nationally and internationally when struggling with alcohol-related violence. The AMPs came into effect in 2002 with a staggered implementation across affected communities. Penetrating and lacerating chest trauma (PLCT) secondary to interpersonal violence is a serious act and it is postulated that it could be used as a proxy-measure for underlying social unrest within a community. Since the introduction of AMPs, anecdotal observation by medical staff at Cairns Base Hospital (CBH) was that PLCTs secondary to interpersonal violence had noticeably decreased. It was hypothesised that with the introduction of AMPs had brought about a decrease in the level of violence within affected Indigenous communities. CBH is ideally suited to capture trends in PLCT by being the tertiary referral centre for FNQ, encompassing the affected communities and with serious chest traumas requiring retrieval. To support this hypothesis, a retrospective chart review, with appropriate human research ethics committee approval and Indigenous adviser input (special thanks to Dallas McKeown-Young for her ongoing assistance) commenced in 2008. This review examined all PLCTs referred to CBH from 2001 to 2006 and mortalities from the National Coroner's Information Service. Cases were identified by use of the ICD-10: Australian Modification codes, S21 to S29: Injuries of the Thorax. During this time 127 cases were identified with temporal trend patterns subjected to regression using Generalized Linear Models with significance set at p<0.05. The initial PLCT incidence rate for the FNQ region was 12.9/100,000 in 2001, falling to 6.9/100,000 in 2006, a statistically significant reduction (p=0.007). Examination of the MCMC communities revealed a very high 2001 PLCT incidence rate of 119.5/100,000, however, by 2006 this rate had fallen considerably to 18.7/100,000. Although these are small communities in absolute size, the reduction observed was statistically significant (p<0.0001). Our research demonstrated an almost two-fold decrease in the incidence of PLCT in FNQ from 2001 to 2006, thus confirming original anecdotal evidence. Further analysis of Indigenous communities with AMPs, to which much of the region's PLCT was attributed, showed a greater than six-fold reduction. This was a gradual but consistent decline over the six-year period, and would appear to correlate historically with the staggered introduction of AMPs in 2002. One limitation influencing these results, however, is the relatively small population of the communities reviewed, meaning that a small change in case numbers greatly influences incidence rates (Table 1). The trends, nevertheless, remained significant on statistical testing. The timeframe of the study was also relatively short, due to the paucity of electronic records and data indexing prior to 2001. The six-year census period nonetheless captured the formal implementation phase of the policy in question with the study design being basically correlational.