"The majority of patients had more minor injuries, like bruises or scratches, or they lost a finger or a toe," says Amber A. Guth, M.D., Associate Professor of Surgery at NYU and primary author of the survey, published in the March 2006 issue of the American Journal of Public Health. During the study, she served as Surgical Director of Bellevue's Intensive Care Unit. "About half the patients went home right away," she says. Among the minority who lost arms or legs, the limbs were either severed by the train itself or were so mangled that they could not be repaired by a team of vascular surgeons, neurosurgeons, and plastic surgeons.
Because of their expertise in dealing with trauma and in performing microvascular surgery on severed limbs, Bellevue sees the majority of subway accident patients in New York City. Last year, the hospital was chosen by the New York City Health and Hospitals Corporation (HHC) to be the official referral center for all the city's subway injuries.
Dr. Guth and her colleagues reviewed the cases of 208 patients treated at Bellevue from 1990 to 2003. Their average age was just under 39, though they ranged from five to 93 years old. Approximately 80 percent of the patients were male. The vast majority, 164 patients, did not lose any extremities during the accident. Among the others, injuries varied from the loss of a single finger, for six patients, to the irreparable damage of an arm or leg, for 28 patients. One person lost all four limbs. At the end of their stay, 111 people returned home, while 73 were discharged to a physical rehabilitation center or psychiatric facility. Twenty patients died in the hospital.
During the years of 2000 to 2003, 25 of 56 patients treated were unemployed, and one quarter of injuries were the result of suicide attempts.
"Our goal was really to see if we saw a pattern to the injuries," says Dr. Guth. "We were curious to see if they related to any societal changes, because people who are injured very often are very marginal people, with less economic resources and a lot of psychiatric issues."
When the results were paired with unemployment and homelessness rates, a pattern emerges. At times when the economy weakened, subway injuries did appear to increase, a trend that could be helpful in prevention efforts. "How can we identify groups that are at higher risk? How can we target these people? When you put your resources towards something, it needs to be useful," Dr. Guth explains.
One answer, says Dr. Guth, is surprisingly simple--slow down. If trains enter the station at reduced speeds, motormen would have more time to notice people on the tracks and stop before impact. Any injuries that did happen would be far less severe. In some newer subway systems, such as in Hong Kong, platforms are being built with barriers between passengers and the tracks. But in New York City, where the subway is over a century old, such changes would be prohibitively expensive, Dr. Guth explains. The article also suggests that, during dips in the economy, law enforcement officers and subway staff should be especially alert to people whose behavior suggests they are considering a suicide attempt.
The authors of the new study are: Amber A. Guth, M.D., Andrea O'Neill, R.N., Thomas Diflo, M.D., and H. Leon Pachter, M.D. of NYU School of Medicine.