Journal of the New Zealand Medical Association, 24-June-2005, Vol 118 No 1217
Angry young men, interpersonal violence, alcohol, and broken faces
Data from the Land Transport Safety Authority (LTSA) show that 30% of all fatal road crashes in New Zealand during 2003 involved alcohol, and the majority of deaths were in males aged 15 to 39 years.1 There is some evidence to suggest that programmes targeting ‘drink-driving’ may have been partly successful in heightening concerns in recent years, and campaigns through the media and roadside advertisements aim to raise public awareness of the dangers of speeding in motor vehicles. However, there remains an important escalating problem in our society of alcohol consumption and interpersonal violence, particularly amongst males in the 18 to 25 year age group.
Interpersonal violence in so-called ‘civilised societies’ tends to be directed at the upper body and in particular the head and face, with often resultant fractures of the facial skeleton. Common maxillofacial injuries are fractures of orbit, zygomatic bone, and mandible, which in the majority of cases require operative treatment. Whereas aetiological factors for these injuries in civilians 50 years ago was generally reported to be road traffic accidents, assaults, sport, industrial, and falls, the influence of excess alcohol consumption and interpersonal violence in the causation of these injuries in the latter part of the 20th century has become widely recognised.
Despite educational programmes directed at teenagers and young adults that illustrate the social and personal ill-effects of alcohol over-consumption, New Zealand along with many other industrialised nations continues to be faced with the high cost of injuries caused by apparent lack of self control.
The life-saving potential of measures such as the introduction of seat belt and crash helmet legislation, and inclusion of air bags in vehicles, illustrates how a rational approach to prevention can reduce costs to the community. Facial injury is a particularly visible consequence of alcohol misuse. Alcohol intervention programmes targeted specifically at those with alcohol-related injuries have been shown to be beneficial,2 but are time-consuming and need additional personnel and resources to be effective. However identification of at risk groups using data from studies such as that by Buchanan et al3 should be welcomed, particularly by organisations such as Alcohol Liquor Advisory Council (ALAC) as well as our politicians, so that these programmes can be correctly focussed making efforts to modify behaviour in these risk groups more successful.
Oral and Maxillofacial Surgery Units providing a service for acute hospitals in New Zealand have noted recent changes in the presentation of facial fractures and the complexity of such injuries. The specialty has a well-established training programme producing surgeons skilled in the management of facial trauma, although there has been no increase in public hospital consultant posts in the specialty in New Zealand over the last 15 years. The increasing incidence of these fractures demands adequate clinical resources (in particular, available operating theatre time) to accommodate the treatment of patients in a timely manner.
Many Units continue to be frustrated by significant delays without regular access to necessary trauma lists. Indeed, District Health Boards (DHBs) providing these specialty services for its community should be urged to determine appropriate funding and staffing levels for these Units.
Author information: Leslie Snape, Oral and Maxillofacial Surgeon, Christchurch Hospital, Christchurch
Correspondence: Mr Leslie Snape, Oral and Maxillofacial Surgery, Christchurch Hospital, Private Bag 4710, Christchurch. Fax: (03) 364 1043; email: firstname.lastname@example.org
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