Craig Zwerling, M.D., Ph.D., M.P.H.
Department of Preventive Medicine and
Environmental Health
134 IREH, Oakdale Campus
Iowa City, Iowa 52242
Phone: 319-335-4428
Fax: 319-335-4225
E-Mail: craig-zwerling@uiowa.edu


Project Title: Rural Trauma System Evaluation
Project Period: 09/01/02-08/31/07

Description: The State of Iowa is implementing a trauma system to provide a comprehensive strategy for care of injured persons. The start date of the system was January 1, 2001, with the hospitals and EMS providers given three years to attain training. This project has three components: 1) a trauma system outcome evaluation, 2) identification of transfer patterns of cases where time and triage criteria are controversial and 3) comprehensive data collection to develop an intervention study of triage transfer protocols.

The first component will utilize pre- (1997-2000) and post- (2001-2003) data to assess the effectiveness of trauma system implementation using categorization, education, and defined criteria for triage of trauma cases. Performance (e.g. response times) and outcome indicators (e.g. mortality) will be assessed before and after implementation. Analysis will utilize databases from trauma registry hospitals, discharge data and, mortality data and will take into account the possible clustering of transfer to particular hospitals. Stratification will be done by nature and cause of injury, as well as by physiologic, anatomic, and mechanistic categories.

The second component will be examination of the data to determine transfer patterns for specific injuries, moderate or severe brain injury, spine injuries, pelvic fractures, complicated long bone fractures, burns, bite wounds and large abrasions requiring resuscitation and/or intensive wound management, major chest injuries and suspicion of aortic disruption, complicated maxillofacial trauma, major ocular trauma and trauma to the gravid female over 20 weeks gestation. Response to these injuries will be examined by EMS, area and community hospitals, and regional and resource hospitals.

The third component involves collecting information from local hospitals to develop a protocol intervention to enhance trauma assessment processes between hospitals and to develop more specific criteria for patient triage and transfer. Data will be collected from emergency departments, transfer data and hospital registries to determine the decisions for admission, treatment and transfer of patients with major critical injuries. The goal is to determine what types of injuries are best treated locally and which should be transferred based on specific capabilities.


Project Title: Rural Smoke Alarm Trial
Project Period: 09/01/02-08/31/07

Description: Fire and burns are the seventh leading cause of injury death in the United States. Although home smoke alarms reduce the risk of dying in a fire by half and the risk of having a reportable fire by three-fourths, even after nearly three decades of availability their use is not universal. There is uncertainty about whether different types of alarms or life spans of batteries could increase the prevalence of homes with working alarms. This project aims to compare the effectiveness of two alternative types of smoke alarms and two different life spans of battery. The primary study outcome is the presence of working smoke alarms. Using randomized control trial methods; we will install new, battery-powered photoelectric alarms in 400 homes and ionizing alarms in 400 homes at baseline. In half the homes in each group the alarms will have alkaline batteries, while in the other half they will have lithium batteries. Homes will be chosen randomly from the 1,004 rural homes of an existing longitudinal cohort study of health and safety. After 18 months and 42 months we will revisit the homes to determine which homes still have working alarms. If there is a between group difference in the prevalence of homes with working alarms, we will use quantitative and qualitative methods to try to determine the reasons. In addition, we will investigate two secondary study aims. First, for the 800 alarm study households, we will use logistic regression methods to identify the demographic, behavioral, and environmental risk factors from interview and observed data for failure to have all alarms working after 18 months. Second, to evaluate the validity of self-reported information on working smoke alarms, we will compare information from household interviews and inspections.


Project Title: Temperament as a Risk Factor for Bicycling Injuries
Project Period: 09/01/03-08/31/07

Description: Bicycle crashes are among the most common causes of severe injuries in childhood (Rivara, 1985). Despite growing national concern over promoting children's bicycling safety, the underlying causes of bicycle crashes remain poorly understood. In particular, little is known about the kinds of temperamental traits that put children at risk for bicycling injuries. One reason why so little is known about the behaviors that put children at risk for bicycling injuries is that it is difficult to study bicycling behavior without putting research participants at risk for injury. Another reason why so little is known about the causes of bicycling crashes is that it is difficult to study bicycling behavior in a controlled environment. Recent advances in virtual environment technology, however, offer a way to address the problem of bicycling safety in a controlled manner without putting children at risk for injury. Using a high fidelity, interactive bicycling simulator, children can be safely presented with the same kinds of bicycling challenges that they confront in the real environment.

The overall aim of this project is to use an immersive, interactive bicycling simulator to identify the kinds of temperamental traits that may put certain children at greater risk for bicycling injuries. As a first step in the research program, the focus will specifically be on children's ability to negotiate traffic-filled roadways. The specific aims of this proposal are to 1) identify temperamental traits associated with errors in negotiating traffic-filled roadways; and 2) examine how temperamental traits lead to such errors in negotiating traffic-filled roadways. Together, these studies will provide important information about who is most at risk for bicycle crashes that may lay the groundwork for the development of pediatrician-based intervention strategies for reducing bicycling injuries.


Project Title: Driver Impairment, Self-Awareness and Crash-Risk in Obstructive Sleep Apnea Syndrome
Project Period: 09/01/03-08/31/07

Description: Automobile driving is a crucial aspect of everyday life, yet vehicular crashes represent a serious public health problem. Sleepy drivers cause many automobile accidents, and drivers with sleep disorders such as Obstructive Sleep Apnea Syndrome (OSAS) are at particular risk for a crash. Sleep deprivation among OSAS sufferers causes cognitive dysfunction and increases the risk of falling asleep at the wheel. Some drivers with OSAS are especially likely to drive while impaired because they are unaware of their drowsiness and cognitive impairment. Still, the cognitive basis of driving performance errors in sleepy drivers with OSAS is not well described and few tools are available for detecting and alerting those drivers who are at greatest risk for a crash. An important step toward reducing potential future injury and damages caused by sleep-related crashes in OSAS will be to improve general understanding of the effects of sleepiness on driver performance and safety errors.

It is proposed to expand the available knowledge of driver safety in OSAS by testing a set of hypotheses. Proposed experiments will assess: (1) cognitive functions using standardized neuropsychological tests (attention, perception, memory, and executive functions), (2) physiologic indices of sleep (including EEG, autonomic functions, and lid closure), (3) standard self-ratings of sleepiness and awareness of acquired cognitive impairment, and (4) driving performance in OSAS. To measure driving performance, the investigators will use a state-of-the-art fixed-base interactive driving simulator, known as SIREN, which allows one to observe driver errors in an environment that is challenging yet safe for the driver and tester, under conditions of optimal stimulus and response control. The results of this study of 50 drivers with OSAS and 50 drivers without a sleep disorder will increase understanding of the role of cognitive impairment and self-awareness on driving safety errors and falling asleep at the wheel in OSAS. A better understanding of how driving performance deteriorates in sleepy motorists with OSAS is necessary steps in the rational development of interventions that could help prevent crashes by impaired drivers. The techniques used in this study could ultimately be adapted to develop future tools for screening, identifying, advising and alerting drivers with OSAS who are at greater risk for impaired driving due to drowsiness, cognitive dysfunction, and lack of insight into their impairment. Fair and accurate means of detecting unfit drivers with OSAS will help mitigate the tragedy of motor vehicle crashes caused by these impaired individuals.