Injury prevention in the Indian Health Service: a role for primary care providers.

Injuries are the second leading cause of death and disability for American Indians and Alaska Natives. Motor vehicle crashes kill Native Americans at three times the rate of the overall U.S. population, with much higher rates for many rural, western Indian reservations. Injuries are the main cause of death for Native American children. Increased risk of death due to injury for Native Americans is partly because so many live on reservations in rural, isolated areas. Lack of ready access to advanced emergency trauma care is a major factor. Rural two-lane highways have higher motor vehicle-related fatality rates, and seatbelt use tends to be lower in rural areas and on reservations. Alcohol use may be a factor in Native American injuries. In 1987, the Native American alcoholism death rate was six times the overall U.S. rate. The Indian Health Service (IHS) has developed an injury surveillance system targeting severe injuries resulting in hospitalization or death. Such data help determine the need for public health action. Through the efforts of Indian tribes and the IHS, there are now intervention programs in all IHS areas to prevent injuries. Primary care providers play an important role as injury prevention advocates by educating parents, advising and screening patients, and serving on injury prevention teams. One crucial injury control strategy is screening, counseling, and referring patients with alcohol problems. Early recognition and referral of subjects at high risk for suicide is also critical for Native Americans. Primary care practitioners are in a key position to encourage patients to improve their lifestyles and make their homes and communities safer.