Wednesday, May 16, 2012

Survive the ED - Good Outcome? Maybe Not...

Back in the 90's I worked at Battelle Memorial Institute Centers for Public Health Research and Evaluation in Baltimore, developing database software to collect and analyze public health information. Battelle is a pretty unique organization, in that their charter is to only do work that is "good". Public health research meets that criterion. I liked working there a lot, because everyone there was well educated and really, really smart. Smarter than me for sure.

Our biggest customer was the Centers for Disease Control and Prevention (CDC), and one of their pet projects was to find ways to increase the use of bike helmets. Smart people at CDC (Jeff Sachs) reasoned that if we could demonstrate to each state government that they could save money by enacting laws that required the use of bike helmets by everyone, they would do it, and the CDC would have succeeded in their mission, by preventing some terrible head injuries. It turns out that bike helmets are really effective at that, and that biking without a helmet is a good way to get a terrible head injury (although apparently scientists argue about the relative risk associated with bike helmet disuse, relative risk being a concept that I still cannot fully understand).

Schwinn Thrasher Adult Micro Bicycle Helmet (Adult)
A bike helmet. You should wear one if you ride a bike.
So I got the project to write the Preventable Injuries, Costs, and Related Deaths (PICARD) application. Woo-hoo. It was daunting. They fed me tons of economic data (projections for lost income, cost to the state to care for these people, much more) , medical outcome data (how many people survive the ED to linger in a brain-damaged state for dozens of years after a helmet-less bike crash, and at state expense, versus what those numbers would be with helmet laws), figuring out what the prevalence of helmet use would be under different circumstances, on and on with arcane to me concepts like these.

It's a stout metal rod with a short
leash at the end. You attach it
to your seat post. Keeps the dog
right where you see this one, safely
away from the bike and running
alongside. It works.

I went to my great boss Jane and said HELP, I'm not qualified as a business analyst to figure these data out. So she got me an economist and a biostatistician to tell me what all this stuff meant. Wow. Jane, you rock! And then I was the weakest member of the team, and grateful for that, and I got the software built with their help. Couldn't have succeeded without those guys.

So Kim and I decided that our dog Phoebe needs more exercise, and that a way to do that was to increase the intensity rather than the amount/time of exercise she gets. How? Strap her to a bike and run her. 

We get a bike, and a device  to lash Phoebe safely to it, which keeps her from getting tangled up in the wheels, chain, etc. Off we go.

Phoebe was a little skittish on our first test ride, but she got with it much quicker than I thought she would. She didn't pull the bike over like I thought she might. I think she'll do better tomorrow morning when she has a lot more energy.

I also got a bike helmet. We both thought that after all the pain of building PICARD, if I did this without a helmet, God would see and be unable to resist the irony of having me go down head first, survive the ED, and then spend the rest of my life wrecked with a terrible head injury. I'm wearing it. Every ride.


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