Est-ce qu'on pourrait affrimer gratuitement
Que les Fran�ais n'ont pas la solution 
� un probl�me qu'il n'ont pas n! ?))))))

Charles Brault


12 aout 2002-08-12 New-York Times
Medical Gains Reduce Deaths From Assaults
By THE ASSOCIATED PRESS


SPRINGFIELD, Mass., Aug. 11 (AP) � Improvements in emergency care
over the last 40 years have helped to lower the death rate among
assault victims by nearly 70 percent, a new study says.
"People who would have ended up in morgues 20 years ago are now
simply treated and released by a hospital, often in a matter of a few
days," said Anthony R. Harris, a sociology professor at the
University of Massachusetts at Amherst who led the study, published
in the journal Homicide Studies. Researchers from Harvard Medical
School also took part in the report, which looked at crime data from
1960 to 1999.
Deaths from criminal assaults dropped almost 70 percent over the 40
years, with annual declines of 2.5 percent for firearm and knife
assaults and 3.5 percent to 4 percent for other assaults, including
poisoning and arson, the researchers found.
In 1960, the police nationwide recorded 9,110 homicides and 154,320
aggravated assaults. That translated into 5.1 homicides per 100,000
people and 86.1 assaults per 100,000. The researchers found 5.6
percent of those assaults ended in death.
In contrast, in 1999 the police recorded 15,522 homicides, a rate of
5.7 per 100,000, and 911,740 aggravated assaults, a rate of 334 per
100,000. But only 1.67 percent of the 1999 assaults ended in death.
The researchers noted that there was a slight increase in deaths from
assaults in 2000 and 2001 and said they were studying it.
Their study credited a variety of medical advancements for the
improved death rate, including the development of 911 services, rapid
stabilization and transportation of trauma victims, better training
for emergency medical technicians, and more hospitals and trauma
centers, particularly in rural areas.
Without the medical advances, the researchers calculated, 45,000 to
70,000 homicides would have been recorded annually nationwide.
The results are consistent with common sense, said Dr. Stephen R.
Thomas of the Harvard Medical School, a specialist in emergency
medicine who worked on the study. Advances in trauma care since the
Vietnam War have increased survival rates for a wide array of
injuries, Dr. Thomas said.
He said that the study could raise questions about how crime
statistics are analyzed, and that researchers should consider whether
medical care has improved when assessing local changes in crime
rates.



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The following appeared in the New York Times Magazine on December
15th.
A very interesting slant on the impact of improved EMS systems:



The Ambulance - Homicide Theory



For all the theoretical talk of "broken windows" and "zero tolerance"
policing that has dominated the public discourse on crime during the
past decade, research published this year suggests that the most
significant factor in keeping the homicide rate down is something
much
more practical: faster ambulances and better care in the emergency
room.
That, in any case, is the intellectual hand grenade that Anthony
Harris, director of the Criminal Justice Program at the University of
Massachusetts, Amherst, has thrown into the polarized debate over
crime prevention.



Harris stumbled upon this simple idea after years of trying to figure
out why the aggravated-assault rate skyrocketed by several hundred
percent over the past four decades, while the murder rate has
remained
flat, never increasing or decreasing by more than 50 percent.  He had
his breakthrough a couple of years ago, while watching an
emergency-room reality TV show that featured the story of a man
stabbed in the head with a huge knife.  Despite horrendous injuries,
E.R. doctors saved the man's life.  Instead of a homicide, the
patient became an
aggravated-assault victim, and Harris realized he had the explanation
he had been looking for.  "It was an epiphany," he says.



In "Murder and Medicine," a paper published in May in the journal
Homicide Studies, Harris and three other researchers determined that
the murder rate is being artificially suppressed because thousands of
potential homicide victims each year are not receiving swift medical
attention and surviving.  Americans, in other words, aren't any less
murderous - it's just getting harder for us to kill one another.  Our
modern 911 dispatchers, E.M.S. Technicians, trauma-care units and
emergency-room surgeons have been saving patients who were on the
cusp
of becoming murder statistics and moving them into the
aggravated-assault column.


Between 1960 and 1999, the proportion of criminal assaults ending in
death - what Harris calls "the lethality rate" - dropped by 70
percent.
(The steepest decline came in the aftermath of the Vietnam War, when
advances in battlefield surgery led to innovations in civilian
emergency
care.)  In fact, Harris estimates that there would be 30,000 to
50,000
additional murders in the U.S. each year - doubling or tripling the
current rate - without our current level of emergency care
technology.

If he's right, the focus by criminologists on the stable or declining
murder rate is actually masking a radical increase of violence in
America, a fact that has unexpected consequences.  For example,
communities without access to the most advanced emergency medical
services may have higher homicide rates.  "How much is the
black-offender rate inflated?" Harris asks.  And there are strange
implications for the criminal-justice system.  An attempted murderer
carrying out his crime in an area with poor emergency services is
more
likely to succeed than one operating near a high-tech trauma center.
The former may be executed, while the latter spends just a few years
in prison, their punishments determined not by any disparity in
lethal
intent, but by the unequal levels of local medical care.






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