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It could be even worse.....

The effect of Medical Advances in Trauma Care on our Homicide rate

Over the last fifty years or so our homicide rate has increased a great deal. As Garth has often said - "This is in my lifetime!! ". In 1951, when he was born, our homicide rate was some two convictions per year. In the period 1951 to 1957 there were 18 convictions for murder (from The Encyclopedia of New Zealand 1966 here). In the 2004/2005 period, with slightly more than double the population, we had 80. This certainly does not look good. However, if we are to take homicide rates to be an indicator of the overall rate of violent crime, then it would appear we have an even worse problem.

Consider this; if medical techniques and technology were still at 1951 standards, our homicide rate would be far worse still. A good number of incidents that today result in a two-three week stay in intensive care, with an ensuing recovery (even if with reduced quality of life), would in the 50's and 60's have resulted in almost certain death. And conversely it is quite possible that one or even both of the homicides of 1951 would not have been homicides today but serious assaults and/or grevious bodily harm.

This point has already been noted overseas - this article from the British Medical Journal asserts that "Murder rates would be up to five times higher than they are but for medical developments over the past 40 years. According to new research, doctors are saving the lives of thousands of victims of attack who four decades ago would have died and become murder statistics.". Extrapolating this to New Zealand conditions our homicide rate would be in the order of 3-400 per year, much the same as our current road death toll, if it were not for the medical advances of the last half century or so.

It is also noted in the article that while the murder rate had not increased a great deal, the rate of assault had gone up by over 750 percent from 1931 to 1997. This is again consistent with New Zealand data - note the graphs on this page particularly that for Violence reported in the top graph, which increased by over 250 percent from 1978 to 1995. Were it not for the huge advances in medical trauma care, it is safe to say that some of these assaults would have been homicides. Since 1995 our violence rate has increased but not as rapidly.

So what improved

Huge progress was made in trauma care over the period from 1950 to 1980, firstly as a result of the knowledge obtained as a result of the Korean War in 1950-1953, and then the Vietnam conflict which dragged on until 1975. Innovations included the use of helicopters to transport people to care quickly, and during the Vietnam period better understanding of shock pulmonary failure resulted in improved systemic care. A considerable portion of the treatment can now be done in ambulances on the way to the hospital now, e.g a basic intravenous drip, breathing assistance etc

All this has made such a major difference as it means that most trauma patients get treated in their "golden hour" - this is the first hour after the initial incident or assault. If the person receives no attention in that time their chances of making are greatly lessened. This concept was developed during the conflicts mentioned above, and there is more here at Wikipedia.

Further advances were made in the 1980's in the US at the peak of the crime wave as hospital surgeons in the worst affected States developed new life saving techniques. As with the earlier innovations there would have been a delay of months (in the case of new techniques or ideas) or years (in the case of new technologies or equipment requiring heavy capital investment) before they were implemented here. Up to the 70's here ambulances were primarily for getting the patient to hospital, now they effectively take the hospital to the patient.

Given that the limited availability of helicopters to transport people from rural locations and the quality of NZ roads in the 50's and 60's someone attacked in New Zealand in 1951 would have been very lucky to have made it into a hospital within the "golden hour". Another consideration is that the population of New Zealand back then was also more rural, as opposed to being more concentrated in urban areas as is the case now. Furthermore these days if the case of an attack the emergency services can be alerted far faster than would have been the case in 1951. A lot of people did not even have a telephone, particularly in rural areas, and there were of course no cellphones.

What is very interesting is that if you look at the period of our most rapid increase in our homicide rates in New Zealand here on the first graph you will note that it was in the 1980's - during or just after the implementation of most of the new life saving technigues. It roughly corresponds with a sudden spike in violent offending around 1982 to 1984 (the homicide rate spiked 2-3 years later). both rates were already on the way up, starting in the early 70's. It would appear that the advances in treatment would have had a damping effect, and without them the statisitics would look far worse...

References;
A Brief History of Trauma Care by Chris Oliver MD FRCS(Orth)
The History of Trauma Care Systems From Homer to Telemedicine by Moishe Liberman, M.D, David S Mulder, M.D, John S Sampalis, Ph.D

This article is by Peter Jenkins. If you wish to use it in your own work, go right ahead. Some acknowledgement of the source i.e. Sensible Sentencing Trust would be appreciated.