Imagine a country road in the summer. Wind blows across fields of barley, heat rises from the pavement and occasionally a car goes past, breaking the tranquility.
Contrast that with the image of the hot, bustling city, where sun glints off skyscrapers, taxicabs blare their horns and hidden danger lurks around every corner.
Which is safer?
According to a study conducted by the Perelman School of Medicine at the University of Pennsylvania and the Childrens Hospital of Philadelphia, its the city.
In a article titled Safety in Numbers: Are Major Cities the Safest Places in the United States? soon to appear in the Annals of Emergency Medicine, researchers found that when all types of fatal injuries are considered together, risk of injury-related death was about 20 percent lower in urban areas than in most rural areas of the nation.
After analyzing more than 1.2 million injury-related deaths in the United States, the study found that the top three causes of death across the entire population, as well as most age subgroups, were motor vehicle accidents, firearms and poisoning.
Its an interesting study. Well see how we can mesh that into our thinking here, said Charles F. Brenon III, director of Jefferson County emergency services.
Jefferson County traditionally has been considered predominantly rural, though it recently was identified by the U.S. Census Bureau as the fastest-growing county, by percentage, in the state.
Given those seemingly contradictory terms, the county defies easy categorization, Mr. Brenon said.
According to maps provided by the study, Jefferson County falls right in the middle of the urban-rural continuum, right in the middle of the population density continuum, and on the low side of the death rates continuum.
Succinctly put, the county is like the third option in the Goldilocks story just right with fewer deaths from injury than most rural areas of the United States.
But the county does fit the rural profile advanced by the study in one major respect: motor vehicle accidents.
Motor vehicle accidents are the leading call for trauma here in the county, Mr. Brenon said.
In 2012, agencies within the county responded to 3,305 calls involving motor vehicle injury accidents.
The second highest number of calls involved chest pain, cardiac/respiratory arrest and breathing problems. Combined, there were 3,040 calls for those types of emergencies.
The third highest number of calls, 2,026, were received about individuals injuring themselves after falling in their homes.
After that came calls related to overdoses, poisoning, psychiatric incidences, abnormal behavior and suicide attempts a total of 980 calls.
The county dispatch log does not include a category for injuries related to firearms, Mr. Brenon said.
The dispatch numbers are somewhat inflated because they account for all agencies that respond to calls.
For instance, if a sheriffs deputy, an ambulance service and a fire department all go to the same scene, three separate calls would be logged.
But the numbers are indicative of the call types that are consuming the most resources, according to Mr. Brenon.
The fact that falls have begun to account for such a large number of emergency dispatches has not escaped the notice of public health officials.
Falls may be preventable through public health programs, Mr. Brenon said. Were just starting to use this data as a prevention tool, so I think this will be good for the EMS agencies, the county and the public.
Mr. Brenon said the county may need to start looking at ways to curb the number of motor vehicle accidents, starting with reinforcing the notion that using cellphones while driving is dangerous.
You cannot believe the number of people texting and talking on cellphones. They just dont understand the risks they are taking. Its discouraging when you see the statistics and all the public service announcements and still see people doing it, Mr. Brenon said.
The study also looked at access to Level I and II trauma centers in each county.
Often, being able to transport an injured person to a trauma center can mean the difference between life and death.
But after adding the proximity to trauma centers to the data as a variable, researchers found that access to trauma centers had a minimal effect on the association between injury-related mortality rate and the urban-rural nature of the county.
Researchers discovered that 61.7 percent of counties had no Level I or II trauma centers.
According to the state Trauma Program, a Level I, or regional, trauma center has specialists in varied surgical and non-surgical fields available 24 hours a day. A Level I trauma center is capable of treating 1,000 severely injured patients a year and will not treat fewer than 400 patients a year.
A Level II, or area trauma center has emergency medicine specialists and general surgeons available 24 hours a day. Other medical specialists are on call. A Level II trauma center will treat at least 250 patients a year.
The closest trauma center available to Jefferson County residents is Upstate Medical University in Syracuse, a Level I facility about 70 miles from Watertown.
The closest trauma center geographically is in Kingston, Ontario, about 30 miles by air from Watertown, Mr. Brenon said.
However, It would take literally an act of Congress to gain access to that facility, he said.
Before it closed, Mercy Hospital in Watertown was a Level II trauma center, Mr. Brenon said.
But putting a trauma center in Watertown is a tricky proposition because there is not enough demand for those services in the county, according to Mr. Brenon.
Surgery, especially trauma surgery, is a specialized niche. Those skills would erode here for lack of use, he said.
In lieu of a trauma center, in 2008 the county began designating landing zones along the Interstate 81 corridor to facilitate transportation to Syracuse.
The Safety in Numbers article concludes with a recommendation to identify local injury prevention priorities, reexamine emergency medicine certification and training requirements and consider prioritizing trauma center placement according to need.