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Lessons from the DeadChris  Hartlove

Lessons from the Dead (continued)


Back in the 1960s, Sue Baker was working toward her MPH at the School when she decided to examine the relationship of automobile accidents to chronic diseases such as alcoholism. Her idea was to compare the autopsy records of drivers who were responsible for their fatal crashes with those of drivers who were merely victims.

 She found a willing partner in forensic pathologist Werner Spitz, then Maryland’s deputy chief medical examiner.

“Before Sue, no one had ever suggested or thought of using files of people who had sustained severe injuries and died, then analyzed them and thought, ‘Well maybe this can be changed or prevented,’” Spitz recalls. “Nowhere in this country was that material ever touched. It filled up the drawers and the filing cabinets and there it stayed, collecting dust—until Sue brought it back to life.”

In the early days, before she had her own office, Baker would pore over records at a big square table in the room where residents changed out of their scrubs and dictated notes from their autopsies.

“I had big ears and lots of questions, and they were nice about answering them,” recalls the 82-year-old Baker today. “They helped me understand what I was reading in the reports. Although I was pre-med in college, and had taught anatomy and physiology to student nurses after graduation, this was a whole new world with its own vocabulary.”

To identify cases to study, she worked her way through ledgers where cases were entered with numerical codes to identify the cause of death. Looking into the choking risks that balloons posed to children, for instance, she might search the code assigned for choking on objects as well as the one assigned for choking on food. Then she would pull the manila folder files that supplied details of the autopsy findings, the toxicology findings and the police report. (Eventually, in that case, she identified hot dogs as the leading cause of childhood choking deaths.)

Spitz remembers Baker quietly gathering data on the adequacy of medical care received by 33 drivers, passengers and pedestrians who died at hospitals following severe abdominal injuries in motor vehicle crashes. Her research showed that half of the deaths may have been prevented by proper diagnosis and prompt treatment, leading to the effort to transport such patients to major trauma centers rather than local hospitals. Spitz was an author on that early study, as well as on papers on highway safety and alcohol published in The New England Journal of Medicine and JAMA.

Before Sue Baker, no one had ever thought to look in medical examiners’ dusty filing cabinets, analyze the findings and learn how to prevent severe injuries.

“Sue was like a paper mill, publishing something every few months,” he says. “Not only did she need that, but we forensic pathologists needed to show the community of physicians and institutions of higher learning that there is something to be looked at in the medical examiner’s office. It’s not just a place where you cut up bodies.”

Over the next four decades, Baker published more than 250 papers, most of them spurred by data from death records. In addition to helping secure mandatory child safety seats in cars and graduated driver’s licensing for new drivers, her research also led to ways to decrease fatalities in aviation and house fires, and to reduce incidents of carbon monoxide poisoning, drowning, childhood asphyxiation and falls among the elderly.

Along the way, she also founded the nation’s first injury control research center to promote injury prevention as a scientific discipline. The Johns Hopkins Center for Injury Research and Policy (CIRP), which celebrated its 25th year in 2012, works to reduce injuries through research, education, policy and practice.

In 2010, Baker became the first injury control researcher to receive the Frank A. Calderone Prize in Public Health, one of the highest honors in the field. And this year the National Association of Medical Examiners established an annual award in Baker’s name to recognize research that demonstrates the greatest potential for public health impact.

The award is a key feature of what chief medical examiner Dave Fowler calls “the Sue Baker Wall” at the state’s $54 million forensic medical center. Under his leadership, a staff of 15 forensic pathologists performs roughly 4,300 autopsies a year as part of the state’s investigation into any death occurring from violence, suicide or casualty, or in any other suspicious and unusual manner. Also reviewed are sudden deaths of people in previously good health who die unattended by a physician.

Nothing, perhaps, has proved more important than using such death records to protect children. In the 1970s, Baker gathered data that showed how infants in their first six months of life had a significantly increased risk of dying in a car crash because their mothers held them in their arms or laps. Evidence from the grim records she read contributed to the policy changes that require kids to ride in car seats today. From 1975 through 2008, child restraints saved the lives of an estimated 8,959 children under the age of 5, according to the National Highway Transportation and Safety Administration.

In the early 1980s, Andrea Gielen, who now directs CIRP, found herself using these data as a new School alumna working at the Maryland Department of Health and Mental Hygiene to create the state’s first child passenger safety program.

“I realized I found my passion,” says Gielen, who studied with Baker. “[Injury prevention] combined so many elements: studying risk and protective factors, educating the public and conducting community advocacy to get the law on the books and programs in place to make sure it was effectively implemented.”

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Death and Data (3.9MB)
Death and Lifespan (2.0MB)
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