Devastating effects of alcohol are well established in trauma. To address this, thve American College of Surgeons Committee on Trauma (ACS-COT) requires ACS-verified Level 1 trauma centers to have an active screening, brief intervention, and referral to treatment (SBIRT) program. In 2015, NewYork-Presbyterian/Queens successfully implemented an SBIRT program. Previous studies indicate difficulty in achieving a high level of SBIRT compliance. We explored the effects of a multidisciplinary approach in implementing a standardized screening protocol for every trauma-activated patient 15 years or older. A multidisciplinary team developed a standardized approach to identifying trauma patients for our SBIRT program. Social workers were trained in performing brief interventions and referral to treatment at a New York State-level training course prior to starting our SBIRT program. Blood alcohol levels were obtained in every trauma activation. Trauma patients who had a blood alcohol level greater than 0.02% were identified and tracked by the trauma service. These patients were referred to social workers, underwent brief intervention, and evaluated for referral to treatment if determined to be a high-risk alcohol user. Over the 8-month implementation period, we evaluated 693 trauma patients. A blood alcohol level was obtained on most trauma patients (n = 601, 86.6%). Patients with a blood alcohol level greater than 0.02% were referred to a social worker (n = 157, 22.6%). Social workers performed a brief intervention and evaluation for referral/treatment services for 129 of the trauma patients with elevated blood alcohol levels. Overall, 82% of intoxicated trauma patients underwent brief intervention, which identified 22 patients who were referred for treatment programs. An inclusive multidisciplinary approach to the implementation of an SBIRT program achieves a high level of compliance.

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The overproportional rate of medical treatment of foreign children in the private practice of paediatricians and in the paediatric hospitals imposes very often special difficulties on our medical care system. These difficulties do not only result from the language barrier but also from the vast difference between the illness concepts of our medical system which bases in natural science, and the traditional concepts of the prescientific medical layman system of the foreign patients. Because of the doctors ignorance in these different cultural forms of understanding, feeling and expression of illness, as well as in the specific attitudes to the body, shown by members--specially women and girls--of the South European an Asia Minor societies, it leads often to deep misunderstandings in the doctor-patient-relation and therefore to false diagnosis and wrong treatment. This should be demonstrated in one case.

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