The costs of a bullet--inpatient costs of firearm injuries in South Africa.

Abstract

To the Editor: South Africa has a reputation for being a violent society, with non-natural causes of death estimated to account for up to 30% of all deaths.Among these, firearm injuries are a common cause of mortality.1,2 In addition, about 127 000 individuals are treated at South African state hospitals each year for non-fatal firearm injuries.3 A previous study examined the cost of treating serious abdominal gunshot wounds in a district hospital and showed that each bullet cost taxpayers the equivalent of US$1 467. 3 Aim and methodsOur study was performed with a similar goal to that of Burch and Allard (to determine the average cost per bullet to the health care system), but we also attempted to review a broader cost perspective at the Tygerberg tertiary teaching public hospital situated in Cape Town.We applied a retrospective methodology, using a convenience sample over the last 3 months of 2006, with a number of distinct differences: we included all patients with firearm-related injuries (identified by the International Classification of Diseases (ICD) code) who required admission >12 hours, to exclude very minor injuries and those for whom care was futile, while attempting to effectively cost the real expenses of care, excluding staff salaries and laboratory and pharmacy costs.The study was approved by the Ethics Committee of Tygerberg Hospital and Umeå University. Resultsknowledge about existence of policies.Documents regulating HCW management used at the hospital were identified: the WHO Manual on Safe Management of Waste from Health Care Activities, the National Environment Conservation Act (1989), the Gauteng Health Care Waste Management Policy, the Gauteng Health Care Waste Management Regulations, the Gauteng Department of Health Code of Practice for Health Care Waste Management, and Johannesburg Hospital Policy on Waste Management.Most of the health professionals in our sample knew about the local hospital policy, with nurses having significantly greater knowledge than doctors (p<0.01). Acquiring knowledge about policies.Participants acquired knowledge about these policies through their own initiative (45, 36%), seminars or courses (40, 32%) and other means (39,

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