Super Bowl Sunday means OT for EDs

Ronald Charles, MD, medical director of the emergency department at the University of Texas Medical School in Houston, doesn't mind working during the Super Bowl. He may not get to watch the game, but it's a quiet time in an otherwise frantic place. The game, watched by 130 million people, is perhaps the most popular television event of the year -- a cause to celebrate.

It's usually after the final play that the real action in the ED begins.

Dr. Charles expects that the end of this year's contest will bring the usual onslaught of patients who have passed out because of what they drank or who sustained traumatic injuries linked to alcohol-, drug- or fatigue-clouded judgment.

There will be the guys who communicated with their fists over referee calls or quarterback quality. There also will be the injured weekend warriors who, despite their usual inactive lifestyle, are inspired to go out and toss the old pigskin.

Meanwhile, those with chronic medical conditions may not be able to handle the deluge of food -- most of it high in fat, salt and sugar -- and may have neglected to take their medications.

Health data connected to the Super Bowl are limited. In general, emergency physicians report that what they see has much in common with the aftermath of other celebrations such as New Year's Eve or Cinco de Mayo.

"We are extra busy any time people have a tendency to celebrate excessively and then exhibit poor judgment," said Roger J. Lewis, MD, PhD, director of research in the Dept. of Emergency Medicine at Harbor-UCLA Medical Center.

Defending against risks

Recent findings indicate that the automobile may be the biggest risk factor, at least after the game.

A research letter published in the New England Journal of Medicine last January reported a 41% increase in traffic fatalities across the country on Super Bowl Sunday compared with other Sundays. States that are home to losing teams have shown even bigger jumps.

"The surge is larger than the one observed during New Year's Eve," said Don Redelmeier, MD, lead author and professor of medicine at the University of Toronto. "This might have something to do with a combination of alcohol, distraction and fatigue."

And this is where public health comes in. Some physicians are taking the opportunity to reiterate healthy eating and drinking messages and warn people to celebrate responsibly because, beyond the acute injuries, there is also some concern about the long-term impact -- particularly on the waistline.

A 2003 survey by NFO Plog Research, a New Jersey-based market research firm, found that a significant number of viewers reported that they ate more junk food during the Super Bowl than during any other occasion.

"Everyone at the new year has a resolution saying they're going to eat right, and then here comes the Super Bowl tempting us to once again break our resolution," said Jimmy Guidry, MD, state health officer at the Louisiana Dept. of Health and Hospitals. "Everything should be done in moderation."

Experts point out that occasional excessive food and drink intake will not cause long-term harm, but it will if it is part of a regular pattern.

"One day doesn't mean anything," said Lee Fischer, MD, a family physician based in West Palm Beach, Fla. "The problem is that most of us are doing it on a small scale every day."

This year's Super Bowl will be Feb. 1, and no one is calling for the experience to be dramatically altered. Some people, however, are suggesting steps to make it more safe.

"It's exciting entertainment that is thrilling for millions of people to watch," Dr. Redelmeier said. "Our recommendations are that people avoid unnecessary nighttime driving on Super Bowl Sunday. Trauma centers should consider extra night staff, and sponsors should consider subsidized taxis or free public transit, as is done in many places on New Year's."