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Environmental Approaches to Injury Prevention

Environmental Approaches to Injury Prevention. Susan P. Baker, MPH Johns Hopkins Center for Injury Research and Policy. Unintentional and Intentional Injury. Common approaches are often appropriate regardless of intent :

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Environmental Approaches to Injury Prevention

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  1. Environmental Approaches to Injury Prevention Susan P. Baker, MPH Johns Hopkins Center for Injury Research and Policy

  2. Unintentional and Intentional Injury • Common approaches are often appropriate regardless of intent : • shootings: personalized weapons would prevent some injuries regardless of intent • poisonings: the reduced carbon monoxide content of cooking gas lowered both unintentional and suicidal death rates

  3. Passive (automatic) protection is needed because those at greatest risk of injury are: • Young children • Teenage males • Elderly people • Intoxicated people • Namely, the people whose behavior is hardest to change.

  4. Deaths/100,000 • Unintentional Poisoning Death Rates from Carbon Monoxide, U.S. 1947-79 – • The period when states gradually converted to non-poisonous natural gas – an example of passive protection and its effects.

  5. Correlation Between Hazardous Driving and Self-protectionLESS SEATBELT USE IF: • High speed • High risk situations • following too closely • running red lights • Nighttime • Young drivers • Alcohol-impaired drivers

  6. People take risks because of • Economic pressure • Productivity pressure • Competition pressure • Peer pressure • Time pressure They will often choose speed and convenience.

  7. The safest way must be the easiest way,or people will make a hazardous choice.

  8. These Sri Lankans are crossing the river using the safe walkway because it is easier than fighting the traffic. Photo by SP Baker

  9. Injuries Among the Hopi IndiansSimpson et al. JAMA 249:1873-76, 1983 • Population based study; all Hopis treated in the two relevant IHS hospitals • The authors read the hospital discharge records • Visited homes, villages to examine setting • Circumstances that were revealed • Falls from roofs • Hangings in jail • Kids falling from pickup trucks • Single-vehicle crashes – narrow, winding steep roads without shoulders or guardrails

  10. The hazardous environment of a Hopi village.

  11. Baltimore’s beautiful Harborplace. The white areas between these bricks are just for decoration. Photo by SPBaker

  12. Nearby, similar white areas mark a change in level. What happens if someone is looking upward? Photo by SP Baker

  13. As I puzzled over how best to illustrate the hazard, I heard a sudden cry. Photo by SP Baker

  14. Photo by SP Baker

  15. Residential facilities for the elderly are an environment where there are an exceptional number of high-risk people needing protection

  16. The water temp at this retirement home was 180 degrees – hot enough to poach eggs. Photo by SP Baker

  17. The cabinets were so high that someone would need to stand on a chair or stepstool to reach them. The sharp corner of the hood over the stove was at eye level Photo by SP Baker

  18. After her forehead healed, she put the bandaid on the sharp corner in case she hit it again. Photo by SP Baker

  19. Photo by SP Baker She was 92 years old, and like most seniors did not lift her feet high with each step. If she were to trip, there was no railing and the surface was hard cement.

  20. To call attention to the tripping hazard, a WHITE stripe -- unlikely to be noticed by anyone with poor eyesight. Photo by SP Baker

  21. One of these held glue, the other had eyedrops. Some people who needed eyedrops did not see well. Some glued their eyelids shut. The glue manu- facturers should have predicted that and used another shape.

  22. Deaths in Housefires • The leading cause of injury death among children in some cities. • Often they are ignited by smoldering cigarettes (cigarettes can be designed to reduce the likelihood that they will ignite fabric)

  23. 55 Housefire Deaths in BaltimoreRecord Review Showed:. • 31 (56%) in cigarette-ignited fires • 12/31 (39%) not the smokers of the cigarettes • BAC =>.10% in half of cigarette-ignited fires • Highest rates were in low-income areas Mierley and Baker, JAMA 249:1466-8,1983

  24. 40 Fatal Housefires in Baltimorevs. Median Rental Value Quintile Mierley and Baker, JAMA 249:1466-8,1983

  25. The sign is hard to read from ground level. Photo by AJ Saah

  26. Even if it could be read, this might not discourage a young climber… Photo by AJ Saah

  27. ...especially one inspired by nearby climbing equipment. Photo by AJ Saah

  28. OSHA might require someone working at this height to have some form of protection. We just say “Be careful, Timmy, and don’t push.” Photo by SP Teret

  29. This slide is built into a hill. It is steep enough to give a child a good ride, but even a fall from the top is not likely to cause injury. Photo by SPBaker

  30. Walkers place toddlers at high risk of falls down stairs. Here’s a low-risk alternative.

  31. Pacifiers like the one at left were small enough to enter a child’s airway. CPSC eventually banned them. Photo by SP Baker

  32. Some foods place children at high risk of choking. Photo by SP Baker

  33. Foods that Caused Death of U.S. Children • 17 hot dogs/sausages • 9 peanuts/nuts • 8 grapes • 6 carrots • 4 beans • 4 hard candies Harris, Baker et al JAMA 251:2231-2235, 1984.

  34. Characteristics of FoodsLikely to Cause Fatal Choking • Smooth • Hard or tough • Small • Airway-sized • Round • Pliable • Cohesive

  35. If the water is >120 F and mom has to answer the phone, disaster can result.

  36. Effectiveness varies inversely with frequency or amount of effort e.g. - To Protect A Child From Scalding Resulting Protection Prevent discharge >120 F MAX Adjust valve on heater Watch child MIN MAX MIN Frequency or Amount of Effort

  37. Should there be a committee that screens the safety of baby/toddler products before they go on the market? Will this encourage the caretaker to leave for a moment?

  38. Messages such as this are too often unseen or ignored.

  39. Whose Decisions Determine Injury? • Designers • Administrators • Legislators • Regulators • Architects • City planners Therefore we need to educate the decision-makers.

  40. Drownings in Australia, Ages 1-4Two cities with similar ratios of pools but different fencing regs.

  41. Airbag regulations followed years of work by scientists and advocates. (Initial deaths of unrestrained children resulted in design changes.)

  42. Findings re Compact Pickup Trucks Children in 2nd row of compact pickups: • Higher risk of injury than front row occupants • Predominantly head injuries • Higher injury risk than children in 2nd row of other vehicles • Higher risk of contact • Higher risk of injury given contact • Design of vehicles is decided by manufacturers who can be influenced by data.

  43. Injuries to Child Passengers by Vehicle TypeFrequency of AIS 2+ head injuriesWinston et al. JAMA 287,1147-1152, 2002 PU=pickup

  44. Photo by AL Dannenberg Look closely; do you think warnings work??

  45. Contributors • Andrew L. Dannenberg, MD • U.S. Centers for Disease Control • Alfred J. Saah, MD • Merck Research Labs • Stephen P. Teret, JD • Johns Hopkins School of Public Health

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