ATLS-9e_eLearn_InjuryPrev.v1.pdf
Content
Injury Prevention
Introduction
Injury should not be considered an “accident,”
which is a term that implies a random circumstance
resulting in harm. In fact, injuries occur in patterns
that are predictable and preventable. The expression
“an accident waiting to happen” is both paradoxical
and premonitory. There are high-risk individuals
and high-risk environments. In combination, they
provide a chain of events that can result in trauma.
With the changing perspective in today’s health care
from managing illness to promoting wellness, injury
prevention moves beyond promoting good health
to take on the added dimension of reducing health
care costs.
Prevention is timely. Doctors who care for
injured individuals have a unique opportunity to
practice effective, preventive medicine. Although the
true risk takers may be recalcitrant about any and all
prevention messages, many people who are injured
through ignorance, carelessness, or temporary loss
of self-control may be receptive to information
that is likely to reduce their future vulnerability.
Each doctor–patient encounter is an opportunity to
reduce trauma recidivism. This is especially true for
surgeons who are involved daily during the period
immediately after injury, when there may be opportunities to truly change behavior. The basic concepts
of injury prevention and strategies for implementation through traditional public health methods are
included in this appendix.
Classification of Injury Prevention
Prevention can be considered as primary, secondary,
or tertiary. Primary prevention refers to elimination of
the trauma incident completely. Examples of primary
prevention measures include stoplights at intersections, window guards to prevent toddlers from falling,
swimming pool fences to keep out nonswimmers and
prevent drowning, DUI laws, and safety caps on medicines to prevent ingestions.
Secondary prevention accepts the fact that an
injury may occur, but serves to reduce the severity of
the injury sustained. Examples of secondary prevention include safety belts, airbags, motorcycle and bicycle helmets, and playground safety surfaces.
Tertiary prevention involves reducing the consequences of the injury after it has occurred. Trauma
systems, including the coordination of emergency
medical services, identification of trauma centers, and
the integration of rehabilitation services to reduce
impairment, constitute efforts at tertiary prevention.
Haddon Matrix
In the early 1970s, Haddon described a useful approach
to primary and secondary injury prevention that is
now known as the Haddon matrix. According to Haddon’s conceptual framework, there are three principal
factors in injury occurrence: the injured person (host),
the injury mechanism (e.g., vehicle, gun), and the environment in which the injury occurs. There are also
three phases during which injury and its severity can
be modified: the pre-event phase, the event phase (injury), and the post-event phase. Table 1 outlines how
the matrix serves to identify opportunities for injury
prevention and can be extrapolated to address other
injury causes. The adoption of this structured design
1
2 Injury Prevention
Table 1 Haddon’s Factor-Phase Matrix for Motor Vehicle Crash Prevention
PRE-EVENT
EVENT
POST-EVENT
Host
Avoidance of alcohol use
Use of safety belts
Care delivered by bystander
Vehicle
Antilock brakes
Deployment of air bag
Assessment of vehicle characteristics
that may have contributed to event
Environment
Speed limits
Impact-absorbing barriers
Access to trauma system
by the National Highway Traffic Safety Administration resulted in a sustained reduction in the fatality
rate per vehicle mile driven over the past two decades.
The Four Es of Injury Prevention
Injury prevention can be directed at human factors
(behavioral issues), vectors of injury, and/or environmental factors and implemented according to the four
Es of injury prevention:
■■
Education
■■
Enforcement
■■
Engineering
■■
Economics (incentives)
Education is the cornerstone of injury prevention.
Educational efforts are relatively simple to implement;
they promote the development of constituencies and
serve to bring the issue before the public. Without
an informed and activist public, subsequent legislative efforts (enforcement) are likely to fail. Education
is based on the premise that knowledge supports a
change in behavior. Although attractive in theory,
education in injury prevention has been disappointing
in practice. Yet it provides the underpinning for implementation of subsequent strategies, such as that to
reduce alcohol-related crash deaths. Mothers Against
Drunk Driving is an organization that exemplifies the
effective use of a primary education strategy to reduce
alcohol-related crash deaths. Through their efforts, an
informed and aroused public facilitated the enactment
of stricter drunk-driving laws, resulting in a decade of
reduced alcohol-related vehicle fatalities. For education to work, it must be directed at the appropriate target group, it must be persistent, and it must be linked
to other approaches.
Enforcement is a useful part of any effective
injury-prevention strategy because, regardless of the
type of trauma, there always are individuals who resist
the changes needed to improve outcome—even if the
improved outcome is their own. Where compliance
with injury prevention efforts lags, legislation that
mandates certain behavior or declares certain behaviors illegal often results in dramatic differences. For
example, safety belt and helmet laws resulted in measurable increases in usage when educational programs
alone had minimal effect.
Engineering, often more expensive at first, clearly
has the greatest long-term benefits. Despite proven
effectiveness, engineering advances may require concomitant legislative and enforcement initiatives, enabling implementation on a larger scale. Adoption of air
bags is a recent example of the application of advances
in technology combined with features of enforcement.
Other advances in highway design and safety have added
tremendously to the margin of safety while driving.
Economic incentives, when used for the correct
purposes, are quite effective. For example, the linking
of federal highway funds to the passage of motorcycle
helmet laws motivated the states to pass such laws and
enforce the wearing of helmets. This resulted in a 30%
reduction in fatalities from head injuries. Although
this economic incentive is no longer in effect, and rates
of deaths from head injuries have returned to their
previous levels in states that have reversed their helmet statutes, the association between helmet laws and
reduced fatalities confirmed the utility of economic
incentives in injury prevention. Insurance companies
have clear data on risk-taking behavior patterns, and
the payments from insurance trusts; discount premiums are available to those who avoid risk-taking
behavior.
eveloping an Injury Prevention
D
Program—The Public Health
Approach
There are five basic steps to developing an injury
prevention program: Analyze the data, Build local
coalitions, Communicate the problem, Develop and
implement injury prevention activities, and Evaluate
the intervention.
ANALYZE THE DATA
The first step is a basic one: define the problem. This
may appear self-evident, but both the magnitude and
community impact of trauma can be elusive unless
reliable data are available. Population-based data on
injury incidence are essential to identify the problem
and provide a baseline for determining the impact of
subsequent efforts at injury prevention. Information
from death certificates, hospital and/or emergency
department discharge statistics, and trauma registry
printouts are, collectively, good places to start.
After a trauma problem is identified, its causes
and risk factors must be defined. The problem may
need to be studied to determine what kinds of injuries
are involved and where, when, and why they occur.
Injury-prevention strategies may begin to emerge with
this additional information. Some trauma problems
vary from community to community; however, there
are certain risk factors that are likely to remain constant across situations and socioeconomic boundaries.
Abuse of alcohol and other drugs is an example of a
contributing factor that is likely to be pervasive regardless of whether the trauma is blunt or penetrating, the
location is the inner city or the suburbs, and whether
fatality or disability occurs. Data are most meaningful
when the injury problem is compared between populations with and without defined risk factors. In many
instances, the injured people may have multiple risk
factors, and clearly defined populations may be difficult to sort out. In such cases, it is necessary to control
for the confounding variables.
BUILD LOCAL COALITIONS
Strong community coalitions are required to change
the perception of a problem and to design strategies
that are likely to succeed in an individual community.
What works in one community may not work in another, and the most effective strategy will fail if the
community targeted for intervention does not perceive
the problem as important.
COMMUNICATE THE PROBLEM
Whereas sentinel events in a community may identify
an individual trauma problem and raise public concern, high-profile problems do not lend themselves to
effective injury prevention unless they are part of a
larger documented injury-control issue/injury prevention strategy. Local coalitions are an essential part of
any communication strategy, not only in getting the
word out but in designing the message that is most
likely to be effective. Members of the media are also
key partners in any communication plan.
Injury Prevention 3
DEVELOP AND IMPLEMENT
PPREVENTION AACTIVITIES
The next step is to develop and test interventions. This
is the time for pilot programs to test intervention effectiveness. Rarely is an intervention tested without some
indication that it will work. It is important to consider
the views and values of the community if an injury prevention program is to be accepted. End points must be
defined up front, and outcomes reviewed without bias.
It is sometimes not possible to determine the effectiveness of a test program, especially if it is a small-scale
trial intervention. For example, a public information
program on safety-belt use conducted at a school can
be assessed by monitoring the incoming and outgoing school traffic and showing a difference, whereas
the usage rates in the community as a whole may not
change. Nonetheless, the implication is clear—broad
implementation of public education regarding safetybelt use can have a beneficial effect within a controlled
community population. Telephone surveys are not reliable measures to confirm behavioral change, but they
can confirm that the intervention reached the target
group.
With confirmation that a given intervention can
effect favorable change, the next step is implementation of injury-prevention strategies. From this point,
the possibilities are vast.
EVALUATE THE IMPACT OF AN
INTERVENTION
With implementation comes the need to monitor the
impact of the program or evaluation. An effective injury-prevention program linked with an objective means
to define its effectiveness can be a powerful message
to the public, the press, and legislators, and ultimately
may bring about a permanent change in behavior.
Injury prevention seems like an immense task,
and in many ways it is. Yet, it is important to remember that a pediatrician in Tennessee was able to validate the need for infant safety seats that led to the
first infant-safety-seat law. A New York orthopedic
surgeon gave testimony that played an important role
in achieving the first safety-belt law in the United
States. Although not all doctors are destined to make
as significant an impact, all doctors can have an impact
on their patients’ behaviors. Injury-prevention measures do not have to be implemented on a grand scale to
make a difference. Although doctors may not be able
to prove a difference in their own patient population, if
all doctors made injury prevention a part of their practice, the results could be significant. As preparations
for hospital or emergency department discharge are
being made, consideration should be given to patient
4 Injury Prevention
education to prevent injury recurrence. Whether it is
alcohol abuse, returning to an unchanged hostile home
environment, riding a motorcycle without wearing
head protection, or smoking while refueling the car,
there are many opportunities for doctors to make a difference in their patients’ future trauma vulnerability.
3. Harvard Injury Control Research Center, Harvard
School of Public Health, 677 Huntington Ave., 2nd Floor,
Boston, MA 02115; 617-432-3420; www.hsph.harvard.
edu/hicrc.
Bibliography
5. Injury Free Coalition for Kids, Columbia University,
Mailman School of Public Health, 722 W. 168th St., Rm.
1711, New York, NY 10032; 212-342-0517; www.injuryfree.org.
1. American College of Surgeons Committee on Trauma.
Resources for Optimal Care of the Injured Patient. Chicago, IL: American College of Surgeons; 2006.
2. Cooper A, Barlow B, Davidson L, et al. Epidemiology of
pediatric trauma: importance of population-based statistics. J Pediatr Surg 1992;27:149-154.
3. Haddon W, Baker SP. Injury control. In: Clark DW,
MacMahon B, eds. Prevention and Community Medicine.
2nd ed. Boston, MA: Little Brown; 1981:109-140.
4. Knudson MM, Vassar MJ, Straus EM, et al. Surgeons
and injury prevention: what you don’t know can hurt
you! J Am Coll Surg 2001;193:119-124.
5. Laraque D, Barlow B. Prevention of pediatric injury. In:
Ivatory R, Cayten G, eds. The Textbook of Penetrating
Trauma. Baltimore, MD: Williams & Wilkins; 1996.
6. National Committee for Injury Prevention and Control.
Injury Prevention: Meeting the Challenge. New York,
NY: Education Development Center; 1989.
7. Rivera FP. Traumatic deaths of children in United States: currently available prevention strategies. Pediatrics
1985;85:456-462.
4. Injury Control Research Center, University of AlabamaBirmingham, CH19 UAB Station, Birmingham, AL
35294; 205-934-1643; www.uab.edu/icrc.
6. Injury Prevention and Research Center, University of
North Carolina, 137 E, Franklin St., CB#7505 CTP,
Chapel Hill, NC 27599-7505; 919-966-2251; www.iprc.
unc.edu.
7. Johns Hopkins Center for Injury Research and Policy,
Hampton House, 624 N. Broadway, 5th Floor, Baltimore, MD 21205-1996; 410-614-4026; www.jhsph.edu/
Research/Centers/CIRP.
8. National Center for Injury Prevention and Control,
Centers for Disease Control, Program Development and
Implementation, Mailstop K65, 4770 Buford Hwy. NE,
Atlanta, GA 30341-3724; 770-488-1506; www.cdc.gov
9. San Francisco Center for Injury Research and Prevention, San Francisco General Hospital, 1001 Potrero Ave.,
Department of Surgery, Ward 3A, Box 0807, San Francisco, CA 94110; 415-206-4623; www.surgery.ucsf.edu/
sfic.
8. Schermer CR. Alcohol and injury prevention. J Trauma
2006;60:447-451.
10. Slide Prevention Programs (Alcohol and Injury, Bicycle Helmet Safety), available from American College of
Surgeons, Customer Service/Publications, 633 N. Saint
Clair St., Chicago, IL 60611-3211; 312/202-5474; https://
secure.facs.org/commerce/2003/trauma.html.
Resources
11. State and Local Departments of Health, Injury Control
Divisions.
1. British Columbia Injury Research and Prevention Unit,
Centre for Community Health and Health Research,
L408-4480 Oak St., Vancouver, BC V6H 3V4, Canada;
604-875-3776; www.injuryresearch.bc.ca.
2. Harborview Injury Prevention and Research Center,
University of Washington, Box 359960, 325 Ninth Ave.,
Seattle, WA 98104-2499; 206-521-1520; http://depts.
washington.edu/hiprc.
12. The Children’s Safety Network, National Injury and
Violence Prevention Resource Center, Education
Development Center, Inc., 55 Chapel St., Newton, MA
02458-1060; 617/969-7100; www.childrensafetynetwork.
org.
13. TIPP Sheets, available from American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL
60007; 800-433-9016; www.aap.org.
Introduction
Injury should not be considered an “accident,”
which is a term that implies a random circumstance
resulting in harm. In fact, injuries occur in patterns
that are predictable and preventable. The expression
“an accident waiting to happen” is both paradoxical
and premonitory. There are high-risk individuals
and high-risk environments. In combination, they
provide a chain of events that can result in trauma.
With the changing perspective in today’s health care
from managing illness to promoting wellness, injury
prevention moves beyond promoting good health
to take on the added dimension of reducing health
care costs.
Prevention is timely. Doctors who care for
injured individuals have a unique opportunity to
practice effective, preventive medicine. Although the
true risk takers may be recalcitrant about any and all
prevention messages, many people who are injured
through ignorance, carelessness, or temporary loss
of self-control may be receptive to information
that is likely to reduce their future vulnerability.
Each doctor–patient encounter is an opportunity to
reduce trauma recidivism. This is especially true for
surgeons who are involved daily during the period
immediately after injury, when there may be opportunities to truly change behavior. The basic concepts
of injury prevention and strategies for implementation through traditional public health methods are
included in this appendix.
Classification of Injury Prevention
Prevention can be considered as primary, secondary,
or tertiary. Primary prevention refers to elimination of
the trauma incident completely. Examples of primary
prevention measures include stoplights at intersections, window guards to prevent toddlers from falling,
swimming pool fences to keep out nonswimmers and
prevent drowning, DUI laws, and safety caps on medicines to prevent ingestions.
Secondary prevention accepts the fact that an
injury may occur, but serves to reduce the severity of
the injury sustained. Examples of secondary prevention include safety belts, airbags, motorcycle and bicycle helmets, and playground safety surfaces.
Tertiary prevention involves reducing the consequences of the injury after it has occurred. Trauma
systems, including the coordination of emergency
medical services, identification of trauma centers, and
the integration of rehabilitation services to reduce
impairment, constitute efforts at tertiary prevention.
Haddon Matrix
In the early 1970s, Haddon described a useful approach
to primary and secondary injury prevention that is
now known as the Haddon matrix. According to Haddon’s conceptual framework, there are three principal
factors in injury occurrence: the injured person (host),
the injury mechanism (e.g., vehicle, gun), and the environment in which the injury occurs. There are also
three phases during which injury and its severity can
be modified: the pre-event phase, the event phase (injury), and the post-event phase. Table 1 outlines how
the matrix serves to identify opportunities for injury
prevention and can be extrapolated to address other
injury causes. The adoption of this structured design
1
2 Injury Prevention
Table 1 Haddon’s Factor-Phase Matrix for Motor Vehicle Crash Prevention
PRE-EVENT
EVENT
POST-EVENT
Host
Avoidance of alcohol use
Use of safety belts
Care delivered by bystander
Vehicle
Antilock brakes
Deployment of air bag
Assessment of vehicle characteristics
that may have contributed to event
Environment
Speed limits
Impact-absorbing barriers
Access to trauma system
by the National Highway Traffic Safety Administration resulted in a sustained reduction in the fatality
rate per vehicle mile driven over the past two decades.
The Four Es of Injury Prevention
Injury prevention can be directed at human factors
(behavioral issues), vectors of injury, and/or environmental factors and implemented according to the four
Es of injury prevention:
■■
Education
■■
Enforcement
■■
Engineering
■■
Economics (incentives)
Education is the cornerstone of injury prevention.
Educational efforts are relatively simple to implement;
they promote the development of constituencies and
serve to bring the issue before the public. Without
an informed and activist public, subsequent legislative efforts (enforcement) are likely to fail. Education
is based on the premise that knowledge supports a
change in behavior. Although attractive in theory,
education in injury prevention has been disappointing
in practice. Yet it provides the underpinning for implementation of subsequent strategies, such as that to
reduce alcohol-related crash deaths. Mothers Against
Drunk Driving is an organization that exemplifies the
effective use of a primary education strategy to reduce
alcohol-related crash deaths. Through their efforts, an
informed and aroused public facilitated the enactment
of stricter drunk-driving laws, resulting in a decade of
reduced alcohol-related vehicle fatalities. For education to work, it must be directed at the appropriate target group, it must be persistent, and it must be linked
to other approaches.
Enforcement is a useful part of any effective
injury-prevention strategy because, regardless of the
type of trauma, there always are individuals who resist
the changes needed to improve outcome—even if the
improved outcome is their own. Where compliance
with injury prevention efforts lags, legislation that
mandates certain behavior or declares certain behaviors illegal often results in dramatic differences. For
example, safety belt and helmet laws resulted in measurable increases in usage when educational programs
alone had minimal effect.
Engineering, often more expensive at first, clearly
has the greatest long-term benefits. Despite proven
effectiveness, engineering advances may require concomitant legislative and enforcement initiatives, enabling implementation on a larger scale. Adoption of air
bags is a recent example of the application of advances
in technology combined with features of enforcement.
Other advances in highway design and safety have added
tremendously to the margin of safety while driving.
Economic incentives, when used for the correct
purposes, are quite effective. For example, the linking
of federal highway funds to the passage of motorcycle
helmet laws motivated the states to pass such laws and
enforce the wearing of helmets. This resulted in a 30%
reduction in fatalities from head injuries. Although
this economic incentive is no longer in effect, and rates
of deaths from head injuries have returned to their
previous levels in states that have reversed their helmet statutes, the association between helmet laws and
reduced fatalities confirmed the utility of economic
incentives in injury prevention. Insurance companies
have clear data on risk-taking behavior patterns, and
the payments from insurance trusts; discount premiums are available to those who avoid risk-taking
behavior.
eveloping an Injury Prevention
D
Program—The Public Health
Approach
There are five basic steps to developing an injury
prevention program: Analyze the data, Build local
coalitions, Communicate the problem, Develop and
implement injury prevention activities, and Evaluate
the intervention.
ANALYZE THE DATA
The first step is a basic one: define the problem. This
may appear self-evident, but both the magnitude and
community impact of trauma can be elusive unless
reliable data are available. Population-based data on
injury incidence are essential to identify the problem
and provide a baseline for determining the impact of
subsequent efforts at injury prevention. Information
from death certificates, hospital and/or emergency
department discharge statistics, and trauma registry
printouts are, collectively, good places to start.
After a trauma problem is identified, its causes
and risk factors must be defined. The problem may
need to be studied to determine what kinds of injuries
are involved and where, when, and why they occur.
Injury-prevention strategies may begin to emerge with
this additional information. Some trauma problems
vary from community to community; however, there
are certain risk factors that are likely to remain constant across situations and socioeconomic boundaries.
Abuse of alcohol and other drugs is an example of a
contributing factor that is likely to be pervasive regardless of whether the trauma is blunt or penetrating, the
location is the inner city or the suburbs, and whether
fatality or disability occurs. Data are most meaningful
when the injury problem is compared between populations with and without defined risk factors. In many
instances, the injured people may have multiple risk
factors, and clearly defined populations may be difficult to sort out. In such cases, it is necessary to control
for the confounding variables.
BUILD LOCAL COALITIONS
Strong community coalitions are required to change
the perception of a problem and to design strategies
that are likely to succeed in an individual community.
What works in one community may not work in another, and the most effective strategy will fail if the
community targeted for intervention does not perceive
the problem as important.
COMMUNICATE THE PROBLEM
Whereas sentinel events in a community may identify
an individual trauma problem and raise public concern, high-profile problems do not lend themselves to
effective injury prevention unless they are part of a
larger documented injury-control issue/injury prevention strategy. Local coalitions are an essential part of
any communication strategy, not only in getting the
word out but in designing the message that is most
likely to be effective. Members of the media are also
key partners in any communication plan.
Injury Prevention 3
DEVELOP AND IMPLEMENT
PPREVENTION AACTIVITIES
The next step is to develop and test interventions. This
is the time for pilot programs to test intervention effectiveness. Rarely is an intervention tested without some
indication that it will work. It is important to consider
the views and values of the community if an injury prevention program is to be accepted. End points must be
defined up front, and outcomes reviewed without bias.
It is sometimes not possible to determine the effectiveness of a test program, especially if it is a small-scale
trial intervention. For example, a public information
program on safety-belt use conducted at a school can
be assessed by monitoring the incoming and outgoing school traffic and showing a difference, whereas
the usage rates in the community as a whole may not
change. Nonetheless, the implication is clear—broad
implementation of public education regarding safetybelt use can have a beneficial effect within a controlled
community population. Telephone surveys are not reliable measures to confirm behavioral change, but they
can confirm that the intervention reached the target
group.
With confirmation that a given intervention can
effect favorable change, the next step is implementation of injury-prevention strategies. From this point,
the possibilities are vast.
EVALUATE THE IMPACT OF AN
INTERVENTION
With implementation comes the need to monitor the
impact of the program or evaluation. An effective injury-prevention program linked with an objective means
to define its effectiveness can be a powerful message
to the public, the press, and legislators, and ultimately
may bring about a permanent change in behavior.
Injury prevention seems like an immense task,
and in many ways it is. Yet, it is important to remember that a pediatrician in Tennessee was able to validate the need for infant safety seats that led to the
first infant-safety-seat law. A New York orthopedic
surgeon gave testimony that played an important role
in achieving the first safety-belt law in the United
States. Although not all doctors are destined to make
as significant an impact, all doctors can have an impact
on their patients’ behaviors. Injury-prevention measures do not have to be implemented on a grand scale to
make a difference. Although doctors may not be able
to prove a difference in their own patient population, if
all doctors made injury prevention a part of their practice, the results could be significant. As preparations
for hospital or emergency department discharge are
being made, consideration should be given to patient
4 Injury Prevention
education to prevent injury recurrence. Whether it is
alcohol abuse, returning to an unchanged hostile home
environment, riding a motorcycle without wearing
head protection, or smoking while refueling the car,
there are many opportunities for doctors to make a difference in their patients’ future trauma vulnerability.
3. Harvard Injury Control Research Center, Harvard
School of Public Health, 677 Huntington Ave., 2nd Floor,
Boston, MA 02115; 617-432-3420; www.hsph.harvard.
edu/hicrc.
Bibliography
5. Injury Free Coalition for Kids, Columbia University,
Mailman School of Public Health, 722 W. 168th St., Rm.
1711, New York, NY 10032; 212-342-0517; www.injuryfree.org.
1. American College of Surgeons Committee on Trauma.
Resources for Optimal Care of the Injured Patient. Chicago, IL: American College of Surgeons; 2006.
2. Cooper A, Barlow B, Davidson L, et al. Epidemiology of
pediatric trauma: importance of population-based statistics. J Pediatr Surg 1992;27:149-154.
3. Haddon W, Baker SP. Injury control. In: Clark DW,
MacMahon B, eds. Prevention and Community Medicine.
2nd ed. Boston, MA: Little Brown; 1981:109-140.
4. Knudson MM, Vassar MJ, Straus EM, et al. Surgeons
and injury prevention: what you don’t know can hurt
you! J Am Coll Surg 2001;193:119-124.
5. Laraque D, Barlow B. Prevention of pediatric injury. In:
Ivatory R, Cayten G, eds. The Textbook of Penetrating
Trauma. Baltimore, MD: Williams & Wilkins; 1996.
6. National Committee for Injury Prevention and Control.
Injury Prevention: Meeting the Challenge. New York,
NY: Education Development Center; 1989.
7. Rivera FP. Traumatic deaths of children in United States: currently available prevention strategies. Pediatrics
1985;85:456-462.
4. Injury Control Research Center, University of AlabamaBirmingham, CH19 UAB Station, Birmingham, AL
35294; 205-934-1643; www.uab.edu/icrc.
6. Injury Prevention and Research Center, University of
North Carolina, 137 E, Franklin St., CB#7505 CTP,
Chapel Hill, NC 27599-7505; 919-966-2251; www.iprc.
unc.edu.
7. Johns Hopkins Center for Injury Research and Policy,
Hampton House, 624 N. Broadway, 5th Floor, Baltimore, MD 21205-1996; 410-614-4026; www.jhsph.edu/
Research/Centers/CIRP.
8. National Center for Injury Prevention and Control,
Centers for Disease Control, Program Development and
Implementation, Mailstop K65, 4770 Buford Hwy. NE,
Atlanta, GA 30341-3724; 770-488-1506; www.cdc.gov
9. San Francisco Center for Injury Research and Prevention, San Francisco General Hospital, 1001 Potrero Ave.,
Department of Surgery, Ward 3A, Box 0807, San Francisco, CA 94110; 415-206-4623; www.surgery.ucsf.edu/
sfic.
8. Schermer CR. Alcohol and injury prevention. J Trauma
2006;60:447-451.
10. Slide Prevention Programs (Alcohol and Injury, Bicycle Helmet Safety), available from American College of
Surgeons, Customer Service/Publications, 633 N. Saint
Clair St., Chicago, IL 60611-3211; 312/202-5474; https://
secure.facs.org/commerce/2003/trauma.html.
Resources
11. State and Local Departments of Health, Injury Control
Divisions.
1. British Columbia Injury Research and Prevention Unit,
Centre for Community Health and Health Research,
L408-4480 Oak St., Vancouver, BC V6H 3V4, Canada;
604-875-3776; www.injuryresearch.bc.ca.
2. Harborview Injury Prevention and Research Center,
University of Washington, Box 359960, 325 Ninth Ave.,
Seattle, WA 98104-2499; 206-521-1520; http://depts.
washington.edu/hiprc.
12. The Children’s Safety Network, National Injury and
Violence Prevention Resource Center, Education
Development Center, Inc., 55 Chapel St., Newton, MA
02458-1060; 617/969-7100; www.childrensafetynetwork.
org.
13. TIPP Sheets, available from American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL
60007; 800-433-9016; www.aap.org.
Sponsor Documents
Recommended
No recommend documents