Inju

ry a

nd S

afet

y Is

sues

Cha

pter

16

The

Sig

nific

ance

of A

ccid

ents

•M

ore

than

400

Am

eric

ans

die

each

day

du

e to

inju

ries

from

acc

iden

ts•

Mos

t peo

ple

expe

rienc

e a

sign

ifica

nt in

jury

at

leas

t onc

e in

thei

r lif

etim

e•

Man

y ar

e di

sabl

ed o

r in

cur

larg

e m

edic

al

cost

s

His

tory

of I

njur

y P

reve

ntio

n

•Jo

hann

Pet

er F

rank

sug

gest

ed th

at a

ccid

ent

prev

entio

n ac

tiviti

es s

houl

d be

par

t of a

co

mpr

ehen

sive

hea

lth p

rogr

am in

178

8–

The

goa

l was

to te

ach

or m

otiv

ate

citiz

ens

to

act s

afet

y–

The

cou

ntry

was

prim

arily

rur

al–

Uni

nten

tiona

l inj

urie

s w

ere

attr

ibut

ed to

hu

man

err

or–

An

emph

asis

on

indi

vidu

al r

espo

nsib

ility

mad

e se

nse

His

tory

of I

njur

y P

reve

ntio

n (c

ontin

ued)

•In

the

early

190

0s a

utom

obile

mak

ers

and

insu

ranc

e co

mpa

nies

beg

an r

esea

rch

on

acci

dent

s–

The

focu

s w

as o

n hi

gh-r

isk

indi

vidu

als

and

high

-ris

k be

havi

ors

–P

reve

ntio

n st

rate

gies

focu

sed

on th

e in

divi

dual

•P

sych

olog

ists

em

phas

ized

the

impo

rtan

ce o

f em

otio

nal a

ntec

eden

ts to

life

eve

nts

from

191

5 to

19

40–

It w

as a

ccep

ted

that

som

e in

divi

dual

s w

ere

“acc

iden

t pro

ne”

Acc

iden

t Pro

ne In

divi

dual

s?

•A

lthou

gh r

esea

rch

pers

iste

d on

the

acci

dent

pr

one

pers

onal

ity fo

r 50

yea

rs, n

o on

e ty

pe o

f pe

rson

was

mor

e “p

rone

” th

an o

ther

s •

Psy

chol

ogic

al in

terv

entio

ns d

id n

ot a

ppea

r to

w

ork

for

thos

e w

ho e

xper

ienc

ed m

ore

acci

dent

s•

It w

as d

eter

min

ed a

ccid

ents

wer

e ca

used

by

hum

an e

rror

, pro

duct

des

ign,

men

tal o

r ph

ysic

al

impa

irmen

t, en

viro

nmen

tal c

ondi

tions

, and

oth

er

fact

ors

J. J

. Gib

son

(190

4–19

79)

•A

psy

chol

ogis

t ins

trum

enta

l in

chan

ging

pe

rcep

tions

abo

ut a

ccid

ent c

ause

s•

Bef

ore

his

wor

k ac

cide

nts

wer

e co

nsid

ered

ran

dom

eve

nts

for

whi

ch n

o on

e bu

t the

vic

tim w

as r

espo

nsib

le•

He

defin

ed a

n ac

cide

nt a

s an

“u

ncon

trol

led,

unp

lann

ed r

elea

se o

f en

ergy

tran

sfer

”

J. J

. Gib

son

(190

4–19

79)

(con

tinue

d)

•J.

J. G

ibso

n id

entif

ied

five

agen

ts c

ausi

ng

inju

ries:

–K

inet

ic o

r m

echa

nica

l ene

rgy

–C

hem

ical

ene

rgy

–T

herm

al e

nerg

y–

Ele

ctric

al e

nerg

y–

Rad

ioac

tive

ener

gy

Hug

h D

eHav

en (

1895

–198

0)

•A

pilo

t in

WW

I w

ho w

as a

ble

to w

alk

away

fr

om a

ser

ious

cra

sh•

Beg

an c

rash

inve

stig

atio

n re

sear

ch a

nd

cras

h te

stin

g•

His

wor

k re

sulte

d in

bet

ter

auto

mob

ile

desi

gn, s

eat b

elts

, and

air

bags

to r

educ

e th

e se

verit

y of

acc

iden

tal i

njur

ies

Dr.

Joh

n S

tapp

(19

10–1

999)

•A

n A

ir F

orce

col

onel

inve

stig

atin

g sa

fety

ha

rnes

ses

for

pilo

ts•

Con

duct

ed e

xper

imen

ts o

n bi

omec

hani

cs

of a

ccel

erat

ion

and

dece

lera

tion

at h

igh

spee

ds•

He

was

kno

wn

to p

erso

nally

test

saf

ety

harn

esse

s su

bjec

ted

to e

xtre

me

ener

gy

tran

sfer

forc

es

Dr.

Joh

n E

. Gor

don

(189

0–19

83)

•A

col

onel

in th

e m

ilita

ry in

WW

II•

Stu

died

non

battl

e in

jurie

s ex

perie

nced

du

ring

war

, pra

ctic

es, a

nd o

n le

ave

•S

tudi

ed th

e di

strib

utio

n of

cau

ses

of in

jury

be

caus

e he

bel

ieve

d ep

idem

iolo

gy w

as

usef

ul fo

r st

udyi

ng a

ccid

ents

Ros

s M

cFar

land

(19

01–1

976)

•A

psy

chol

ogis

t and

trai

ner

of a

viat

ion

med

icin

e sp

ecia

lists

•D

ocum

ente

d th

at h

ighw

ay c

rash

es a

mon

g m

ilita

ry p

erso

nnel

wer

e m

ore

prev

alen

t th

an p

lane

cra

shes

•A

pplie

d er

gono

mic

s to

sho

w th

at g

ear

shift

de

sign

wou

ld r

educ

e th

e nu

mbe

r of

ac

cide

nts

Erg

onom

ics

•A

fter

WW

II th

e fie

ld o

f erg

onom

ics

was

bo

rn•

“The

bod

y of

kno

wle

dge

abou

t hum

an

abili

ties,

hum

an li

mita

tions

, and

oth

er

hum

an c

hara

cter

istic

s re

leva

nt to

des

ign”

•U

sed

to d

esig

n to

ols,

mac

hine

s, s

yste

ms,

ta

sks,

jobs

, and

env

ironm

ents

for

safe

hu

man

use

Dr.

Will

iam

Had

don

(192

6–19

85)

•A

n en

gine

er a

nd p

ublic

hea

lth p

hysi

cian

for

New

Y

ork,

“th

e fa

ther

of i

njur

y ep

idem

iolo

gy a

nd

inju

ry c

ontr

ol”

•B

elie

ved

the

way

to

redu

ce in

cide

nce

and

seve

rity

of a

ccid

ents

was

to s

tudy

the

kin

etic

en

erg

yin

volv

ed•

Look

ed a

t the

cra

sh s

eque

nce

for

his

rese

arch

•H

is w

ork

repr

esen

ted

the

first

epi

dem

iolo

gica

l st

udy

for

inju

ry r

esea

rch

that

incl

uded

rel

ativ

e ris

k an

d in

tera

ctio

n of

con

trib

utor

y fa

ctor

s

The

Had

don

Mat

rix

•T

hree

pha

ses

of a

n ac

cide

nt1.

Pre

-inju

ry p

hase

Whe

n co

ntro

l of e

nerg

y ex

pend

iture

is lo

st2.

Inju

ry p

hase

Less

than

one

sec

ond;

whe

n en

ergy

is

tr

ansf

erre

d to

peo

ple

and

caus

es d

amag

e3.

Pos

t-in

jury

pha

seW

hen

atte

mpt

s ar

e m

ade

to r

epai

r th

e da

mag

e an

d re

gain

phy

siol

ogic

al

hom

eost

asis

Ral

ph N

ader

(19

34–p

rese

nt)

•H

is 1

959

artic

le T

he S

afe

Car

You

Can

’t B

uyde

clar

ed th

at a

utom

obile

mak

ers

wer

e de

sign

ing

cars

for

styl

e, c

ost,

and

perf

orm

ance

whi

le ig

norin

g ac

cide

ntal

in

jurie

s, d

isab

ilitie

s, a

nd d

eath

s•

His

196

5 bo

ok U

nsaf

e at

Any

Spe

edfo

cuse

d on

env

ironm

enta

l asp

ects

of t

he

pre-

cras

h an

d cr

ash

phas

es o

f aut

o ac

cide

nts

Ral

ph N

ader

(19

34–p

rese

nt)

(con

tinue

d)

•H

e ta

rget

ed G

ener

al M

otor

s’ fa

ulty

rea

r su

spen

sion

sys

tem

on

the

Cor

vair

•H

e dr

ew a

ttent

ion

to th

e fa

ct th

at s

ome

auto

mob

ile m

anuf

actu

rers

wer

e hi

ding

in

form

atio

n ab

out p

rodu

ct s

afet

y•

He

foun

ded

the

NG

O P

ublic

Citi

zen,

cr

edite

d w

ith th

e pa

ssag

e of

sev

eral

law

s ap

prop

riate

to e

nviro

nmen

tal h

ealth

Pub

lic H

ealth

Initi

ativ

es

•T

he W

. K. K

ello

g F

ound

atio

n aw

arde

d gr

ants

for

publ

ic h

ealth

dem

onst

ratio

n pr

ojec

ts in

the

1950

s an

d 19

60s

•T

he D

ivis

ion

of S

peci

al H

ealth

Ser

vice

s fo

r th

e U

.S. P

ublic

Hea

lth S

ervi

ce in

itiat

ed in

jury

con

trol

pr

ogra

ms

for

–R

adio

logi

cal h

ealth

–T

uber

culo

sis

–A

ir po

llutio

n–

Chr

onic

dis

ease

s

U.S

. Gov

ernm

enta

l Age

ncie

s

•In

195

6 th

e D

ivis

ion

of A

ccid

ent

Pre

vent

ion

was

add

ed to

add

ress

hig

hway

an

d no

nhig

hway

saf

ety

conc

erns

•In

196

7 th

e N

atio

nal H

ighw

ay S

afet

y B

urea

u (N

HS

B)

was

form

ed w

ith D

r.

Had

don

as d

irect

or; i

t was

late

r re

nam

ed

the

Nat

iona

l Hig

hway

Tra

ffic

Saf

ety

Adm

inis

trat

ion

(NH

TS

A)

U. S

. Gov

ernm

enta

l Age

ncie

s (c

ontin

ued)

•In

the

1970

s, th

e C

onsu

mer

Pro

duct

S

afet

y C

omm

issi

on w

as c

reat

ed•

Em

erge

ncy

med

ical

ser

vice

s w

ere

also

ex

pand

ed in

the

1970

s to

red

uce

deat

hs

due

to a

ccid

ents

•In

the

1980

s, s

ubst

antia

l im

prov

emen

ts in

hi

ghw

ay s

afet

y ha

d be

en g

aine

d

U. S

. Gov

ernm

enta

l Age

ncie

s (c

ontin

ued)

•In

198

5 th

e C

omm

ittee

on

Tra

uma

Res

earc

h pu

blis

hed

Inju

ry in

Am

eric

are

port

ing

all i

njur

ies

•A

fter

that

, Con

gres

s–

Pro

vide

d fu

ndin

g fo

r in

jury

con

trol

res

earc

h to

th

e C

ente

rs fo

r D

isea

se C

ontr

ol–

Est

ablis

hed

the

Nat

iona

l Cen

ter

for

Inju

ry

Pre

vent

ion

and

Con

trol

•T

he A

mer

ican

Pub

lic H

ealth

Ass

ocia

tion

(AP

HA

) re

esta

blis

hed

its in

jury

con

trol

sec

tion

Inte

ntio

nal I

njur

ies

•T

hose

that

res

ult w

hen

one

pers

on in

tend

s to

har

m h

imse

lf/he

rsel

f or

anot

her

pers

on–

Hom

icid

e–

Sui

cide

–R

ape

–D

omes

tic v

iole

nce

•P

hysi

cal a

ssau

lt•

Oth

er a

busi

ve b

ehav

iors

Hom

icid

e

•N

early

hal

f of a

ll de

aths

from

fire

arm

in

jurie

s ar

e vi

ctim

s of

hom

icid

e•

The

mur

der

rate

has

falle

n to

its

low

est

leve

l in

thre

e de

cade

s (6

per

100

,000

po

pula

tion)

•It

is th

e th

ird le

adin

g ca

use

of d

eath

for

child

ren

ages

5 to

14

year

s of

age

•M

ore

than

80%

of i

nfan

t hom

icid

es a

re th

e re

sult

of c

hild

abu

se b

y pa

rent

s

Sui

cide

•U

sual

ly s

elf-

infli

cted

•D

iffic

ult t

o de

term

ine

as n

ot a

ll su

icid

al

deat

hs a

re id

entif

ied

•S

uici

de r

ates

are

ver

y hi

gh a

mon

g yo

ung

peop

le in

Jap

an, C

hina

, Eur

ope,

and

the

U.S

.

Dom

estic

Vio

lenc

e

•P

hysi

cal v

iole

nce

and

abus

ive

beha

vior

le

adin

g to

inte

ntio

nal i

njur

y•

Unf

ortu

nate

ly v

ery

com

mon

•A

ssau

ltis

a v

erba

l thr

eat

•B

atte

ryis

a p

hysi

cal t

hrea

t

Rap

e

•It

is in

tent

iona

l, no

t an

acci

dent

•It

is a

crim

e of

vio

lenc

e, n

ot p

assi

on•

For

ced

sexu

al in

terc

ours

e–

The

re is

phy

sica

l dam

age,

psy

chol

ogic

al

dam

age,

and

pos

t-tr

aum

atic

syn

drom

e

•S

tatu

tory

rap

e is

sex

with

a m

inor

und

er

age

21•

It ca

n le

ad to

arr

est a

nd p

rose

cutio

n

Uni

nten

tiona

l Inj

urie

s

•Im

plie

s ci

rcum

stan

ces

that

cou

ld n

ot b

e av

oide

d; e

rror

s in

judg

men

ts; p

oor

heal

th;

or la

ck o

f phy

sica

l abi

lity

to a

void

har

m•

Cou

ld b

e du

e to

hum

an e

rror

, fau

lty

prod

uct d

esig

n, im

pairm

ent,

envi

ronm

enta

l co

nditi

ons,

and

oth

er fa

ctor

s•

The

lead

ing

caus

e of

dea

th fo

r in

divi

dual

s un

der

age

45•

Fift

h le

adin

g ca

use

of d

eath

in th

e U

.S.

Uni

nten

tiona

l Inj

urie

s: M

VA

s

•M

otor

veh

icle

acc

iden

ts (

MV

As)

are

the

mos

t com

mon

cau

se o

f dea

th 1

5–25

yea

rs

of a

ge•

Tee

nage

rs h

ave

the

high

est r

ate

of M

VA

-re

late

d de

aths

•S

enio

rs o

ver

age

75 a

re th

e se

cond

hi

ghes

t•

MV

As

are

the

mos

t com

mon

cau

se o

f se

rious

inju

ry

DU

I/DW

I

•D

rivin

g U

nder

the

Influ

ence

(D

UI)

or

Driv

ing

Whi

le In

toxi

cate

d (D

WI)

acc

ount

s fo

r 45

% o

f MV

A fa

talit

ies

•T

he h

ighe

st in

toxi

catio

n ra

tes

in fa

tal

cras

hes

wer

e am

ong

21–2

4 ye

ar o

lds

•Y

oung

driv

ers

arre

sted

for

DU

I/DW

I are

fo

ur ti

mes

mor

e lik

ely

to d

ie in

a fu

ture

M

VA

Zer

o T

oler

ance

Law

s

•M

any

stat

es h

ave

this

law

•It

does

not

mat

ter

wha

t the

blo

od a

lcoh

ol le

vel

(BA

C)

is o

f a m

inor

•T

he u

se o

f pre

scrip

tion

pain

kille

rs a

nd o

ver-

the-

coun

ter

antih

ista

min

es a

re tr

eate

d th

e sa

me

if th

e pe

rson

is d

rivin

g•

If an

und

erag

e pe

rson

is c

augh

t driv

ing

unde

r th

e in

fluen

ce o

f dru

gs o

r al

coho

l (D

UI o

r D

UIA

) th

eir

licen

se c

an b

e re

voke

d, th

ey c

an s

pent

tim

e in

jail,

and

a fi

ne m

ust b

e pa

id

Oth

er C

ause

s of

MV

As

•H

eavy

traf

fic a

nd tr

affic

del

ays

•C

onst

ruct

ion

•D

istr

actio

ns (

infa

nts

and

child

ren,

cel

l ph

ones

, foo

d, m

aps)

•In

cons

ider

ate

or im

paire

d dr

iver

s•

Agg

ress

ive

driv

ing

beha

vior

s

Agg

ress

ive

Driv

ers

•E

xcee

d th

e sp

eed

limit

•T

ailg

ate

the

car

in fr

ont o

f the

m•

Cha

nge

lane

s fr

eque

ntly

•V

erba

lly a

buse

or

mak

e ru

de g

estu

res

to

anot

her

driv

er•

Dis

obey

traf

fic s

igns

Roa

d R

age

•O

ccur

s w

hen

one

driv

er p

hysi

cally

as

saul

ts a

noth

er d

river

or

car

Red

ucin

g R

isk

of M

VA

Inju

ries

•K

eep

your

veh

icle

in g

ood

cond

ition

•Le

t roa

d co

nditi

ons

and

traf

fic d

icta

te g

ood

driv

ing

beha

vior

•O

bser

ve th

e sp

eed

limit

exce

pt w

hen

ther

e is

fog,

rai

n, s

how

, or

ice

on th

e ro

ad•

Use

the

“tw

o se

cond

rul

e” r

athe

r th

an

tailg

ate

•W

ear

safe

ty r

estr

aint

s an

d se

at b

elts

Saf

ety

Res

trai

nts

for

Infa

nts

and

Chi

ldre

n

•S

eatb

elts

hol

d oc

cupa

nts

in p

lace

dur

ing

a co

llisi

on–

Pre

vent

s ej

ectio

n–

Pro

tect

s th

e pe

rson

from

obj

ects

in th

e ca

r•

Infa

nts

and

child

ren

shou

ld b

e in

the

back

sea

t•

Infa

nts

(less

than

1 y

ear)

sho

uld

face

the

rear

of

the

car

•C

hild

ren

(wei

ghin

g 40

lbs.

or

mor

e) c

an fa

ce

forw

ard

Hom

e S

afet

y

•In

jurie

s oc

cur

from

falls

, poi

soni

ngs,

gun

s,

fires

, and

pow

er e

quip

men

t•

You

ng c

hild

ren

have

the

high

est r

isk

•C

abin

ets

with

toxi

c m

ater

ials

, med

icin

es,

and

guns

sho

uld

be lo

cked

•M

atch

es a

nd li

ghte

rs s

houl

d be

kep

t in

a sa

fe p

lace

•P

ower

equ

ipm

ent s

houl

d ha

ve s

afet

y sh

ield

s

Gun

Con

trol

•T

he 1

968

Gun

Con

trol

Act

pro

hibi

ts th

e sa

le o

f rif

les

by m

ail a

nd th

e sa

le o

f gun

s to

min

ors,

fe

lons

, or

addi

cts

•T

he 1

993

Bra

dy H

andg

un C

ontr

ol A

ct p

rovi

des

for

a w

aitin

g pe

riod

befo

re s

omeo

ne c

an b

uy o

r tr

ansf

er a

han

dgun

to a

noth

er w

hile

a c

rimin

al

chec

k is

mad

e•

The

199

4 V

iole

nt C

rime

Con

trol

and

Law

E

nfor

cem

ent A

ct b

anne

d th

e m

anuf

actu

re, s

ale,

an

d po

sses

sion

of c

erta

in a

ssau

lt w

eapo

ns

Whi

ch A

re Y

ou?

•P

ropo

nent

s re

cogn

ize

the

high

inci

denc

e of

dea

ths,

dis

abili

ties,

and

inju

ries

due

to

guns

•O

ppon

ents

feel

it is

thei

r rig

ht to

car

ry a

gu

n fo

r pr

otec

tion

Pro

duct

Saf

ety

•T

he C

onsu

mer

Pro

duct

Saf

ety

Com

mis

sion

(C

PS

C)

was

cre

ated

in 1

972

beca

use

som

e pr

oduc

ts p

rese

nted

an

unre

ason

able

ris

k of

inju

ry•

The

CP

SC

req

uire

s sa

fety

labe

ls, r

ecal

ls

haza

rdou

s pr

oduc

ts, a

nd b

ans

them

Sch

ool S

afet

y

•C

ross

wal

k sa

fety

for

pede

stria

ns is

a

conc

ern

–M

any

scho

ols

have

vol

unta

ry c

ross

ing

guar

ds

•T

he s

ale

of d

rugs

on

scho

ol p

rope

rty

is a

fe

dera

l offe

nse

•B

ully

ing

is a

con

cern

•B

us s

afet

y is

a c

once

rn–

Sch

ool b

uses

are

not

req

uire

d to

hav

e se

at

belts

Pla

ygro

unds

•Ja

ne A

ddam

s pr

ovid

ed a

pla

ygro

und

at

Hul

l Hou

se in

Chi

cago

for

imm

igra

nt

child

ren

livin

g in

tene

men

ts•

Pla

ygro

und

equi

pmen

t is

lega

lly

cons

ider

ed “

an a

ttrac

tive

nuis

ance

”

Pla

ygro

und

Haz

ards

•W

ood

equi

pmen

t may

be

trea

ted

with

ar

seni

c–

Chi

ldre

n sh

ould

was

h th

eir

hand

s af

ter

play

ing

and

befo

re e

atin

g

•D

ange

rous

equ

ipm

ent i

nclu

des:

–M

erry

-go-

roun

ds, t

eete

r-to

tters

, sw

ings

, sl

ides

, clim

bers

(ju

ngle

gym

, mon

key

bars

)

Rec

reat

iona

l Nee

ds

•N

atio

nal p

arks

wer

e de

sign

ated

•T

he p

arks

and

rec

reat

ion

mov

emen

t ex

pand

ed a

fter

WW

II•

The

Pre

side

nt’s

Fitn

ess

Pro

gram

en

cour

aged

phy

sica

l act

ivity

for

good

he

alth

Saf

ety

Rul

es F

or…

•W

alki

ng, j

oggi

ng•

Bik

ing

•H

orse

back

rid

ing

•S

wim

min

g•

Boa

ting

•H

ikin

g an

d m

ount

ain

clim

bing

•A

ll-te

rrai

n ve

hicl

es a

nd s

now

mob

iles

•S

kiin

g an

d sn

owbo

ardi

ng•

Hun

ting

and

fishi

ng

Mec

hani

sms

of In

jury

•T

he c

ircum

stan

ces

foun

d af

ter

a cr

ash

or

acci

dent

that

det

erm

ines

how

inju

ries

wer

e re

ceiv

ed

Haz

ards

Mec

hani

cal

•O

ccur

whe

n th

e tr

ansf

er o

f mec

hani

cal

ener

gy r

esul

ts in

im

med

iate

or

grad

ually

acq

uire

d in

jury

Psy

chos

ocia

l•

Usu

ally

fact

or in

to

mec

hani

cal h

azar

ds•

Incl

udes

DU

I/DU

IA,

dist

ract

ions

, pre

senc

e in

cr

ime

area

s, n

ot u

sing

sa

fety

dev

ices

, not

he

edin

g sa

fety

adv

ice

•E

mot

ions

suc

h as

ang

er,

fear

, fee

ling

a la

ck o

f co

ntro

l or

viol

ence