Injury Control Update

IN THIS

ISSUE

▼

FOCUS ON RURAL

EMERGENCY

CARE . . . . . . . . . . . 5

▼

INJURY ONLINE . . . 8

▼

FIRST NATIONAL

VIOLENCE

PREVENTION

CONFERENCE . . . . . 9

▼

NEW INJURY

CONTROL

RESOURCES . . . . . 12

▼

WINNING

RESEARCH ON

ALCOHOL-IMPAIRED

DRIVERS . . . . . . . . 13

▼

NCIPC PHONE

DIRECTORY . . . . . 14

▼

INJURY JOURNAL

CLUB . . . . . . . . . . 15

Vol. 1 No. 1 ▲ Winter, 1996

Every day, the headlines and local

newscasts remind Americans of the

human cost of injuries — and of the

potential for prevention.

▲ A fire started by a burning cigarette

in one apartment sweeps through

the entire complex, leaving dozens

of families homeless.

A smoke detector could have alerted

the family to the hazard in time to take

action.

▲ An 8-year-old boy playing with his

father’s revolver inadvertently kills a

young playmate. Securely locked storage could have kept the gun out of a

child’s hands.

▲ On New Year’s Eve, a drunk driver

swerves out of control and crashes

into a car occupied by two young

couples, both parents of toddlers;

three of the four young adults are

killed. A system of sobriety checkpoints

could have intercepted the drunk driver, and quick EMS response and

triage to the appropriate trauma care

center might have saved these lives.

▲ An elderly woman falls and fractures

her hip; her treatment and rehabilitation cost thousands, and her limited mobility erodes her quality of

life. Minor modifications in her environment could have prevented the fall

or at least reduced its impact, thus limiting her injury.

Events like these, duplicated by the

thousands every day of the year, are

not “accidents.”They are not random

acts of fate. They are predictable — and

they can be prevented.

The mission of the National Center for

Injury Prevention and Control (NCIPC)

of the Centers for Disease Control and

Prevention (CDC) is to prevent such

injuries from happening in the first

place and to control and to minimize

the extent of injury or disability among

those who are injured.

Fulfilling that mission over the past

decade, CDC has been a catalyst in the

field of injury through its national

leadership, support of research and

training, and focus on a science-based

prevention approach. Since 1985 when

the landmark publication 

CDC Injury Center works to make

families and communities safer

A QUARTERLY PUBLICATION OF TH E NATIONAL CENTER FO R INJURY PREVENTION AN D CONTROL

Injury in America recommended that

federal injury control efforts be centralized under CDC, the agency has shaped

a national response to the problems of

injury.

CDC has fulfilled the challenge to focus

federal injury control efforts, according

to Dr. C. Everett Koop, the former U.S.

Surgeon General. He credits NCIPC’s

leadership “with making a tremendous

difference in helping the children of

America lead safer lives and in reducing

health care costs.”

CONTINUED ON PAGE 4

CDC

CENTERS FOR DISEASE CONTROL

AND PREVENTION

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service
GUEST COMMENTARY

Producing a

masterpiece

By William Foege, MD, MPH

Few problems of public health are more

important, more frustrating, more vexing

than injuries. Throughout recorded history,

the two major causes of premature death

have been infectious diseases and injuries

(both intentional and unintentional).

While infectious diseases are still troublesome, impressive progress has been made,

and measles has gone from the single

most lethal agent in the world to a rare

disease in this hemisphere.

But injuries remain, unmoved and 

unimpressed by 20th century science,

rhetoric, and political organizations, a

plague of rich and poor countries alike.

The landmark report by the World Bank,

The World Development Report 1993, provides a way to measure the combined suffering and mortality for various diseases.

By this measure, injuries (falls, automobile

injuries, homicide, suicide, and war) constitute the second leading cause of suffering in the world, second only to respiratory infections.

The United States now has the potential

to lead the world in trying to address this

problem. A coherent, collaborative effort is

being made to improve all aspects of

injury control, from basic research through

treatment and rehabilitation. But the big

picture is sometimes hard to appreciate as

we work on specific aspects of the problem. A Monet painting, viewed from

across the room, can make you feel as

though you are actually in the painting,

feeling the 

sun while gazing at the waterlillies.

At the distance Monet stood while he was

painting, though, one sees only 

isolated brushstrokes. Monet, somehow,

saw the larger picture while working 

on the details.

Hundreds of people are now working on

an injury control masterpiece that will be

fully appreciated only in years to come.

The individual strokes are coming from

people in national, state, and local government; from university researchers and

private companies; from nongovernmental

groups; and from volunteers and concerned citizens. Collectively, they are

defining and describing the problem,

identifying the risk factors, developing a

nationwide research enterprise, developing and testing interventions, and then,

with great ingenuity, finding ways to

implement those interventions.

The field is young, the National Center for

Injury Prevention and Control is barely

two years old, but early results give hope

that science can provide alternatives to

fatalism. The center and its constituents

have supported more than 1,000 peerreviewed research papers and 10 injury

control research centers. They are testing

interventions from smoke detectors and

bicycle helmets to ways for preventing

youth and domestic violence. And they are

developing creative partnerships with an

ever-widening coalition of those interested in improving the quality of life.

Future generations will know by history

only that the canvas once was stark and

grim. We, on the other hand, conscious of

the daunting size of the problem, are sufficiently refreshed by these early successes

to try to visualize the masterpiece in

progress. It is a dream of making AmeriINJURY CONTROL UPDATE

▲ Winter 1996

▲

“If you don’t work on important

problems, it’s not likely that you’ll

do important work.”

— RICHARD HAMMING

▲
cans safe, of reducing, for the first time in

history, a scourge that has plagued everyone, but especially children and young

people.

This newsletter is a way to share the hope

and excitement, to identify and solve problems, to speed the application of “inspired

strokes,”and to say thanks 

for being part of the attempt to plan a

rational and safe future.

Dr. Foege is chairman of the Advisory Committee for Injury Prevention and 

Control. A former director of CDC, he is

now a health policy fellow at The Carter

Center in Atlanta.

3

▲INJURY CONTROL UPDATE

▲

▲

Winter 1996

INJURY CENTER (continued)

Science is the foundation for

prevention and control

NCIPC fuses science and practical programs to tackle the complex challenge of

injury prevention. Effective prevention

depends on more than intuition, hunches,

or admonitions to “be careful.”It depends

on a scientific approach to define the

problem and to demonstrate what works

to prevent it.

That analytic approach has been used 

by CDC throughout the last half-century

to combat public health problems like

infectious and chronic diseases. And it can

be applied to the problem of injury, now

the major killer of children and young

people. This approach asks four key questions:

▲ What is the problem?

▲ What causes the problem?

▲ What works to prevent it?

▲ How do you deliver effective prevention programs in communities?

In seeking the answers to these questions

in the context of a broad range of types of

injury, NCIPC has funded nearly 200 current and completed extramural research

projects around the country. The research

proposals undergo rigorous scrutiny,

including peer review by experts outside

CDC, to assure that they are scientifically

credible and likely to yield information on

which to build prevention and control

interventions.

Examples of such research projects

include:

▲ 15 community-based projects evaluating the effectiveness of various interventions (including peer counseling,

mentoring, conflict resolution) to prevent violence among young people.

▲ a study of driver characteristics associated with fatal motor vehicle crashes,

which showed that alcohol use is the

strongest predictor for a fatality.

▲ preliminary surveillance for spinal cord

injury in five states, showing that

young black men have twice 

the rate of such injuries as young white

men.

▲ a biomechanics research project, which

found that energy-absorbing flooring

materials could help reduce hip fractures from a fall.

A resource for states

NCIPC also supports programs in 35 state

health departments that focus on a range

of injury interventions, including prevention of domestic violence, infant safety

seat use and seat belt use, and preventing

motor vehicle crashes.
CDC’s role in assisting states has been “a

significant milestone for injury prevention

and control,”according to Jeff Simon, MS,

president of the State and Territorial Injury

Prevention Directors’Association (STIPDA), who also heads the New York State

injury control program.“It gives states a

point of reference and resources. We know

the response and commitment are there

when we need it.”

One characteristic of the field of injury

prevention and control is its multidisciplinary nature. To help forge links between

professionals in public health, criminal

justice, trauma care and rehabilitation,

biomechanics, and behavioral research,

NCIPC supports 10 Injury Control

Research Centers (ICRCs) throughout the

country. These university-based centers

conduct research, provide training, and

support injury prevention efforts in their

communities.

NCIPC’s extramural grants program for

research projects and injury control

research centers was funded at $15.1 million for FY 1995. NCIPC supports state

and community-based intervention evaluations in the amount of 

$17.6 million.

Building an injury prevention

community

Many partners are needed to make prevention of injuries a reality. To help create

a national agenda for injury prevention in

the 1990s, CDC launched a two-year

process to identify national goals and concrete plans. Representatives from federal

agencies, state and local health departments, academic institutions, voluntary

and professional organizations, and labor

and management participated. Experts

from various disciplines developed position papers on the prevention of four categories of injury—intentional, motor vehicle, home and leisure, and occupational—

as well as trauma care, acute care, and

rehabilitation of injuries. More than 800

injury professionals discussed these

papers at the Third National Conference

on Injury Control in 1991. Further review

and refinement followed, leading to 165

recommendations, published in CDC’s

Morbidity and Mortality Weekly Report

(MMWR). Executive summaries of position papers also were published in selected journals, and the complete set of

papers and recommendations was published by CDC in 1992.

In the next phase, the injury control community identified 22 priority objectives,

which were described in Injury Control in

the 1990s: A National Plan for Action,

published in 1993. This plan will help

individuals and organizations set their

own priorities for research and education.

NCIPC takes the lead

In the past decade since Injury in America

recommended a centralized national effort

to integrate disparate research and program activities throughout the country,

CDC has played a leadership and coordinating role, exemplified by the process

leading to the national plan. In addition,

NCIPC convenes national conferences,

collects and analyzes statistics on injury,

provides technical assistance to programs

throughout the country, and publishes

guidelines and recommendations in various injury-related areas. ■

▲

“NCIPC fuses science and practical

programs to tackle the complex

challenge of injury prevention”

▲
5

▲INJURY CONTROL UPDATE

▲ Winter 1996

The state of West Virginia presents a

challenge to people wanting to get anywhere fast. That includes emergency

medical services (EMS) professionals.

Winding two-lane mountain roads cut

through the state, separating isolated rural

areas. Distances between the home or

workplace of an injured person and the

nearest hospital can be measured in hours,

not miles. Rescue helicopters are the emergency vehicles of choice for reaching

injured people in remote areas,

but fog and snow limit their

ability to fly into outlying

areas in some seasons.

But don’t be too quick to

stereotype West Virginians

as being behind the times

when it comes to injury

control.

Quite the contrary. In fact, West Virginia

boasts one of the most sophisticated injury

control programs in the country, one that

puts the tools of technology to work to

meet its challenges of access to emergency

care.

Rural, emergency 

care focus

The Center for Rural Emergency Medicine (CREM), based

at the Robert C. Byrd Health

Sciences Center of West Virginia University in Morgantown, is beginning its fourth

year as a CDC-funded Injury

Control Training and Demonstration Center. The center

focuses on training health professionals and on emergencydepartment-based injury surveillance, a statewide injury prevention program, and applied research in rural injury

prevention, control, treatment, and rehabilitation. CREM is unique among CDC

injury grantees as the only one with a primary focus on training.

Dr. John E. Prescott, MD, FACEP, director

of CREM, said that a focus on needs of

rural care providers has been a “guiding

light”for all their activities. “We look at

the issues confronting rural health care

providers, conduct research to help them

solve those problems, and then implement

practical, low-cost solutions.”Access to

care for emergency treatment of injuries

has been a priority from the start, he said.

“Injury presents a unique picture in West

Virginia,”added Leah J. Heimbach, JD,

RN, NREMT-P, and CREM administrator.

“The state is sparsely populated: our total

population is only about 1.8 million, and

Charleston, the capital and largest city,

has only 57,000 people.” Other special

features are pockets of Appalachian culture with a tradition of people taking care

of their own, and a rise in outdoor adventure tourism such as whitewater rafting,

skiing, hiking, all with the potential for

SPOTLIGHT 

ON THE 

STATES

West Virginia puts premium on

training, acute care, and research

West Virginia’s natural attractions draw many visitors,

but the rugged mountain setting is a challenge in medical

emergencies.

▲
▲

injuries. Narrow mountain roads and

rugged terrain in many parts of the state

add to the challenge of treating injured

people.

Training emergency responders

is essential

Early on, training was a priority to expand

prehospital care in more remote areas. To

date, CREM has trained more than 900

health professionals and has taken educational programs or technical assistance to

35 of the state’s 55 counties. A standard

training focus is delivery of specialty care

courses such as basic life support,

advanced cardiac life support, basic trauma

life support, pediatric advanced life support, and advanced burn life support.

Additional courses emphasize the role of

EMS professionals in injury prevention.

An effort to enhance skills of emergency

department nurses in outlying areas

resulted in the “Emergency Nurses Partnership Program,”in which rural ED nurses participate in both classroom training

and a one-day clinical rotation at 

the West Virginia University Hospital. The

curriculum encompasses trauma care, cardiac care, triage strategies, respiratory emergencies, and medico-legal issues.

CREM also is committed to establishing an

integrated training program in rural emergency medicine and trauma care. Toward

that goal, it supports an emergency medicine residency program and an emergency

medicine master’s degree program for

physicians assistants.

Surveillance is key

From the start, the CREM leadership team

put a premium on getting information

about injuries. Appreciating that surveillance data could help draw a picture of

injuries in the state and point the way to

educational and other types of interventions, CREM custom developed the Emergency Department-Based Injury Surveillance System (EDBISS). The system links

data from the emergency department (ED)

patient log, trauma registry, and hospital

billing systems.

CREM staff have used the injury surveillance data for numerous purposes. For

example, West Virginia has the fifth highest rate of occupational fatalities in 

the country and also a high rate of nonfatal injuries, many related to high-risk

ACTIVE INJURY CONTROL NETWORK PRODUCES 

2 VALUABL E R ESOURC E R EPOR TS

The West Virginia Injury Control Network is a an advocacy group committed to

raising public awareness about the impact of injury in the state. More than 70 individuals and organizations participate in efforts to educate the community and local

and state governments. The Network recently published two resource documents

that provide state-specific information. Both can be downloaded from the CREM

home page.

▲ Injury in West Virginia provides a “snapshot”of injury in the state, including

cause of death information by age group by county. The report notes that West

Virginia’s overall injury rate is higher than the national average in almost all categories.

▲ Injury Control and Prevention Programs in West Virginia is a sourcebook that inventories all the state’s injury programs with contact names and numbers. It is crossindexed by category, e.g., bicycle injuries, fires and burns.

▲
7

▲INJURY CONTROL UPDATE

▲ Winter 1996

industries such as logging, mining, and

transport. An EDBISS analysis of medical

charges related to work injuries found that

transportation-related injuries accounted

for the most expensive hospital charges on

average. A separate study found that,

because of disability, logging injuries had

an impact greater than the number of

injuries alone would indicate: “The longterm effects were devastating in cases

where a worker lost a hand,”said Ms.

Heimbach. As a result of these findings,

the center will work to develop specific

employee education programs.

“MAPS” aids rural EMS providers

The response of EMS providers can make

a life or death difference for injured and

sick people who live in areas distant from

hospital care.

The problem is that many EMS squads

operating in sparsely populated areas

don’t have a heavy call load and also have

a difficult time getting reimbursement. That

dual problem threatens the economic viability of some squads and, consequently,

EMS capacity in rural areas.

CREM responded to this challenge by

developing Management Assistance Program for Squads (MAPS). The program

provides computers, custom software, and

training to make billing more effective and

thus help the providers stay in business.

The project also furnishes injury data to

CREM, where it is analyzed to design

interventions for injury problems in rural

areas.

The first group of 10 EMS squads began

training in August, and many others are

on a waiting list. A 3-year grant of

$360,000 to launch the program came

from the Claude W. Benedum Foundation,

a regional fund that fosters selfsufficiency in rural West Virginia, especially

in the areas of education and health.

Technology expands access

Taking training to all the hospitals 

in the state put thousands of miles on the

CREM van—and the demand is 

still growing. The program turned to

MDTV, an interactive physician’s telemedicine network, to expand their educational

reach.

CONFERENCE HIGHLIGHTS LINK BETWEEN MANAGED CARE 

AND INJURY CONTROL

Managed care is fast becoming a fact of life in the U.S. health care system. What will its impact be

on injury control and prevention? And what role can injury surveillance data play in helping identify

areas of high costs and potential prevention interventions?

These issues and related subjects were addressed at the fall conference sponsored by the Injury

Control Training and Demonstration Center of the West Virginia University Center for Rural Emergency Medicine (CREM).

The faculty tackled topics like barriers to collection and use of injury data, the impact of managed care on delivery of trauma care, and measuring the benefit of prevention programs.

Dr. John E. Prescott, CREM director, commented,“Managed care organizations want to know what

prevention interventions really make an impact on the health and health-related costs of their

enrollees. Injury projects with solid surveillance data can help target their efforts. For example, we

know that falls and motor vehicle crashes are the major problems in our state—that’s where the

money goes for care. If we can get people to wear seat belts consistently and help the elderly at risk

for falls, we can make a major impact on hospital utilization rates. That should catch the eye of managed care organizations and encourage them to tailor interventions.”

▲
▲

The distance-based learning program made

its debut in September with 

“Accidents Aren’t,”a presentation 

that emphasized the role of EMS 

providers in injury prevention.

EMS personnel could attend the 

presentation at any one of seven 

hospitals nearest them. Another 

MDTV program scheduled before

the winter tourist season was preventionand treatment of 

hypothermia and ski injuries.

CREM also has created its own

niche on the information highway. It

has an Internet “home page”which

includes such offerings as a list of

injury mechanisms (similar to 

e-codes), information on causes of

injuries treated at the WVU Emergency Department, a hypertext map

of West Virginia with extensive injury data

by county, and a link to the University of

Pittsburgh’s injury control research information network. The address is:

http:/www.hsc.wvu/ crem/crem.htm.

CREM staff saw the impact of Internet

communications when they realized that

about half the registrations for their recent

conference on injury and managed care

(see sidebar) came via Injury-L, an Internet-based discussion list managed by

CREM.

Publications spread the word

Communications about research findings

and injury prevention are high on 

the list for CREM staff. A quarterly

newsletter Friends of CREM updates 

people around the state on the project’s

activities. Articles based on their approach

to rural injury prevention and surveillance

data appear in professional publications,

and senior staff participate in numerous

medical and health-related 

conferences. Their influence will even span

the globe: in early 1996, Janet M. Williams,

MD, CREM research director, will travel to

Melbourne, Australia, to present papers on

CREM at the Third International Injury

Control Conference. ■

Injury control

goes online

Always eager to bend technology to good

use, the injury control community has

added its presence to the information

highway.

The NCIPC Home Page makes its debut

in February 1996. The resources available

will include general information on the

center and its divisions, publications,

research grants and funding opportunities,

a “what’s new”section, and scientific data,

surveillance, and statistics on injury. The

address is 

http://www.cdc.gov. ncipc.htm.

The Injury Control Resource Information

Network (ICRIN) provides a comprehensive listing of injury control resources available on the Internet. The world wide web

home page was developed by the Center for

Injury Research and Control at

▲ Local EMTs take a break with CREM staff, Dr. John Prescott

and Leah Heimbach.
9

▲INJURY CONTROL UPDATE

▲ Winter 1996

“Community support and personal

responsibility are the foundation to preventing violence and building a stronger

country,”said Vice President Al Gore in his

keynote address opening the first National

Violence Prevention Conference in Des

Moines, Iowa, last fall.

Emphasizing the role of community-based

projects, the Vice President said,“Everyone

in the community—parents, teachers, law

enforcement, the business sector, religious

leaders—everyone has a stake in designing

and implementing violence prevention

programs.”

The Vice President set the tone for the 3-

day conference, which was sponsored by

NCIPC and the University of Iowa Prevention Research Center in Des Moines.

More than 1200 participants heard experts

from the fields of public health, criminal

justice, education, social service, academia,

federal and state governments, and community-based organizations confront the

problems of violence and discuss promising solutions.

In his welcoming address, Senator Tom

Harkin (R, Iowa), who was key in 

arranging the conference, pointed out that

the conference was a nonpartisan event,

as indeed the field of injury prevention

must be.

Rep. Greg Gansky (D, Iowa) stressed the

same theme in his opening address by

highlighting the importance of injury

prevention to people from all walks of

life and all parts of the political spectrum.

Attorney General Janet Reno also

addressed the conference participants,

echoing the Vice President’s theme.

“Communities are at the center of violence prevention efforts. They understand

their needs and resources, and the community is where so much of the innovation is

happening.”

Bringing people together

Building bridges to span differences in the

field was a central conference theme,

according to Mark L. Rosenberg, MD,

MPP, director of NCIPC. He noted the following challenges:

▲ the gap between researchers and program practitioners

▲ different disciplines that may not speak

the same language

▲ different types of violence (youth violence, domestic violence, and so on),

First National Violence Prevention

Conference builds bridges, seeks

solutions

Vice President Al Gore opens Violence ▲

Prevention Converence.
0

▲

leading to a kind of “Balkanization”in

the field

▲ different types of organizations, from

community groups to foundations.

By bringing together professionals from

the many sectors, Dr. Rosenberg said,

CDC hopes to foster an interdisciplinary

violence prevention community. Conference programs clustered around four prevention areas: family and intimate violence, youth violence, suicide, and workplace violence. Special sessions also

addressed violence against people with

disabilities, and cross-cutting sessions

encompassed broad areas of violence prevention.

Violence impact felt by all

Focusing broad attention on the problem

of violence couldn’t be more timely, said

David M. Satcher, MD, PhD, director of

CDC. He highlighted several reasons for

confronting violence, particularly within

the context of public health:

▲ its devastating impact on the health of

people in this country, in terms of disability as well as death

▲ the impact of pervasive fear in 

communities

▲ the burden on the health care system.

Recent CDC statistics underline the effect

on young people in particular. Despite the

recent slight dip overall, homicide remains

the second leading cause of death for

young Americans aged 15-24, and suicide

rates have increased. The FBI’s Uniform

Crime Report (UCR) data show that,

although the national crime rate overall

fell 2% in 1994, there was an increase in

crimes committed by adolescents, especially crimes committed with guns.

“While it’s encouraging to see the overall

homicide rate come down, it’s distressing

to see so many of our young people dying

from violence that is either self-inflicted

or inflicted by another,”said Dr. Satcher.

“We have got to find more effective ways

to prevent this.”

Seeking solutions

Too many youth at risk for violence lack

life opportunities, hope, and positive adult

role models, said Peter Edelman, JD, acting

assistant secretary for planning and evaluation at the U.S. Department of Health and

Human Services. Speaking at the opening

plenary panel, he said young people “need

things to say ‘yes’ to.”Challenges include

providing increased opportunities for

employment and other life choices, as well

as changing a culture that glorifies violence.

People are becoming overwhelmed by the

statistics and “horror stories”about violence, maintained panel member Susan

Schechter, MSW, of the Injury Prevention

Center at the University of Iowa at Iowa

City.“We haven’t given people solutions—

that’s the missing piece.”She said communities need to forge solutions at the

community level.

Another panelist gave an example of how

one community successfully took a strong

stand against violence. Numerous violent

events threatened to shut down a high

school in Brooklyn. But the community

refused to give up and developed a system

of cluster schools as a response to the

problem, according to Luis Garden-Acosta, president of 

El Puente in Brooklyn.

Highlighting the role of criminal 

justice in violence prevention, Don C.

Nickerson, the U.S. Attorney for the

Southern District of Iowa, acknowledged

that policemen have a long history of

mistrust to overcome. Part of the solution

is community policing, he said.“Police get

out of the squad cars and talk to people

in the neighborhood about what’s important to them.”
11

▲INJURY CONTROL UPDATE

▲ Winter 1996

The workplace can be a focus for

violence prevention efforts, suggested Linda Rosenstock, MD, MPH,

director of the National Institute for

Occupational Safety and Health

(NIOSH). The public is becoming

more aware that violence is the

leading cause of death in the workplace, she said.

Investing in prevention

Several speakers underlined the

need to confront resource issues for

prevention. Vice President Gore

said,“The problem of violence will

yield to a response if we make the

resources available.

Prevention programs are not a 

luxury—they are basic.”

“We must renew our efforts to convince

Americans that we should be investing in

prevention,”said Attorney General Reno.

“That shouldn’t be hard. I’ve never met a

person who would rather have had the

crime committed and been a victim of the

crime than to have prevented the crime in

the first place.”■

CDC Director Dr. David Satcher and DHHS

official Peter Edelman participate in 

conference sessions.

▲

CONFERENCE IMPACT 

CONTINUES 

A guide to resources related to the violence prevention conference will be available

soon in print and on the NCIPC worldwide

web home page. The annotated guide will

highlight publications, training manuals, and

audiovisual materials appropriate for programs. Additional information will be available in an upcoming issue of Injury Control

Update.

▲

Attorney General Janet Reno chats with NCIPC staff.

Left to right: Dr. Mark Rosenberg, Janet Reno, Chet

Pogostin, Gene Shelly, Denise Johnson, Laura Martin,

Mary Ann Fenley, Lee Annest.

▲ ▲
2

▲

Two publications on injury control topics

have recently been published by the National Center for Injury Prevention and Control

(NCIPC).

Guidelines for Surveillance of Central Nervous System Injury describes standards and

recommendations for establishing a local or

state system for surveillance of central nervous system (CNS) injury. The publication

was developed as part of NCIPC’s commitment to promote CNS surveillance throughout the country. The goal is to develop a

more comprehensive picture of traumatic

brain injuries and spinal cord injuries: their

incidence, severity, and causes.

The manual provides case definitions and

recommended data elements for collection

and recommends approaches for designing

and implementing surveillance plans. Also

included are summaries of current state programs with a contact for each.

Authors of the publication are David J.

Thurman, MD, MPH; Joseph E. Sniezek,

MD, MPH; Denise Johnson, MS; Arlene

Greenspan, DrPH; and Suzanne M. Smith,

MD, MPH.

Suicide in the United States, 1980-1992 is

the first in a series of surveillance summaries to be published by NCIPC’s Division of Violence Prevention. Analysis of the

data shows only a slight rise in the ageadjusted suicide rate for the total U.S. population during the 13-year period. However,

the overall rate masks changes in specific

rates related to age, race, sex, and geography. For example, suicide rates increased

among young people aged 10-19, young

black males, and elderly males of all races.

Suicide rates are higher in Western states,

linked to the higher rate of firearm suicides.

Overall, firearms accounted for 77% of the

increase in suicides in the 1980s and early

1990s.

The suicide surveillance report discusses

trends and displays graphics related to age,

race, gender, ethnicity, method, and geographic variation. It also presents data tables

on numbers and rates of suicide, which are

based on death certificate data provided by

all 50 states and the District of Columbia.

The report’s authors are S. Patrick Kachur,

MD, MPH; Lloyd Potter, PhD, MPH;

Stephen P. James; and Kenneth E. Powell,

MD, MPH.

Both NCIPC publications can be ordered

from NCIPC, Attention: Library Desk, MS

K-65, 4770 Buford Highway NE, Chamblee,

GA 30341-3724.

Resources You Can Use ▼

CALENDAR

MARCH 20 - 23 Ninth Youth Crime Prevention Conference, Miami, FL. Sponsored by 

Youth Crime Watch of America and the National Crime Prevention 

Council (NCPC). Contact: NCPC, 1700 K Street, NW, 2nd Floor,

Washington, DC 20006-3817, or phone Youth Crime Watch of America 

at (305) 670-2409.

MARCH 26 - 30 Twelfth National Symposium on Child Sexual Abuse, Huntsville, AL.

Sponsored by the National Children’s Advocacy Center (NCAC) and 

the National Resource Center on Child Sexual Abuse (NRCCSA).

Contact: NCAC, 106 Lincoln St, Huntsville, AL 35801, or phone 

(205) 533-0531.
13

▲INJURY CONTROL UPDATE

▲ Winter 1996

As anyone who observes an emergency

department or trauma center on a weekend

night can attest, alcohol remains one of the

most important risk factors for serious

injury and death in this country.

Alcohol played a role in 44% of the more

than 40,000 traffic fatalities in 1993. An

estimated two out of every five Americans will be involved in an alcohol-related motor vehicle crash at some time during their lives.

Daily headlines tell the tale of innocent

victims killed by drunk drivers. But what

of the drunk drivers themselves? Are their

chances of dying in a crash increased?

Common sense would say “yes,”but that

assumption was largely untested until

Robert Brewer, MD, MSPH, a medical epidemiologist at NCIPC, and his colleagues

in North 

Carolina examined the increased risk of

future death for people arrested for DWI.

The researchers used state medical examiner data, police crash reports, and driver

history files to evaluate the relationship

between DWI arrests and future alcoholrelated crash deaths. The study defined

DWI as 100 mg/dL or refusal to be tested

for alcohol levels. The research team came

up with these findings:

▲ Teenagers and young adult drivers

(ages 16-29) who were arrested for

DWI were four times more likely to die

in future crashes involving alcohol than

were those who had not been arrested

for DWI.

▲ Adult drivers over 30 who had one 

or more DWI arrests were eleven times

more likely to die in future crashes than

were drivers in that age group who had

not been arrested for drunk driving.

▲ The risk of future death in an alcoholrelated crash increases with the number

of DWI arrests.

Alcoholism may be underlying

problem

Dr. Brewer carried out the study in collaboration with Peter Morris, MD, MPH;

Thomas Cole, MD, MPH; Stephanie

Watkins, MSPH; and Michael Patetta, MA,

all of the North Carolina Department of

Environment, Health, and Natural

Resources, and with Carol Popkin, MSPH,

of the University of North Carolina Highway Safety Research Center. Their study,

“The Risk of Dying in Alcohol-Related

Vehicle Crashes among Habitual Drunk

Drivers,”was published in the August 25,

1994, issue of The New England Journal of

Medicine.

“We know from previous studies that

more than half of all people arrested for

DWI have serious drinking problems,”said

Dr. Brewer.“This may help to explain why

so many people who are arrested for DWI

continue to drink and drive. And we know

that serious drinking is most common

among men in the 35 to 50 age group.

That may explain why ‘older drivers’ who

are arrested for DWI are at greater risk of

Alcohol-impaired drivers: a danger

to themselves

“We know from previous studies 

that more than half of all people

arrested for DWI have serious

drinking problems.”

— ROBERT BREWER, MD, MSPH

▲
4

▲

Injury online (Cont. from page 8)

the University of Pittsburgh. The address is

http://info.pitt.edu/~hweiss/injury.htm.

Partnerships Against Violence Network

(PAVNET) Online offers online information

about federal resources related to violence

prevention. It was created as a way to provide state and local groups with information

about programs, funding sources, technical

assistance, and teaching materials. The online

service was developed by a coalition of federal agencies to improve speedy access to ideas

and resources related to violence prevention.

The address is

Gopher//cyfer.esusda.gov:70/11/violence ■ ✄

death in a future alcohol-related crash

than younger drivers.”

The authors emphasize the need to combine substance abuse assessment and

treatment with strict legal sanctions

against drunk driving.“Our society’s tendency has been to focus mainly on legal

interventions to address the problems of

alcohol-impaired driving,”said Dr. Brewer.

“There is no doubt that such legal measures as increasing the minimum drinking

age, administrative license revocation, and

lowering the legal blood level for driving

have all had a dramatic impact on reducing alcohol-related crash deaths. But we

also need to evaluate the role of courtmandated substance abuse assessment

and treatment for DWI offenders.”

North Carolina has such a mandatory

substance abuse assessment program, and

Dr. Brewer and his colleagues are currently evaluating its effectiveness.

For their study of DWI arrests and alcoholrelated crash deaths, Dr. Brewer and his

co-authors received the 1995 Charles C.

Shepard Science Award. The award is presented each year to the authors of the

most outstanding peer-reviewed research

paper published by CDC scientists during

the preceding year. This was the first time

an injury control study had received this

award for scientific excellence. ■

NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL

CENTERS FOR DISEASE CONTROL AND PREVENTION 

Division of Unintentional Injury Prevention . . . . . . . .770/488-4652

Division of Violence Prevention . . . . . . . . . . . . . . . . .770/488-4362

Division of Acute Care, Rehabilitation Research 

and Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .770/488-4031

Office of Research Grants . . . . . . . . . . . . . . . . . . . . . .770/488-4265

State Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .770/488-4400

Automated Information Line . . . . . . . . . . . . . . . . . . .770/488-4677

Injury Control Update is a quarterly 

publication of the Centers for Disease Control and

Prevention (CDC), National Center for Injury

Prevention and Control (NCIPC).

DIRECTOR, CDC

David Satcher, MD, PhD

DIRECTOR, NCIPC

Mark L. Rosenberg, MD, MPP

EDITOR

Gwen Ingraham

MANAGING EDITOR

Katie Baer, MPH

WRITER-EDITORS

Virginia Ross, PhD • Daphna Gregg, RN

DESIGN

Oldroyd Digital

Direct editorial correspondence to:

Gwen Ingraham, Director of Health

Communications, NCIPC, CDC,

MS K-65

4770 Buford Hwy. NE • Chamblee, GA 30334-3724

Internet: GNI1@CIPCOD1.EM.CDC.GOV
15

▲INJURY CONTROL UPDATE

▲ Winter 1996

The following articles are based on work by

NCIPC-supported injury control research

centers.

Kyriacou DN, Arcinue EG, Peek C, Kraus

JF. Effect of immediate resuscitation on

children with submersion injury. Pediatrics 1994;84:137-142.

Do immediate efforts by bystanders or rescuers to resuscitate a child who has been

submerged underwater improve neurological

outcome? The answer is a resounding yes,

according to this study of 166 children at a

California hospital. The authors found that

immediate resuscitation before the arrival of

paramedics improved clinical outcomes—

whatever the patient's age, duration of submersion, or method of resuscitation. Teaching

parents, siblings, and caretakers of children

simple and rapid artificial respiration is recommend.

Li G, Baker SP. Crashes of commuter aircraft and air taxis: what determines pilot

survival? JOM 1993;35:1244-1249.

Most airplane crashes should be survivable if

aircraft are well-designed. An analysis of

National Transportation Safety Board data for

the years 1983 to 1988 identified several factors related to pilot survival in commuter aircraft and air taxi crashes. Among the most

important determinants of pilot death were

postcrash fire, bad weather, and nonuse of

shoulder restraints. Pilots are more likely to

survive crashes if planes are equipped with

more crashworthy fuel systems and aircraft

seats. The study also underscored the value of

shoulder restraints for pilots of commuter aircraft and air taxis; their use should be vigorously promoted.

Schootman M, Fuortes LJ, Zwerling C,

Albanese MA, Watson CA. Safety behavior

among Iowa junior high and high school

students. Am J Public Health 1993;83:1628-

1632.

Know your audience: that familiar concept

can help injury prevention professionals target intervention strategies to specific groups.

A recent study of adolescents in Iowa found

that students attending rural schools use

front seat belts and helmets less frequently

than urban students. Seat belt and helmet

use and swim safety decreased dramatically

with age, while occurrences of driving or riding while drunk or high increased with age.

Boys were less likely than girls to wear safety

belts if they rode in the backseat of a car, and

were less likely to wear moped helmets and

to check water depth before diving.

Wrigley JM,Yoels WC, Webb CR, Fine PR.

Social and physical factors in the referral

of people with traumatic brain injuries to

rehabilitation. Arch Phys Med Rehabil

1994;75:149-155.

The specialty of the attending physician was

the most important determinant in referrals

of people with traumatic brain injuries (TBI)

to formal rehabilitation programs, according

to this study. A patient is more likely to

receive more formal rehabilitation care after

discharge from the hospital when a physical

medicine and rehabilitation specialist makes

the referral. The study results underline the

importance of rehabilitation medicine consultation, as well as making acute care providers

aware of formal rehabilitation as a management option.

Injury Journal Club
6

▲

MAKE THIS YOUR NEWSLETTER!

Welcome to the first issue of the quarterly newsletter, Injury Control Update. NCIPC has three

main goals in publishing this newsletter:

▲ to foster exchange of information about research, programs, and resources in the field

▲ to highlight innovative work taking place in communities throughout the country

▲ to update injury control professionals on meetings, publications, and electronic media.

In short, we hope that this newsletter will be a tool to help build the injury control community.

That will happen only if you—the readers—participate. We encourage you to submit ideas for

articles, nominate outstanding programs for highlighting, and give us your thoughts on how to

make this newsletter timely and relevant for you.

We look forward to a lively two-way communication. Write, e-mail, or send a message on our

home page, where the newsletter also will appear.

Mark L. Rosenberg, MD, MPP

Director, NCIPC

Send your comments to Gwen Ingraham, Director, Office of Health Communications, NCIPC, CDC,

MS K-65, 4770 Buford Hwy. NE, Chamblee, GA 30341-3724, or e-mail – GNI1@CIPCOD1.EM.CDC.GOV.

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES

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Centers for Disease Control and Prevention

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