Injuries

in the School

Environment

SECOND EDITION

APRIL 1997

A Resource Guide
Second Edition

April 1997

Children’s Safety Network National Injury and Violence Prevention Resource Center

Education Development Center, Inc.

Funded by the Maternal and Child Health Bureau, Health Resources and Services Administration

U.S. Department of Health and Human Services

Children’s

Safety

Network

Injuries

in the School

Environment

A Resource Guide
Cite as: Children’s Safety Network at Education Development Center, Inc. (1997).

Injuries in the School Environment: A Resource Guide (Second Edition).

Newton, MA: Education Development Center, Inc.

The Children’s Safety Network (CSN) is a national resource for child and adolescent injury

prevention. Funded by the federal Maternal and Child Health Bureau, CSN consists of six

sites that provide technical assistance to state and local public health professionals,

especially those serving MCH populations. This guide was developed by the National

Injury and Violence Prevention Resource Center at Education Development Center Inc.,

one of the six centers. Primary authors: Susan Gallagher, Alison Dana, Anara Guard.

Graphic designer: Jonathan Bruce.

This publication was produced by CSN under its cooperative agreement MCJ-253A1-05

with the Maternal and Child Health Bureau, Health Resources and Services Administration,

Public Health Service, U.S. Department of Health and Human Services.

Additional copies of this guide are available at no charge from

Michelle Stober

Children’s Safety Network

Education Development Center, Inc.

55 Chapel Street

Newton, MA 02158-1060

☎ 617.969.7100, ext. 2207

This guide is also accessible on the World Wide Web at www.edc.org/HHD/csn/schoolinj/schoolpack.html.

Readers are free to duplicate any and all parts of the information contained in this publication.

However, in accordance with standard publishing practices, CSN requires acknowledgment,

in print, of any information reproduced.
TABLE OF CONTENTS

Introduction............................................................................................................................... 1

Understanding the Problem ................................................................................................... 3

Examining the Circumstances ................................................................................................ 7

What Is Being Done: Selected Examples ........................................................................... 12

 Arizona School Injury Surveillance Program .............................................................................. 12

 California School Injury Work Group ........................................................................................... 13

 School Nurse Emergency Medical Services for Children Program ......................................... 16

 Estimating the Cost of Injuries to Children at School................................................................ 17

 Needham High School Health and Safety Reporting................................................................. 18

 New Hampshire Safe Playground Project ................................................................................... 19

 South Carolina Annual School Health Nurse Survey ................................................................ 20

 Texas Independent School District Crime Report....................................................................... 20

 Utah Student Injury Reporting System ........................................................................................ 21

 School Injuries in Virginia: A Pilot Study..................................................................................... 22

 Development of Capacity for Prevention of Injuries in

 School Settings in Washington State ..................................................................................... 23

Sample Data Collection Forms ............................................................................................. 25

Further Reading ...................................................................................................................... 31
INTRODUCTION

While media reports sensationalize violence occurring in U.S. schools, the problem of

unintentional injuries in the school setting has gone virtually unpublicized.

Almost 22 million children in the United States are injured each year. An estimated 10 to 25

percent of these injuries occur in and around schools. Injuries are one of the most frequent

conditions cared for by school health personnel. Over a two-year period, an estimated 80

percent of elementary school children will see a school nurse for injury-related complaints.

Yet the problem of injuries in the school environment is often unrecognized, and consequently,

preventive measures are neglected. Recent government initiatives to improve the health of

children and adolescents have not addressed the safety of the school environment. For

example, neither the problem statement nor the background papers for the National Health

Promotion and Disease Prevention Objectives, Healthy People 2000, specifically mention

injuries in the school setting. And although the National Education Goals call for schools to

be free of violence by the year 2000, they do not recognize the importance of preventing

unintentional injuries in order to create a safe environment for learning.

Most relevant research in the medical and public health literature focuses on the

underreporting of school injuries and the poor quality of data collected, rather than possible

prevention measures. The education literature contains numerous references to safety but

focuses primarily on liability in the school setting.

71 pupils were killed and 201 severely wounded in schools by handguns during the

years 1986–1989, according to the Center to Prevent Handgun Violence.

175 pupils were killed in incidents involving school buses during that same period.

An additional 29,600 children suffered school-bus-related injuries, with more than

half being struck by the bus or another motor vehicle as they boarded or left the bus.
Patterns and causes of school injuries are poorly understood, and resources to help public

health and education professionals address injuries are scarce. Schools usually respond to

injuries on an ad hoc basis—after the damage is done. Injury events are not consistently

tracked, and it is often difficult to identify who has responsibility for preventing a recurrence.

Currently, no comprehensive guidelines are available for school administrators and other

health and education professionals interested in addressing the problem of injuries in the

school environment. Thus, schools need to begin by assessing the causes of injuries within

individual schools in order to target the leading causes of injury and to prevent them.

A multifaceted intervention—including modifications to school equipment and facilities,

development of supervision and safety policies, and education of students, teachers, parents,

and administrators about injury prevention at school—provides the most comprehensive

approach. State maternal and child health practitioners and other injury control experts can

provide information and technical assistance to schools interested in developing and evaluating

the impact of school-based injury prevention activities.

Schools have an important role to play in addressing the problem of child and adolescent

injuries. The Children’s Safety Network has designed this packet to inform school personnel,

injury prevention professionals, parents, and others about the extent of the problem of injuries

in the school environment and to stimulate dialogue about possible solutions. Included are the

following materials:

n UNDERSTANDING THE PROBLEM—a fact sheet on school injuries, derived from National

Pediatric Trauma Registry data and accompanied by suggested prevention strategies

n EXAMINING THE CIRCUMSTANCES—a series of vignettes that illustrate the circumstances

surrounding injuries occurring in the school environment, along with questions for further

discussion

n WHAT IS BEING DONE: SELECTED EXAMPLES—a description of steps that agencies in

nine states are taking to address this problem

n SAMPLE DATA COLLECTION FORMS—data entry forms from three states that are

collecting school injury data

n FURTHER READING—an annotated bibliography of selected resources, journal articles,

studies, and state and federal reports. Topics include: playgrounds and sports, students

with special needs, legal and liability issues, transportation, and violence.

The photographs in this publication illustrate settings and circumstances where students

may be injured. You may want to examine these and other settings in your school to identify

additional hazards.

We encourage you to distribute this packet or any of its parts to school nurses, school health

personnel, other relevant professionals, and community organizations. This guide is also

accessible on the World Wide Web at www.edc.org/HHD/csn/schoolinj/schoolpack.html.

Please cite the Children’s Safety Network at Education Development Center, Inc. (EDC) as the

source. We would appreciate hearing how you use this information, suggestions of additional

resources of which we should be aware, and work you may be initiating in this area.
Understanding the Problem

3

UNDERSTANDING THE PROBLEM

The research literature indicates that an estimated 10 to 20 percent of all injuries to children and

adolescents occur in and around schools. Yet serious injuries that happen on school grounds

and result in hospitalization have not been well studied in the United States. The following facts

were compiled from a descriptive analysis of the causes and outcomes of 1,558 cases reported to

the National Pediatric Trauma Registry (NPTR).1

 Although this is not a population-based source

of information, the data are useful in drawing attention to the problem of severe injuries in the

school environment.

School Injuries Overall

n The ratio of injury to males vs. females was 3:1.

n 46% of these incidents occurred among 10 to 14 year olds.

n 17% of those injured in school had a preexisting medical condition (e.g., physical or mental

disability or chronic illness).

n 49% of the injuries happened in recreational areas, as opposed to the school building or

other premises.

n The ratio of unintentional injuries to violence-related injuries was 9:1.

n Falls were the most frequent cause of injury (43%), followed by sports activities (34%) and

assaults (10%).

n Other major causes of injury included being cut, striking against objects, and being struck

by objects.

1 National Pediatric Trauma Registry, October 1988–October 1995. Reports from 74 participating hospitals across the United States

regarding children ages 0–19. N = 1,558 cases of injuries occurring in the school environment out of 49,540 total cases in the

database. NPTR does not include cases of injuries on school grounds to children younger than 5 or older than 18, those that

occurred during transportation to or from school, and those reported by a Canadian hospital.
Injuries in the School Environment

4

Falls (N = 665)

n 53 falls were from a height greater than 8 feet, including 12 from windows, roofs, skylights,

or balconies; other falls involved bleachers, stairs, and playground equipment.

n Falls accounted for 3 out of 8 deaths, 3 out of 11 cases requiring extensive rehabilitation,

and 36% of cases with a high injury severity score.

Sports (N = 524)

n A common scenario involved falling during a sports activity or being struck by a ball or

another piece of sports equipment; injuries were related to asphalt surfaces, ruts in the

playing field, bleachers, concrete gymnasium walls, and lack of protective equipment.

n Injuries occurred both in gymnasiums and on playing fields.

n Many kinds of sports were implicated, the most common being football, basketball,

wrestling, soccer, track and field, and gymnastics.

n 75% of spinal cord injuries occurred during sports.

Assaults (N = 160)

Following falls and sports, assaults were the third most frequent cause of injury.

n Assaults included beatings (57%), gunshot wounds (10%), and stabbings (14%).

n The majority of the assaults (78%) occurred to students in grades 7–12.

Severity

Many school-related injuries result in hospitalization or surgery.

n 11% of children injured were in the intensive care unit for one day or longer.

n 35 children sustained a spinal cord injury.

n 39% had a head injury.

n 41% had one or more injuries to the extremities.

n One or more surgical interventions were required in 38% of school-related injuries.

n 8 children died, 6 from head injuries; 4 were unintentional injuries and 4 were

assault-related.
Understanding the Problem

5

n 44% of children were discharged with functional limitations expected to last less than

7 months, mainly due to fractures of the extremities; 2% were discharged with functional

limitations expected to last 2 years or longer, caused by head or spinal cord injury.

n The average length of hospital stay was 3.5 days.

Cost

Assuming a conservative average cost of $1,000 per day, the cost of hospitalization was more than

$5 million for a total of 5,391 hospital days.

School Triage

Many school-related injuries were not treated immediately or appropriately.

n 248 children (16% of cases) were sent home after being injured and were subsequently

admitted to a trauma center.

n 34% of those 248 children ended up in the operating room; 6% were admitted to the

intensive care unit.
Injuries in the School Environment

6

Prevention

A number of strategies can prevent unintentional injuries and violence in the school environment.

Environmental Changes to Improve Physical Surroundings

n Removal of physical hazards (e.g., breakable glass in doors, concrete or asphalt under

playground equipment, bleachers on playing field lines, holes or ruts in playing fields).

n Maintenance of equipment and facilities (e.g., protective guards on shop equipment, lockers

anchored securely, playground equipment in good repair, working smoke detectors).

n Addition of safety features and equipment (e.g., padded mats on concrete gymnasium

walls, use of mouthguards and other protective equipment, locks on roof doors,

improved lighting).

n Institutionalization of an annual safety checklist for school premises.

Policies and Regulations that Are Enforced

n Collection of injury data to identify causes and patterns of injury.

n Development and enforcement of schoolwide safety policies.

n Development of a response protocol for school staff in the event of an injury; emergency

or disaster training for school staff.

n Enforcement of regulations, especially during sports and recreational activities.

Modification of Behavior

n Education of students and staff regarding potential hazards and preventive measures,

and what to do in the event of an emergency or disaster.

Student Instruction in How to Play Safely

n Training of coaches, gym teachers, and other school staff in emergency first-aid procedures.

n Increased supervision of students.
Examining the Circumstances

7

EXAMINING THE CIRCUMSTANCES

The school environment contains a wide variety of potential hazards. Risks vary

considerably as students move through the school day. Students begin in supervised,

structured classroom environments; move to science labs and industrial arts shops; take lunch

periods; participate in physical and at times aggressive activity in gymnasiums, on playing

fields, and during recess; and finish by walking, riding bicycles, or taking the school bus home.

While media attention has focused on violence in U.S. schools, the problem of unintentional

injuries in the school environment has gone virtually unpublicized. What follows are real-life

descriptions of injury events in the United States that illustrate the scope, causes, and patterns

of school injuries.2

 Many of these injuries could have been prevented through better

maintenance or repair of school facilities, equipment, and playing fields; enforcement of rules,

building codes, and other standards; emergency preparedness; improved supervision; and

education of school officials, students, and parents.

These vignettes are designed to spark discussion among staff in public health agencies and

educational systems and among parents regarding how each can play a role in preventing

such injuries.

2 Case studies derived from National Pediatric Trauma Registry, October 1988–April 1993; ATLA Law Reporter, 1986–1992; and

Jury Verdict Research, 1987–1992.
Injuries in the School Environment

8

Each example brings to mind a number of questions. Among them are:

? How could this injury have been prevented?

? Does my school or school district have policies in place that would prevent similar

tragedies?

? Is the incident strictly a supervision issue or are changes needed in the physical

environment?

? Is it less expensive to implement a prevention strategy or to pay the cost of litigation

for even one case of injury?

? What injuries have happened in my school?

? Are the appropriate safety issues discussed with students in school health education?

? Whose responsibility is it to follow through and take corrective action after a reported

injury?

? Who should have a role in preventing unintentional injuries and violence in schools?

? What is my role in preventing unintentional injuries and violence in schools?

Crossing a busy street after

exiting his school bus, a 6 year old

was struck by the driver’s side view

mirror of a passing car. He received

serious damage to his optic nerve

and is now totally blind. The bus

stop was in an unsafe location, and

the bus driver had not used flashing

lights to stop traffic for a sufficient

period.

A student’s hand was severely injured when she raised it to stop a classroom door from

being shut by another student. Her hand broke through and shattered one of the glass

panels. The panel was not made of safety glass or coated with a safety glaze and did not

meet the building code.
Examining the Circumstances

9

A 15-year-old student was using a

table saw in his high school shop class

when the board he was cutting flew

up. When he pushed the board down

again, his hand landed on the saw

blade. He lost most of the flesh on his

left thumb and underwent a fusion of

the joints of his index and middle

fingers. He now has little feeling and

no fine motor coordination in his hand.

The school staff had removed the saw

guard and failed to replace it.

A vocational student in an auto mechanics class in a 2-story building was injured when he

slipped on a staircase while carrying an engine block. His right hand was crushed by the

block, 3 tendons were severed, and he underwent 8 major surgeries. Although heavy auto

parts were frequently transported into and out of the building, the school had no elevator or

lift and relied on students to carry the parts up and down the grease-stained wooden stairs.

A high school senior participating in a

football game blocked an opposing

player and sustained a broken neck and

a slipped disk. Although he underwent

two surgeries, he still has permanent

neurological damage and partial

paralysis of his neck and left arm.

His high school “B” division team

had been allowed to play with an

“A” division team and was grossly

mismatched. The coach was aware that

the player was very fatigued but decided

to keep him in the game anyway.

A 15-year-old student slid head-first into home plate during a baseball game, sustaining a

neck fracture that resulted in quadriplegia. He now requires a respirator and 24-hour care.

A subsequent investigation revealed that the student’s helmet was too small and twisted his

neck on impact. No instruction had been given to the students about the danger of sliding

into bases head-first; nor were breakaway bases used on the playing field.
Injuries in the School Environment

10

A 13-year-old student was walking

between 2 school buildings when he

was repeatedly hit on the head by a

group of students. He suffered a

detached retina that could not be

corrected, and he lost sight in that

eye. Even though the school had

been notified that other students had

been harassed in that area, it had

neither posted an adult staff member

to supervise the area nor provided

other remedies for the situation.

An 11-year-old boy with muscular

dystrophy collided with another

student on a ramp and fell out of his

wheelchair. He died of head injuries

12 hours later.

While taking a state-mandated physical

performance test during gym class, a 16 year

old complained of leg cramps and exhaustion

and sat down on the outdoor field. His class

headed indoors, leaving him on the field.

Fifteen minutes later, he was found unconscious and not breathing. Once notified, the

school nurse telephoned paramedics and took

a wheelchair to the field. The fire department

arrived in 2 minutes and administered CPR,

but was unable to resuscitate the student and

he died. The substitute physical education

teacher had not followed guidelines, and the

only staff person trained in CPR did not react

promptly to the emergency situation.

A 13-year-old girl was killed when a

flagpole on the grounds of her parochial

school fell in heavy winds. The flagpole

had corroded and rusted 3 years prior to

the incident and not been restored.
Examining the Circumstances

11

An 8-year-old girl was

sliding down a slide during

recess when the cords of

her hood became entangled

in the poles of the slide.

Her teacher was on the

scene to free her, but the

girl suffered a brain injury

from near strangulation.

An 8-year-old girl was shot in the back

by an 8-year-old boy who brought a

.38-caliber handgun to school and fired it

randomly. She received a spinal cord

injury and is unable to walk. Earlier that

morning the boy had sold a handgun for

$20 to a school bus driver, and on a

previous occasion he had sold bullets for

50 cents to other children at school.

A 16-year-old student and members of a school club were being

photographed in front of a skylight on the roof of their high school.

The 16-year-old stood on the skylight and fell through to the concrete

stairwell below. She was in a coma for two days and subsequently

died of her injuries.

As these vignettes demonstrate, injuries in the school environment do not have one or two

single identifiable causes that can be targeted to “solve the problem.” Nor are school injuries

just a result of inadequate supervision. Consequently, public health and education

professionals must build consensus with parents, legislators, school board members, and

others to effectively address this issue on local, state, and national levels.
Injuries in the School Environment

12

Arizona School Injury Surveillance Program

Doris Evans-Gates

Office of Women’s and Children’s Health

Arizona Department of Health Services

411 North 24th Street

Phoenix, AZ 85008

602.220.6550 ☎

602.220.6551 FAX

WHAT IS BEING DONE:

 SELECTED EXAMPLES

The Arizona School Injury Surveillance Program was initiated in 1991 with two years of funding

from the Arizona Disease Control Research Commission. The original goal of the program

was to collect accurate and reliable data to reflect the nature, incidence, and outcome of

playground-related injuries to students in Arizona’s elementary schools. This focus has since

been expanded to include (1) high schools, junior high schools, and day care centers and

(2) all intentional and unintentional injuries—regardless of where they occur.

School health personnel, upon receiving training and a “self-help” manual, complete an

Arizona Student Injury Report form detailing information on injuries that require the student

to be (1) sent home, (2) sent to a physician, (3) transported and/or admitted to a hospital, or

(4) placed under restricted activity. Forms are completed (usually by a school nurse) and

forwarded to the Office of Women’s and Children’s Health on a monthly basis. Forms are

reviewed for completeness and accuracy via quality control procedures and scanned into an

injury surveillance database on a weekly basis. In addition, Arizona Department of Health

Services minigrants are made available to participating schools to assist them in making

changes to their physical environment and in expanding staff training.
What Is Being Done

13

Data are analyzed annually for each individual school, and school injuries are compared with

the incidence of injuries statewide. In addition, each participating elementary/junior high/high

school and day care center receives an annual summary with recommendations for injury

prevention activities specific to each site. Data are also analyzed, interpreted, and presented in

aggregate form for a year-end review. As trend data become available, it will be easier to

determine whether the prevention initiatives being implemented are having an effect on

reducing the number of injuries at each school site. Due to the comprehensive examination

of school-based injuries at more than 162 public and private schools, the Arizona School

Injury Surveillance Program is frequently the topic of presentations at local, national, and

international health-related conferences (e.g., the 1996 World Health Organization’s

international conference in Melbourne, Australia).

The program has been supported primarily by Maternal and Child Health Block Grant funds.

School injury data are shared with the schools, Arizona Department of Health Services

program staff, the state SAFE KIDS Coalition coordinator, and organizations and individuals

throughout Arizona. The data are used to plan risk management strategies and interventions

to make schools safer places. Minigrants are made available to those participating in the program to assist schools and daycare centers in eliminating or modifying identified hazards that

are contributing to the incidence of injury. A statewide School Injury Task Force will be

established, to be composed of parents, principals, teachers, students, insurers, risk managers,

school health professionals, and representatives from the department of education, the

department of health, and the Consumer Product Safety Commission.

A copy of the Arizona Student Injury Report may be found with other sample data forms

beginning on page 25.

Key Recommendations for Injury Prevention in California: School

Injury Work Group

Tina Zenzola

California Center for Childhood Injury Prevention

San Diego State University

Graduate School of Public Health

Maternal and Child Health Division

6505 Alvarado Road, Suite 208

San Diego, CA 92120

619.594.3691 ☎

619.594.1995 FAX

At the tenth annual California Conference on Childhood Injury Control in 1996, participants

attended action-planning workshops at which they developed recommendations on a range of

injury control topics for use in the development of the 1998–2002 Strategic Plan for Injury

Prevention and Control in California. Workshop participants included federal, state, and county
Injuries in the School Environment

14

public health administrators; physicians; public health nurses; school nurses; injury prevention

coordinators from local departments of education; directors of county and community injury

prevention programs; PTA representatives; police officers; other public safety professionals;

researchers; advocates; child care and child development experts; and emergency medical

services professionals. School injuries was one of 13 topics, and recommendations were

developed in the following five areas:

n research/data

n policy/advocacy

n prevention programs

n infrastructure/systems enhancement

n public information/professional training

The action-planning workshop was preceded by a one-hour plenary session on “School

Injuries: Issues and Interventions,” which provided conference attendees with background

information on (1) the causes and costs of injuries at school, (2) barriers/reasons why schools

have not adequately addressed the injury problem, and (3) potential solutions/policies that

could be implemented to make schools a healthier and safer environment.

These are the primary recommendations developed for school injury prevention:

n Encourage the state health department to take the lead in developing a statewide

task force to examine and make recommendations for a universal school injury

tracking system.

n Establish uniform state regulations on school personnel CPR and first-aid training

and policy enforcement.

n Amend the State Education Code to include formation of school district safety

boards (with parent participation) to enforce, enhance, implement, and evaluate

school safety and violence prevention plans.

n Develop and implement school safety and violence prevention programs.

n Hire a school nurse for every school.

Additional workshop discussion topics included:

Research/Data

n Encourage the state health agency to provide funding for local county

agencies to examine school injury data. Conduct pilot demonstrations.

n Enhance the level of data collection and perform cost analysis.

n Streamline accident report collection among school districts so that uniform

data collection and definitions are used.
What Is Being Done

15

Policy/Advocacy

n Utilize more fully the expertise of school nurses.

n Improve the California Playground Safety Standards legislation to

include enforcement of the law.

n Review existing school injury policies and levels of enforcement.

n Encourage members of the PTA and other parents to lobby for increasing

the ratio of school nurses to students. Emphasize that school nurses are

ideal personnel to do injury prevention.

Prevention Programs

n Perform a safety hazard inspection at the beginning of the school year and

on a regular basis thereafter.

n Encourage the development of parent-school-community partnerships.

Infrastructure/Systems Enhancement

n Restructure schools so that emergency protocols are in place, especially

since health personnel are so rarely on-site.

n Include CPR/first-aid training requirements in the collective bargaining

agreement between teachers and schools.

n Include a uniform safety inspection of each school in the statewide

commission’s annual visit to schools.

Public Information/Professional Training

n Assess the safety training of school nurses and coaches. Provide

appropriate training where necessary.

n Increase parents’ participation in educating children about safety.

n Educate parents about how much time nurses spend at the schools and

what they do.

The recommendations from the workshop will be submitted to the California Department of

Health Services, Emergency Preparedness and Injury Control Branch, as a suggested starting

point for developing a new state plan.
Injuries in the School Environment

16

School Nurse Emergency Medical Services for Children Program

Elaine Brainerd

SNEMS-C Project

P.O. Box 3115

Branford, CT 06405-1715

203.488.1524 ☎

203.488.6334 FAX

To help school nurses improve their skills in providing emergency care to injured or ill students,

the Department of Pediatrics at the University of Connecticut Health Center developed the

School Nurse Emergency Medical Services for Children Program (SNEMS-C). The program is

funded by a two-year grant from the federal Emergency Medical Services for Children (EMSC)

program of the Maternal and Child Health Bureau of the U.S. Health Resources and Services

Administration.

SNEMS-C trains registered school nurses to:

n use emergency assessment skills recognized by EMSC

n provide a level of pre-hospital care that conforms to EMSC protocols

n develop specific intervention strategies for students with special health care needs

n collect and analyze data on school-related injuries to improve student health and safety

The course consists of a three-day workshop presented by a team of instructors (a school

nurse and an emergency nurse with pediatric experience), a manual for school nurses on

providing emergency care in schools, and demonstration and practice of assessment, triage,

documentation, planning, and prevention. In collaboration with emergency medical services

personnel, participants also analyze victim scenarios and determine applicable assessment and

intervention strategies.

The program was piloted at four sites in Arizona, Iowa, New Jersey, and Texas during summer

1996. Materials were revised based on these initial pilot programs, and in late 1996, 19 teams

of instructors were trained to teach the course. Each team has committed itself to replicate the

SNEMS-C program and evaluate its effectiveness with 40 to 60 school nurses in the teams’

individual states during the second year of the project.

The states that will be assisting in the evaluation and the second phase of the program include

Alabama, Arizona, Connecticut, Georgia, Illinois, Iowa, Kansas, Maryland, Montana, Nebraska,

New Hampshire, New Mexico, New York, Pennsylvania, Texas, Washington, and Wyoming. At

the end of the grant, the SNEMS-C manuals will be published and available for purchase and a

mechanism for training of additional instructors will be established.
What Is Being Done

17

Estimating the Cost of Injuries to Children at School

Rebecca Spicer

Children’s Safety Network Economics and Insurance Resource Center

National Public Service Research Institute

8201 Corporate Drive, Suite 220

Landover, MD 20785

301.731.9891, ext. 121 ☎

301.731.6649 FAX

Cost analysis is an important research tool that is increasingly a focal point for debate and

decisionmaking. In injury prevention research, cost analyses provide data that help formulate

health policy and improve delivery systems. These analyses provide a way to reduce disparate

outcomes—traumatic deaths, fractured wrists, head injuries—to a common metric. That makes

cost data invaluable for problem size and risk assessment, broad priority setting, resource

allocation modeling, health and safety advocacy, regulatory analysis, and program evaluation.

The CSN Economics and Insurance Resource Center (EIRC) has undertaken two projects that

estimate the cost of injuries to children at school.

First, EIRC is collaborating with the Utah Department of Health’s Child Injury Prevention

Program (CIPP) to analyze the cost of injuries in Utah schools. The Utah Student Injury

Reporting System collects data on date, time, activity, location, victim demographics, body

region injured, type of injury, and level of treatment of the injury. Costs are estimated based

on the body region and type of injury, as well as treatment received. CIPP will share the results

with state legislators, school administrators, the Utah Offices of Risk Management and

Education, and parent-teacher organizations to promote school safety programs. The analysis

is expected to be completed in spring 1997.

Recently, EIRC estimated the national incidence and cost of injuries to children at school

using 1987–1992 National Health Interview Survey (NHIS) data. The NHIS annually collects

information from 45,000 nationally representative households regarding demographic

characteristics, health care use, and acute and chronic conditions, including episodes of

persons injured and place the injury occurred. Costs were estimated based on the injury

diagnosis. Results show that each year, an estimated 1 in 14 children suffers a medically

treated injury at school. These injuries annually result in $3.2 billion in medical spending

and nearly $89 billion in good health lost.
Injuries in the School Environment

18

Needham High School Health and Safety Reporting

Sally Toran

Needham High School

609 Webster Street

Needham, MA 02194

617.455.0865 ☎

617.449.5111 FAX

Like many school districts, the town of Needham, Massachusetts, finds itself with a growing

school population and aging school facilities. As a result, many of the schools are undergoing

large-scale renovations, including new carpeting, fresh paint, and new heating and ventilation

systems. These renovations have brought with them some unanticipated health and safety

outcomes. Many students attending classes in the renovated school buildings presented

to the school nurse with headaches, allergy symptoms, and other health complaints.

Investigation revealed that fumes from paint and new carpeting were the culprits. As a

result of these incidents, the town’s health officer, in cooperation with the school nurses,

instituted a surveillance system to track health and safety complaints and incidents at the

schools. Injuries are one of 10 categories included in this surveillance system. Although not

originally designed as an injury prevention tool, this surveillance system has become a

valuable source of information about injuries and has resulted in several preventive measures.

Every school is required to complete a school accident report form for all serious injuries that

occur within the school building or on school grounds. The school nurse is responsible for

ensuring that the information on the forms is accurate and complete. Each month, the school

nurse conducts a simple analysis of frequency and circumstances of injuries (and other health

and safety incidents or complaints) occurring in the school environment. The results of each

school’s analysis are presented at the monthly meeting of the school’s Health and Safety

Committee, whose members include the school principal, representatives from the faculty,

parents, students, and a school nurse. The committee discusses the cause of the injuries and

potential strategies for prevention. When possible, the committee recommends amendments

to the physical environment or school policy to lessen the chances of these injuries recurring.

Examples of changes that have been implemented as a result of data collected through this

surveillance system include, at the elementary school level, repair and replacement of

playground equipment, the addition of teacher aides on playgrounds to enhance supervision,

and a bike helmet program. At the high school level, athletic trainers have used these data

to improve conditioning regimens and to make modifications to the gym environment to

enhance safety.

The school nurses and the Health and Safety Committees in every school in Needham are

committed to maintaining this surveillance system in order to improve the health and safety of

their students and to collect detailed documentation of incidents when they do occur.
What Is Being Done

19

New Hampshire Safe Playground Project

Elaine Frank

The Injury Prevention Center

Dartmouth Hitchcock Medical Center

7455 Butler Building, Room 8

Hanover, NH 03755-3851

603.650.1780 ☎

603.650.1614 FAX

The New Hampshire Safe Playground Project is designed to identify risks and strategies for

reducing the number and severity of playground-related injuries in New Hampshire schools for

grades K–8. The project is funded by the New Hampshire Department of Education, Division of

Educational Improvement, and managed by the Injury Prevention Center at Dartmouth

Hitchcock Medical Center, in conjunction with the North Country Educational Foundation,

a consortium of superintendents and school boards in the rural northern region of New

Hampshire that provides training and technical assistance to teachers and administrators.

The goal of the Safe Playground Project is to assist elementary school nurses and staff, school

administrators, and insurers to systematically examine playground- and recreation-related

injuries in order to develop effective prevention strategies to reduce risks. Data are collected

for incidents that occur during school-sanctioned time, on the playground, or during recess or

recreational activities, including physical education classes and school-sponsored sports. The

data collection form is a modified version of the form developed in Arizona. Also reported are

injuries that result in the loss of one half-day of school or more, students referred for outside

medical care, and any other significant playground injury. The project is particularly interested

in collecting data on injuries to students with special educational needs, to assess the incidence

of playground injuries to this population.

Beginning in October 1996, more than 65 schools began voluntary participation in the data

collection effort. Schools provide completed injury reports for all incidents meeting the data

collection criteria. Participating schools receive training for school nurses and designees

related to the project, individualized reports detailing school-based injuries, access to and use

of Playground Inspection Kits, ongoing technical assistance and updates on playground safety,

and first-aid kits/fannypacks for use on playgrounds and on field trips. All training is provided

by the staff of the Injury Prevention Center at Dartmouth Hitchcock Medical Center.

The project has produced six Playground Inspection Kits, located around the state and available

for loan at no charge. The kits include materials that can assist schools and community groups

to learn more about playground safety in general, as well as assess their own playgrounds.

A resource library has been developed; it houses playground safety information that is

available for loan to schools.
Injuries in the School Environment

20

South Carolina Annual School Health Nurse Survey

Mary Ellen Hatfield

Division of Women and Children’s Services

South Carolina Department of Health and Environmental Control

Robert Mills Complex

Box 101106

Columbia, SC 29211

803.737.4085 ☎

803.737.4005 FAX

The South Carolina Department of Health recommends tracking all serious injuries, which are

defined as those needing immediate medical care and involving loss of one half-day of school.

The purpose is to determine the causative factors and prepare a report for the school principal,

with suggestions for preventing or deterring future injury occurrences. The South Carolina Annual

School Health Nurse Survey includes questions on unintentional injuries and violence. Survey

questions assess the number, type, and location of serious injuries occurring at school and the

number of minor injuries requiring first aid. Currently, 56 of the 91 school districts (61 percent)

report injuries to the Division of Women and Children’s Services. School nurses collect the data

throughout the school year.

Subsequently, the school district report is submitted to the South Carolina Department of Health

and Environmental Control for compilation in an aggregate report that documents the health status

of students and quantifies the many services that school nurses provide. Continuing education and

technical assistance are provided to school districts to help them develop and use local data for

program planning.

The South Carolina Department of Health assumes major responsibility for providing continuing

education for locally employed school health nurses. Managing school emergencies and developing health and injury control programs are included in the compendium of topics planned for

school nurses. These are presented at the orientation for new school nurses,

regional seminars, and the annual School Nurse Conference.

Texas Independent School District Crime Report

Pam Nickel

Texas Department of Public Safety

Uniform Crime Reporting

5805 North Lamar Boulevard

Box 4143

Austin, TX 78765-4143

512.424.2090 ☎

In 1994, the Texas legislature passed a resolution encouraging the Texas Department of Public

Safety to collect information on crimes that occur on campuses within independent school
What Is Being Done

21

districts. A three-month pilot project was conducted, from September to November 1994, to

collect data from a sampling of the 1,048 school districts across the state. Participation was

voluntary. The incident reporting form was developed by the Department of Public Safety in

cooperation with the Texas Education Agency, the Juvenile Probation Commission, and Sam

Houston State University.

Data were collected on the incident, offense, victim and offenders, circumstances, location,

time, and grade level. Data collection tools and training were provided to participating districts

at no charge. The pilot data were compiled by the Texas Education Agency and submitted to

the state legislature in January 1995. Copies of the report are available from the Texas

Department of Public Safety.

Utah Student Injury Reporting System

Cal Cazier

Violence and Injury Prevention Program

Community and Family Health Services Division

Utah Department of Health

288 North 1460 West, PO Box 144240

Salt Lake City, UT 84114-4240

801.538.6863 ☎

801.538.6510 FAX

In operation since 1984, the Utah Student Injury Reporting System is funded by the state Title V

Maternal and Child Health Block Grant. All 40 local school districts voluntarily participate in

this surveillance system. School personnel complete a student injury report form when an

injury causes a student to miss one half-day or more of school or if the injury necessitates a

visit to a health care provider. Completed forms are sent to the Violence and Injury Prevention

Program (VIPP) at the state health department.

The form was developed collaboratively by VIPP and the state office of education. Forms and

self-addressed, stamped envelopes are provided at no cost to schools. The Utah Department of

Health completes the data analysis and generates statewide injury data reports. In the near

future, district-specific reports will be disseminated at no charge and will be formatted to best

meet the information and presentation needs of local communities.

VIPP also provides consultation to school districts and individual schools to develop injury

prevention strategies in response to the findings from the student injury report forms. VIPP,

the Utah Office of Risk Management, and local health department staff serve as a resource

on the selection of new playground equipment, maintenance of existing equipment, and

liability issues.

A copy of the Utah Department of Health Student Injury Report Form may be found with other

sample data forms beginning on page 25.
Injuries in the School Environment

22

School Injuries in Virginia: A Pilot Study

Jeanne K. Sanders

Childhood Injury Prevention Program

Medical College of Virginia

Commonwealth University

P.O. Box 980522

Richmond, VA 23298

804.828.7009 ☎

804.828.8668 FAX

The Childhood Injury Prevention Program at the Medical College of Virginia is conducting a

seven-month pilot project to evaluate the use of a school injury reporting form in 54 Virginia

public schools. The project is funded by the state health department, using Maternal and

Child Health Block Grant funds. The objectives of the pilot project are to determine what

injury reporting policies are currently in place; whether an injury reporting form can be used

to identify the leading causes of school injuries; whether the pilot form is manageable,

user-friendly, and amenable to rapid analysis; and whether institutionalizing the form would be

feasible. The findings from the pilot project will be used to develop recommendations to the

Virginia Departments of Health and Education regarding the feasibility of using standardized

reporting forms statewide, types of information to collect, ways this information could help in

determining the leading causes of school injuries, and methods of preventing school injuries in

the future.

Virginia will use a modified version of the surveillance form developed in Arizona and

also used in New Hampshire (see Arizona and New Hampshire project descriptions). Data

fields will be added to collect information on special education and disabled students, and

playground equipment and surface specifics will be detailed as well. Other data elements

include supervision at time of injury, activity during which injury occurred, equipment involved,

and action taken.

A school information survey will also be used to collect information on ecological variables at

each school, such as demographics (enrollment, student-staff ratios, percentage of students

enrolled in special education or free lunch programs), programmatic characteristics (school

hours, lunch/recess procedures, playground policies), physical characteristics (age of school

buildings, age and condition of playground and playground equipment), and health program

characteristics (current injury reporting policies, nurse’s experience and education, nurse hours,

presence of a nurse’s aide). School nurses will collect the data. An hour-long training will be

provided on how, when, and why to complete the injury reporting forms.
What Is Being Done

23

Development of Capacity for Prevention of Injuries in School

Settings in Washington State

Richard Ellis

Washington State Department of Health

Airdustrial Park, Building 7

Olympia, WA 98504-7880

360.586.4496 ☎

360.586.7868 FAX

In 1990, the Washington State Department of Health published the School Injury Surveillance

Project Report, a study that assessed injury incidence in typical elementary, junior high, and

high school settings in one county in the state. Reportable injuries were those that were

more serious as determined by treatment levels (e.g., child was sent home, physician care was

required). This report demonstrated an overall school-based injury incidence rate during the

two-year surveillance period of 3.36 injuries per 100 student-years. Extrapolating these

findings statewide suggested that approximately 22,000 injuries are experienced by

Washington State students per year. The greatest proportion of the injuries documented

occurred on school playgrounds. The occurrence of injuries in school settings had not

previously been systematically assessed and reported to local, state, and federal public

health officials.

Over the next three-year period, a school-based safety program was developed by the

Disability Prevention Program to address playground injury. Playground inspection programs

and a pilot injury surveillance system were developed to identify injury risks and determine

injury incidence at elementary schools. State specialists trained personnel in local health

departments and at schools in playground hazard identification, injury surveillance, and

program plan review. With the expertise gained through this project, the state assisted in

the development of Consumer Product Safety Commission and American Society of Testing

Materials playground safety standards.

During the following three years, 1993–1996, with disability prevention funding from the

Centers for Disease Control, the state, in collaboration with Washington State University and

the private consulting firm of Thom Thompson and Associates, piloted an elementary school

injury surveillance system in five school districts at 15 elementary schools located in various

geographic regions. More detailed than any previous research, this effort focused on obtaining

epidemiologic information about the settings, mechanisms, and risk factors related to injury in

the elementary school setting and, in particular, on the playground. Preliminary analysis of the

data from this research has provided information about the characteristics of injuries occurring

on the playgrounds of the elementary schools studied, as well as the association of these

injuries with environmental factors such as playground design, equipment, and supervision.
Injuries in the School Environment

24

The results of this project have helped to weave playground injury monitoring and inspection

into the fabric of public health in the state. Intervention strategies focusing on playground

design and supervision modifications have been suggested and the feasibility of testing and

evaluating the effects of these and similar ideas have been explored. Feedback from this

project can provide others with a base of information from which to develop their own

surveillance systems and assessment tools. Also, it has provided some basic epidemiologic

information about elementary school injury. Upon completion of the project, the Washington

State Department of Health will transfer the data collection and analysis system to the state

superintendent of public instruction, for use with school districts throughout the state.

A copy of the Washington Elementary School Student Injury Reporting Form may be found with

other sample data forms beginning on page 25.
Data Collection Forms

25

SAMPLE DATA COLLECTION

FORMS

Washington Elementary School Student Injury Reporting Form (1 page)

Arizona Student Injury Report (double-sided)

Utah Department of Health Student Injury Report Form (double-sided)
WASHINGTON




Further Reading

31

FURTHER READING

General Resources

American Academy of Pediatrics Policy Statements.

A listing of AAP policy statements relevant to school injury has been compiled by CSN.

Evans, GD, and Sheps, SB. (1987). The epidemiology of school injuries: The problem of

measuring injury severity. Journal of Community Health, 12(4): 246–256.

Examines the association between two commonly used measures of injury severity and referral to

medical assessment. Reviewed 3,000 school accident reports in Vancouver. Concludes that the major

issue facing school staff is appropriate referral of the child for medical treatment.

National School Safety Center. School Safety.

This quarterly publication regularly covers topics of bullying, violence in schools, and other safety

concerns. Published by the National School Safety Center, 4165 Thousand Oaks Boulevard, Suite 290,

Westlake Village, CA 91362. ☎ 805.373.9977.

Office of Technology Assessment. (1995). Risks to Students in School. Washington, DC: OTA.

This background paper reviews the available data on environmental hazards, infectious diseases, and

unintentional and intentional injuries occurring in schools K–12. Available from Superintendent of

Documents. ☎ 202.512.1800. $14.00. Stock number 052-003-01447-5.

Shearer, RM. (1994). Emergency care training for school nurses in Fairbanks, Alaska. Journal

of School Health 64: 340–341.

Describes a program that provided emergency care continuing education to school district nurses and

led to improved plans and procedures.
Injuries in the School Environment

32

U.S. General Accounting Office. (1995). School facilities: Condition of America’s schools.

Washington, DC: GAO.

This report presents information on the overall physical condition and prevalence of schools that

need major repairs and the amount of funding that schools report needing to improve inadequate

facilities. Available from GAO. ☎ 202.512.6000. Document number GAO/HEHS-95-61.

U.S. General Accounting Office. (1996). School facilities: America’s schools report differing

conditions. Washington, DC: GAO.

Analyzes conditions of school buildings, amounts of funding needed for repairs, and numbers of

students attending schools in inadequate condition, by state and region, community type, percentage

of minority and poor students, and school level and size. Available from GAO. ☎ 202.512.6000.

Document number GAO/HEHS-96-103.

U.S. General Accounting Office. (1996). School facilities: Profiles of school conditions by

state. Washington, DC: GAO.

This report profiles by each state the condition of school buildings, and estimates the amount of

funding needed to bring schools into good overall condition. Available from GAO. ☎ 202.512.6000.

Document number GAO/HEHS-96-148.

Wilson, MH, Baker, SP, Teret, SP, Shock, S, and Garbarino, J. (1991). Saving Children:

A Guide to Injury Prevention. NY: Oxford University Press.

This book is aimed at educators, policymakers, and health care providers. Each chapter contains a

section on opportunities for prevention, organized by audience and including schools. Part IV

focuses on the school and recreation environment: playground injuries, sports injuries, and

drowning and other water-related injuries.

Legal and Liability Issues

Dunklee, DR. (1989). An educator’s responsibility for proper maintenance of property. School

Business Affairs, July: 25–27.

Briefly discusses school liability for personal injury that results from negligent maintenance.

Grier, TB, Reep, BB, and Turner, MJ. (1991). Follow these 10 cardinal rules and stay out of

court. Executive Educator, 13(8): 21–22.

Advice for principals, including steps to ensure student supervision, reporting of dangerous

situations, and preparation of emergency procedures.

Quinlan Publishers. School Law Bulletin. Boston, MA: Quinlan.

Gives examples of court cases and lawsuits relevant to schools, including injuries; issued monthly.

Available from Quinlan Publishing, 23 Drydock Avenue, Boston, MA 02210-2387. ☎ 617.542.0048.

Vos, R, and Pell, SW. (1990). Limiting lab liability: Protect yourself and your students.

Science Teacher, 57(9): 34–38.

By examining several litigation cases, the authors demonstrate that teachers are held responsible

for vigilantly supervising their lab students. Self-assessment checklists for teachers, guidelines to

mitigate the risk of liability, and a list of proper safety actions are included.
Further Reading

33

Studies

Boyce, WT, Sprunger, LW, Sobolewski, S, and Schaefer, C. (1984). Epidemiology of injuries in a

large, urban school district. Pediatrics, 74(3): 342–349.

Describes the results of 5,379 school injury reports over a two-year period. Eighteen percent of the

injuries were severe; playground- and equipment-related injuries were more likely to be severe; and

49 injuries occurred per 1,000 student-years.

Boyce, WT, and Sobolewski, S. (1989). Recurrent injuries in schoolchildren. American Journal

of Diseases of Children, 143: 338–342.

Identifies injuries prospectively over three school years, from school nurse reporting forms. One

percent of the school district population sustained recurrent injuries, especially among boys, junior

high students, and students in alternative educational programs.

Bremberg, S. (1989). Is school-based reporting of injuries at school reliable? A literature

review and an empirical study. Accident Analysis and Prevention, 21(2): 183–189.

Combines a literature review of studies from six countries with a four-year empirical study in

Sweden of injuries requiring physician treatment. Results indicated that routine school nurse

reports underestimate the extent of injuries.

Burke, GS, Lapidus, GD, Zaboski, RW, Wallace, L, and Banco, LI. (1996). Evaluation of the

effectiveness of a pavement stencil in promoting safe behavior among elementary school

children boarding school buses. Pediatrics, 97: 520–523.

School bus stops with pavement stencils and education of the children proved more effective than

bus stops with education alone. The presence of an adult at the stop did not have an independent

effect on behavior.

Dale, M, Smith, ME, Weil, JW, and Parrish, HM. (1969). Are schools safe? Analysis of 409

student accidents in elementary schools. Clinical Pediatrics, 8(5): 294–296.

Examines accidents as recorded on school report forms (including those that did not always result in

injury) and concludes that boys and second graders experienced the most accidents, most events

occurred during lunch hour and recess, and head injuries accounted for 64 percent of the injuries.

Feldman, W, Woodward, CA, Hodgson, C, Harsanyi, Z, Milner, R, and Feldman, E. (1983).

Prospective study of school injuries: Incidence, types, related factors, and initial management.

Canadian Medical Association Journal, 129: 1279–1283.

A prospective study of school accident report forms from 212 schools over one year revealed that

most injuries occurred during athletic activities and 28.7 percent of all injuries were serious.

Fothergill, NJ, and Hashemi, K. (1991). Two hundred school injuries presenting to an accident

and emergency department. Child: Care, Health, and Development, 17(5): 313–317.

Analyzes 204 medical exam records of students injured at school and brought to an emergency

department in Surrey, England. More than half of the injuries occurred while students were

unsupervised.
Injuries in the School Environment

34

Hodgson, C, Woodward, CA, and Feldman, W. (1984). A descriptive study of school injuries in

a Canadian region. Pediatric Nursing, May/June: 215–220.

Analyzed more than 4,000 school accident report forms, as well as parent recall and school board

records. The results showed an occurrence of 5.4 injuries per 100 children, with 29 percent of the

injuries deemed serious. Discusses the importance of the school nurse’s role in addressing these

issues.

Hodgson, S, Woodward, CA, and Feldman, W. (1985). Parent report of school-related injuries.

Canadian Journal of Public Health, 76: 56–58.

Fifteen percent of respondents in a random survey of parents reported that their children had been

injured at school during the previous month.

Hodgson, C, Yacura, W, Woodward, CA, Feldman, W, and Feldman, E. (1984). Sequelae of

school-related injuries: School and parent perspectives. Canadian Journal of Public Health, 75:

273–276.

A prospective study of three boards of education over one year found that schools underestimated

the number of health care visits resulting from school injuries, and parents overestimated the amount

of first aid provided at school.

Langley, JD, Chalmers, D, and Collins, D. (1990). Unintentional injuries to students at school.

Journal of Pediatric Child Health, 26: 323–328.

Examines national mortality data and more than 1,000 hospital admissions in New Zealand.

Deaths from school-related injuries were most frequently the result of falls. Overall incidence

rate for hospitalization from school injury was 151 per 100,000 students per year.

Langley, JD, Silva, PD, and Williams, SM. (1981). Primary school accidents. New Zealand

Medical Journal, 94: 336–339.

Analyzes two years of standard school accident report forms. Of 518 primary school injuries, nearly

one-third resulted in fractures.

Lenaway, DD, Ambler, AG, and Beaudoin, DE. (1992). The epidemiology of school-related

injuries: New perspectives. American Journal of Preventive Medicine, 8(3): 193–198.

Prospective surveillance of a modified student injury report form from nine Colorado schools over

one school year showed that sports activities accounted for 53 percent of all injuries; middle/junior

high school had the highest rates.

Nader, PR, and Brink, SG. (1981). Does visiting the school health room teach appropriate or

inappropriate use of health services? American Journal of Public Health, 71(4): 416–419.

A study over two school years of a random sample of urban K–5 children concluded that trauma

was the most frequent reason for a visit to the school health room, across all ages, genders, and

socioeconomic groups.

Passmore, D, Gallagher, S, and Guyer, B. (1989). Injuries at school: Epidemiology and

prevention. Harvard Injury Control Center Working Paper Series, No. 17. Boston, MA:

Harvard University School of Public Health.

A population-based study of injuries requiring hospital treatment or resulting in deaths found that

injuries at school account for 9.5 percent of all injuries. Of these, 36 percent involve a product

(usually a stair, a wall, bleachers, or recreation or sport equipment).
Further Reading

35

Sheps, SB, and Evans, GD. (1987). Epidemiology of school injuries: A two-year experience in

a municipal health department. Pediatrics, 79(1): 69–75.

A retrospective Canadian study of injury report forms for two school years showed a rate of 2.82

injuries per 100 students per year; contusions and abrasions to the head were the most frequent type

of injury. Falls were most common among elementary school children; sports injuries were

most frequent among secondary school students.

Taketa, S. (1984). Student accidents in Hawaii’s public schools. Journal of School Health,

54(5): 208–209.

One school year of student injury report forms from 204 schools showed the highest number of

injuries occurring in the intermediate grade level and 43 percent of injuries involving the head

and neck .

Woodward, CA, Feldman, W, Feldman, E, Hodgson, C, and Milner, R. (1983). The McMaster

school injury study. 1: Overview of methods. Canadian Journal of Public Health, 74: 276–280.

Describes the research design, sampling strategies, and analysis procedures used in surveying school

injuries in Ontario.

Ways to Identify and Improve Conditions

Most of these articles are aimed at educators and administrators. Such articles tend to be brief, appear

in appropriate professional literature, and are not written by injury professionals. The focus is often on

avoiding legal liability.

Child Accident Prevention Foundation of Australia. (1993). School Safe: A Program for Injury

Prevention in Primary Schools. Melbourne, Australia: Child Accident Prevention Foundation of

Australia.

Covers the components and process of an effective school safety program, common school accidents,

helpful hints, and curriculum starters, organized by elementary, middle, and upper school levels.

Available from Kidsafe Australia, 10th floor, 123 Queen Street, Melbourne, Australia 3000.

Fax (61) (3) 670-7616. Cost: $20 Australian.

Gerlovich, JA, and Gerard, TF. (1989). Don’t let your hands-on science program blow up in

your face. American School Board Journal, 176(5): 40–41.

Advice for administrators and school board members on their responsibilities and on the wisdom of

conducting safety audits.

McKenzie, JF, and Williams, IC. (1982). Are your students learning in a safe environment?

Journal of School Health, 52(5): 284–285.

Presents no data but acknowledges that unsafe conditions exist in schools and that teachers must be

responsible for providing a safe environment. A teacher checklist for self-awareness of safety is

included.

Padham, EA. (1990). Safety: Your first responsibility. Vocational Education Journal, 65(2): 16–17.

Advocates for a school safety philosophy with clear policies for teachers, administrators,

maintenance staff, students, and shop architects.
Injuries in the School Environment

36

Sabo, SR. (1993). Security by design. American School Board Journal, January: 37–39.

Discusses safety issues that can be addressed by architects so that the building design enhances

security, on both the exterior and the interior of the facility.

Saunders, CS. (1994). Safe at School: Awareness and Action for Parents of Kids Grades K–12.

Minneapolis, MN: Free Spirit Publishing.

Helps parents identify and respond to safety problems at their children’s schools, using step-by-step

action plans. Topics includes violence and crime, discipline, transportation issues, supervision, the

building and playground, physical and mental health, environmental issues, legal issues, and disaster

preparation. Cost: $14.95.

Texas Education Agency, Office of Curriculum, Assessment and Professional Development.

(1994). Safe school checklist. Austin, TX: Texas Education Agency.

Helps students, parents, teachers, and administrators assess a school’s safety strengths and

weaknesses. Topics include accidents, assaults, violent behavior, natural disasters, and suicide

attempts. Checklists are included. The document is issued in English and in Spanish.

Playgrounds/Sports Injuries

American Medical Association Group on Science and Technology. (1994). Athletic

preparticipation examinations for adolescents: Report of the Board of Trustees. Archives of

Pediatrics and Adolescent Medicine, 148: 93–98.

Assesses the usefulness of these examinations at identifying adolescents at risk for orthopedic injury

and recommends guidelines developed by the American Academy of Pediatrics.

American Orthopedic Society for Sports Medicine. (1988). Sports injury research. American

Journal of Sports Medicine, 16 (Supp. 1).

Research issues and findings in sports medicine, as well as vignettes, information on four

surveillance systems, and a primer for beginning sports injury researchers.

Arizona Department of Health Services, Community and Family Health Services, Office of

Women’s and Children’s Health. (1993). A study of the nature, incidence and consequences of

elementary school playground-related injuries: Final report. Tucson, AZ: Arizona Department

of Health Services.

Summarizes the results of the first year of using injury report forms in grades K–8 to collect data on

body part injured, actions taken by schools and parents, type of surface and equipment involved, and

activity in which student was engaged. Samples of injury form, database descriptions, and data

forms are included.

Association of Trial Lawyers of America and Johns Hopkins Injury Prevention Center. (1992).

Good sports: Preventing recreational injuries. Washington, DC: ATLA.

Summary of a safety conference that included presentations, discussions, and recommendations on

school sports injuries and playground injuries.
Further Reading

37

Consumer Product Safety Commission. (1994). Handbook for Public Playground Safety.

Washington, DC: CPSC.

Covers major types of equipment, surfacing, use zones, and layout and design. Available from CPSC,

Washington, DC 20207. ☎ 800.638.2772.

Daugs, DR, and Fukui, F. (1989). Playground Perspectives: A Curriculum Guide for Promoting

Playground Safety. Salt Lake City, UT: Utah Department of Health.

Provides background information, classroom activities, and resources for teachers, with an emphasis

on grades K–3. Available from Utah Department of Health. ☎ 801.538.6864.

Helsing, K., Massachusetts Sports Injury Prevention Task Force. (1990). The status of sports

injury prevention and treatment among Massachusetts high school interscholastic athletic

programs. Boston, MA: Massachusetts Department of Public Health.

Assesses the status of injury prevention within high school athletic programs in Massachusetts and

identifies 15 areas of concern. Provides specific recommendations to address these concerns.

Morrison, ML, and Fise, ME. (1992). Report and Model Law on Public Play Equipment and

Areas. Washington, DC: Consumer Federation of America.

Discusses playground injuries and developmental issues, and presents model law provisions for all

play areas, preschool areas, and school-age areas. Also includes a parent checklist.

National Center for Catastrophic Sports Injury Research. (1994). Twelfth annual report, fall

1982–spring 1994. Chapel Hill, NC: University of North Carolina.

A summary of data collected from high school and college coaches, athletic directors, and athletic

organizations on catastrophic injuries and fatalities.

National Institute of Arthritis and Musculoskeletal and Skin Diseases, U.S. Department of Health

and Human Services. (1992). Conference on Sports Injuries in Youth: Surveillance Strategies.

Proceedings and Executive Summary. Bethesda, MD: NIAMSD.

Provides recommendations and findings from a 1991 conference, including the need for a uniform

surveillance system, national database of sports-related injuries, investigation of reinjury rates, and

evaluation of standard classification systems.

National Youth Sports Safety Foundation. (1994). Bibliography of youth and adolescent sport

medicine literature, June 1990–1994. Needham, MA: NYSSF.

Includes a list of sports medicine books currently in print and journal articles on the subject.

Supplements an earlier bibliography, covering 1984 to June 1990. Available from NYSSF, 10 Meredith

Circle, Needham, MA 02192. ☎ 617.449.2499.

Nowjack-Raymer, RE and Gift, HC. (1996). Use of mouthguards and headgear in organized

sports by school-aged children. Public Health Reports, 111: 82–86.

Assesses the wearing practices of this protective equipment, using data from the 1991 National

Health Interview Survey’s Child Health Supplement. Results indicate that football was the only sport

in which the majority of children used mouthguards and headgear.
Injuries in the School Environment

38

Sosin, DM, Keller, P, Sacks, JJ, Kresnow, M, and van Dyck, PC. (1993). Surface-specific fall

injury rates on Utah school playgrounds. American Journal of Public Health, 83(5): 733–735.

Studies injury reports from elementary schools over two years to estimate fall injury rates and the

surfaces involved. Data showed that impact-absorbing surfaces do not reduce fall injuries better

than grass.

U.S. Consumer Product Safety Commission. (1995). Guidelines for drawstrings on children’s

outerwear. Washington, DC: CPSC.

Guidelines to help consumers prevent hazards of drawstrings catching on playground equipment

and other items. Document number 1006. Available from CPSC, Washington, DC 20207.

☎ 800.638.2772.

School Buses/Transportation Issues

American Academy of Pediatrics, Committee on School Health and Committee on Injury and

Poison Prevention. (1996). School transportation safety. Pediatrics, 97: 754–757.

A revised committee policy statement that provides updated information regarding relevant federal

regulations and outlines recommendations for addressing school bus safety education, awareness,

and practices.

Center for Urban Transportation Research. (1994). To belt or not to belt? Experiences of school

districts that operate large school buses equipped with seatbelts. Tampa, FL: Center for Urban

Transportation Research, College of Engineering, University of South Florida.

This report, prepared for the Florida legislature, summarizes results of a national-scale, exploratory

study pertaining to experiences of school districts in 15 states that operate school buses equipped

with seat belts.

Harrington-Lueker, D. (1992). School buses buckle up. American School Board Journal,

178(11): 37–38.

New Jersey became the first state to require the use of seat belts on school buses; arguments for and

against this requirement are summarized.

National Highway Traffic Safety Administration. (Annual). Traffic Safety Facts: School Buses.

Washington, DC: NHTSA.

An annual summary, with tables of occupant fatalities by principal impact point on school bus;

school-age pedestrians killed by school bus vehicle maneuver; fatalities by time of day; and other

information on fatalities associated with school buses.

National Highway Traffic Safety Administration. (1992). Highway safety program guideline

#17: Pupil transportation safety. Washington, DC: NHTSA.

Establishes minimum recommendations for state highway safety programs for pupil transportation

safety, including school bus operation and maintenance; training of passengers, pedestrians, and

bicycle riders; and administration.
Further Reading

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National Highway Traffic Safety Administration. (1993). School bus safety report. Washington,

DC: NHTSA.

Summarizes and updates school bus safety activities conducted by NHTSA and points out that school

bus crashes tend to be minor, while pedestrians—particularly 5 and 6 year olds—are significantly at

risk around school buses. Seat belt issues and use of vans as school buses are also addressed.

National Safety Council. (1995). Walk-Ride-Walk: Getting to School Safely. Itasca, IL: National

Safety Council.

A comprehensive school bus/pedestrian safety program, with videos and brochures, for teachers,

parents, and bus drivers. Available from National Safety Council, 1121 Spring Lake Drive, Itasca, IL

60143-0242. ☎ 800.621.7619.

Spital, M, Spital, A, and Spital, R. (1986). The compelling case for seat belts on school buses.

Pediatrics, 78(5): 928–932.

Argues that training children to use seat belts on school buses will keep them safer and will instill

lifelong habits of seatbelt use.

Special Needs

American Academy of Pediatrics, Committee on Injury and Poison Prevention. (1994). School

bus transportation of children with special needs. Pediatrics, 93: 129–130.

A committee policy statement that addresses child safety seats, wheelchairs, and staffing issues.

Collins, BC, Wolery, M, and Gast, DL. (1991). A survey of safety concerns for students with

special needs. Education and Training in Mental Retardation, 26(3): 305–318.

Based on a survey of special educators and parents of children with special needs, this article

presents a list of safety concerns across different age groups.

University of Colorado Health Sciences Center School of Nursing. (1995). Safe at School:

Planning for Children with Special Needs. Denver, CO: University of Colorado, School

of Nursing.

A 28-minute videotape and viewer’s guide that includes information about planning for the safety of

children with special needs by using a systematic process of assessing risk factors and implementing

intervention strategies. Available for purchase or rental from Learner Managed Designs, Inc.,

P.O. Box 3067, Lawrence, KS, 66046. ☎ 913.842.9088. Order number 1801.
Injuries in the School Environment

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Violence

Kachur, SP, Stennies, GM, Powell, KE, Modzeleski, W, Stephens, R, et al. (1996).

School-associated violent deaths in the United States, 1992–1994. JAMA, 275(22): 1729–1733.

Examines 105 school-associated violent deaths, identified through news accounts, police reports,

medical examiner records, and interviews with school officials; 77 percent of the deaths were

attributable to firearms.

Metropolitan Life Insurance. (1993). The Metropolitan Life Survey of the American Teacher,

1993: Violence in America’s Public Schools. New York: Metropolitan Life Insurance Company.

A national survey found that despite media attention to crime and violence in schools, the large

majority of teachers and students feel safe and have not been personally involved in a violent

incident. Students see and fear violence more than teachers do; law enforcement officials express

the highest levels of concern about violence in public schools.

National School Safety Center. (1990). School Safety Check Book. Malibu, CA: Pepperdine

University.

Covers school climate and discipline, attendance, personal safety, and school security. Prevention

and response strategies and assessment surveys for each of these topics are included.