U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001

42–290 PDF 2009

S. HRG. 110–899 

KEEPING AMERICA’S CHILDREN SAFE: 

PREVENTING CHILDHOOD INJURY 

HEARING 

OF THE

COMMITTEE ON HEALTH, EDUCATION, 

LABOR, AND PENSIONS 

UNITED STATES SENATE 

ONE HUNDRED TENTH CONGRESS 

SECOND SESSION 

ON

EXAMINING PREVENTING CHILDHOOD ACCIDENTAL INJURY 

MAY 1, 2008 

Printed for the use of the Committee on Health, Education, Labor, and Pensions 

( 

Available via the World Wide Web: http://www.gpoaccess.gov/congress/senate 

COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS 

EDWARD M. KENNEDY, Massachusetts, Chairman 

CHRISTOPHER J. DODD, Connecticut 

TOM HARKIN, Iowa 

BARBARA A. MIKULSKI, Maryland 

JEFF BINGAMAN, New Mexico 

PATTY MURRAY, Washington 

JACK REED, Rhode Island 

HILLARY RODHAM CLINTON, New York 

BARACK OBAMA, Illinois 

BERNARD SANDERS (I), Vermont 

SHERROD BROWN, Ohio 

MICHAEL B. ENZI, Wyoming, 

JUDD GREGG, New Hampshire 

LAMAR ALEXANDER, Tennessee 

RICHARD BURR, North Carolina 

JOHNNY ISAKSON, Georgia 

LISA MURKOWSKI, Alaska 

ORRIN G. HATCH, Utah 

PAT ROBERTS, Kansas 

WAYNE ALLARD, Colorado 

TOM COBURN, M.D., Oklahoma 

J. MICHAEL MYERS, Staff Director and Chief Counsel 

ILYSE SCHUMAN, Minority Staff Director 

(II) 

C O N T E N T S 

STATEMENTS 

THURSDAY, MAY 1, 2009 

Page 

Dodd, Hon. Christopher, a U.S. Senator from the State of Connecticut, opening statement ........................................................................................................ 1 

Isakson, Hon. Johnny, a U.S. Senator from the State of Georgia, statement .... 2 

Kennedy, Hon. Edward M., Chairman, Committee on Health, Education, 

Labor, and Pensions, opening statement ........................................................... 3 

Prepared statement .......................................................................................... 4 

Arias, Ileana, Director, National Center for Injury Prevention and Control, 

Atlanta, GA ........................................................................................................... 5 

Prepared statement .......................................................................................... 7 

Korn, Alan, Director of Public Policy, Safe Kids USA International, Washington, DC ............................................................................................................. 16 

Prepared statement .......................................................................................... 17 

Bruns, Justin, The Boys Latin School of Maryland, Baltimore, MD ................... 26 

Prepared statement .......................................................................................... 27 

Appy, Meri-K, President, Home Safety Council, Washington, DC ...................... 28 

Prepared statement .......................................................................................... 30 

Williams, Amber, Executive Director, State and Territorial Injury Prevention 

Directors, Atlanta, GA ......................................................................................... 30 

Prepared statement .......................................................................................... 31 

ADDITIONAL MATERIAL 

Statements, articles, publications, letters, etc.: 

Enzi, Hon. Michael B., a U.S. Senator from the State of Wyoming, prepared statement ............................................................................................ 42 

Kathleen Bruns, mother of Justin Bruns, prepared statement .................... 28 

(III) 

(1) 

KEEPING AMERICA’S CHILDREN SAFE: 

PREVENTING CHILDHOOD INJURY 

THURSDAY, MAY 1, 2008 

U.S. SENATE, 

COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS, 

Washington, DC. 

The committee met, pursuant to notice, at 10:35 a.m. in Room 

SD–430, Dirksen Senate Office Building, Hon. Edward M. Kennedy, chairman of the committee, presiding. 

Present: Senators Kennedy, Dodd, and Isakson. 

OPENING STATEMENT OF SENATOR DODD

Senator DODD [presiding]. The committee will come to order, and 

we welcome all of you here this morning. We are here today to celebrate the victories over the past 20 years of an organization and 

organizations like Safe Kids USA in protecting America’s children 

from unintentional childhood injury. 

First of all, I want to congratulate Safe Kids on their 20th anniversary. I have been fortunate enough to work with this organization for the past 20 years on numerous occasions in various settings, as we have celebrated the work of Safe Kids and their contributions. They deserve a great deal of credit for the progress that 

has been made in protecting our children from accidental injuries. 

On average, the fatality rate from unintentional injuries has 

dropped by 45 percent over the past 20 years, and that is due to 

the dedication of all of the organizations we have here today to research the best ways to prevent childhood injury and to get that 

information out to parents and to caregivers. 

But we are also here today to talk about what still needs to be 

done in this area, and a lot needs to be done, of course. Despite the 

decrease I mentioned, we still have an average of 430 children 

dying each month from accidental injuries. It is still the No. 1 killer of American children under the age of 14, regrettably. 

I remember a time, and I am sure my colleague does, when there 

were no car seats, we didn’t always buckle up, and it was okay to 

smoke around your children. We have been able to become far more 

sophisticated in how we protect our children, but we have got a 

ways to go. So I am pleased to have all of you here today to discuss 

that with this committee. 

The burden of preventing childhood injury falls on American 

families and caregivers, and they have so much to worry about. 

Parents have to be concerned about dangers in the home, at their 

2 

childcare provider, at the homes of family and friends, and the potential dangers which arise when children are out of their sight. 

The constant concern can be quite an emotional toll on parents, 

but the financial cost associated with keeping a child safe can be 

astronomical. Parents and caregivers need to have car seats, helmets, smoke detectors, carbon monoxide detectors, temperaturesensing faucets. The list goes on and on. We need to ensure that 

families of all income levels have access to the best technology 

available to keep their children safe. 

I have got to take a moment here to brag a little bit. Coming 

from the State of Connecticut, we recently were named the ‘‘Safest 

State For Kids’’ by Parents magazine. We are deeply proud of that 

recognition. It is an honor to be so designated, and there are a lot 

of people in my State who deserve credit for that, helping us—our 

mayors, our State legislators, our governors, the State officials, and 

others who have worked over the years to earn that reputation. 

Today, we have with us representatives from the Centers for Disease Control and Prevention, Safe Kids USA, the Home Safety 

Council, and the State and Territorial Injury Prevention Directors 

Association, who have all been crucial in the decrease in numbers 

of injuries over the years. 

We also have with us a young man, Justin Bruns, who has a personal story about how he was able to escape permanent injury because of the safety precautions that he took, and the story highlights why it is so important for caregivers to take seriously the 

issue of injury prevention to protect their children from harm. We 

are honored to have Justin with us this morning, and we thank 

him in advance for his testimony. It is very courageous to come forward and talk about a situation that you have been in. 

With that, let me turn to my colleague, Senator Isakson, and 

then we will hear from our witnesses. We thank them for being 

with us. 

STATEMENT OF SENATOR ISAKSON

Senator ISAKSON. Well, thank you very much, Chairman Dodd. 

It is an honor to be here, and I welcome Safe Kids USA and all 

our witnesses, in particular young Justin. We are glad to have you 

here to tell your story today. 

I am glad to be a part of this. I am the father of three and the 

grandfather to eight, six of whom are under 4 years old. We end 

up keeping them a lot of weekends when I am home. So I have become an expert in child safety restraints and all kinds of things 

that have been a product of the movement over the last 20 years 

really to make our homes safer and our children safer. 

I was particularly pleased to be the co-sponsor of the Cameron 

Gulbransen Kids and Cars Safety Act recently, which came out of 

a personal tragedy in my district, where a young lady by the name 

of Cindy Donald, who was a cheerleader at Lassiter High School, 

was sunbathing during the summer between her junior and senior 

year. Her father, in a hurry, backed his SUV out of the garage and 

rolled over her legs, severing part of her spine, and she is a quadriplegic today. 

I am a part of the Cindy Donald Foundation, where we raise 

money to help her rehabilitate and recover. But because of this new 

3 

act, now we will have the sounds made by cars backing up in reverse so that someone who might be in harm’s way has a warning 

and knows something like that is getting ready to happen. 

I think learning the lessons of life, as Justin is going to tell us 

about in his experience, help us to do those things that make our 

children safer, and we need to celebrate that. Today is a celebration of child safety, but it is also an awareness that we have to continue to be acutely aware of those challenges that confront us everywhere we can reasonably and responsibly protect our children 

and make them safe. 

Again, I welcome all of our guests who testify today. 

Thank you, Mr. Chairman. 

Senator DODD. Thank you very much. 

I mentioned informally at the outset of the hearing that Senator 

Kennedy will be here shortly. He has been tied up this morning 

and asked me to come on in and be a part of this. 

But as I mentioned at the outset, I have enjoyed immensely over 

the years, my involvement with Safe Kids USA. As Chairman of 

the Subcommittee on Children and Families, we have worked very 

closely together over the years developing a lot of various ideas 

that I hope have contributed to exactly the celebration we are enjoying here this morning. 

I should also point out, as my friend Johnny, as the father of— 

well, here he is now. Look at this. The timing—well, very good. I 

was kind of enjoying this right here. 

The Chairman [presiding]. That is what I was afraid of. 

[Laughter.] 

How many years—— 

Senator DODD. A lot. I have been waiting a lot. 

The CHAIRMAN. How many years have you been waiting? 

Senator DODD. I know. I keep on holding his wrist to get a pulse 

every now and then. 

[Laughter.] 

I am sad to report it is very strong. Well, I was just saying with 

two young children as well, we are very conscious in our homes, as 

all of us are, of safety methods that need to be taken. I have made 

an opening statement, as has Senator Isakson. We have got our 

first witness here, but do you want to make some opening comments? 

OPENING STATEMENT OF SENATOR KENNEDY

The CHAIRMAN. Well, I will just put mine in the record. 

We want to acknowledge, as we do frequently, that our good 

chairman today, Senator Dodd, has been the chairman of the Children’s Caucus before being chairman of a Children’s Caucus was 

being cool. Years and years, he has chaired that and has been enormously involved in all of the policy issues relating to children and 

has really made a great difference. 

Senator Isakson has also been so involved and active in our committee in terms of the children’s issues. So we are very fortunate 

to have him as well. 

I think the really good news is that progress has been made. We 

are not used to good news around here. It seems that so many of 

the challenges that we face are so overwhelming and whether we 

4 

can really make some progress. But we find out if we really do 

what these wonderful organizations have recommended and the 

outreach that they have had in terms of families and parents and 

urging it in local community levels has really made a very important difference. 

We want them to know that we want to be part of that whole 

process because we think they can continue to make progress. 

Second, just very quickly, there is always the issue of the cost 

of some of these items. Whether they are available, accessible to 

parents, and whether they can afford them. We are going to hear, 

I know, this incredible story about this young person’s life probably 

saved because of the use of a helmet, and can people afford it? Particularly these economic ties are things we ought to be able to do 

or think about some of those issues. 

I will put my whole statement in the record, Mr. Chairman. But 

I thank you, and I thank our witnesses. We have got a really extraordinary group of people who have been on this issue for years 

and have really been enormously helpful to our committee and very 

helpful in terms of helping to shape national policy. We are very 

grateful to all of them. 

[The prepared statement of Senator Kennedy follows:] 

PREPARED STATEMENT OF SENATOR KENNEDY

Our hearing today is on protecting American children more effectively from unintentional childhood injury and death. I’d like to 

begin by congratulating the organization of Safe Kids USA on its 

20th anniversary and on its 20 years of dedication and achievement on this important issue. 

First, let me say, I’ve had the privilege of working with you since 

the beginning and you deserve great credit for the progress that 

has been made in protecting children from accidental injury. All of 

our panelists here today represent organizations that research 

ways to prevent injury, educate caregivers in creative ways, and 

help kids learn to keep themselves safe. An important challenge 

that we face in helping families protect their children is the cost. 

As I mentioned, this hearing today focuses on unintentional 

childhood injury, but I also want to take this opportunity to highlight an important related program up for reauthorization this 

year—The Child Abuse Prevention and Treatment Act. It was originally enacted in 1974 to identify and address the issues of child 

abuse and neglect, and to support effective methods of prevention 

and treatment. It provides grants to States to offer child protective 

services, funds for research and demonstration projects, assistance 

to States to investigate and prosecute cases of child maltreatment, 

and grants for community-based support service. Furthermore, I 

look forward to working with my colleagues to reauthorize this important program. 

It’s so important that we do all we can to support safety research 

and prevention measures. Despite all that we’ve accomplished over 

20 years, 430 children are still dying each month from accidental 

injury. In Massachusetts alone, there are nearly 43,000 children 

under the age of 4 who visited the emergency room each year for 

nonfatal injuries. 

5 

It’s amazing how times have changed in not only how we behave 

around our children today, but also take extra care in protecting 

them. Not long ago, I can remember it was acceptable to place a 

baby seat in the front of your car and child bike helmets were considered optional. It has been proven that these changes in our behavior, which all of you have been strong advocates and educators 

in bringing to our attention, save lives. Such examples include that 

since 1987, we have decreased child motor safety injuries by 49 

percent and bike injuries have fallen 49 percent. These statistics 

demonstrate the success in your work and how sophisticated and 

aware we have become in protecting our children. 

Today unintentional injuries remain the No. 1 killer of American 

children under the age of 14. The burden of preventing childhood 

injuries can be a tremendous drain on parent’s energy and the worrying can be overwhelming. As a parent, who has raised three children, I have first-hand knowledge of how emotionally draining it 

can be to protect your children and ensure their safety. It is important for parents to be aware of dangers in not only their home, but 

their daycare centers, relative’s houses, and child’s friend’s houses. 

It is only through education and proactive action by parents can we 

further reduce childhood injuries. 

Today, we have with us representatives from the Centers for Disease Control, Safe Kids USA, the Home Safety Council, and the 

State and Territorial Injury Prevention Director’s Association. Also, 

we have a tremendous example here with us today of how safety 

precautions prevent childhood injury. A young man, named Justin 

Bruns, has a personal story of why it’s so important for caregivers 

to take their responsibility of childhood safety precautions seriously. 

The CHAIRMAN. I will ask you if you want to—— 

Senator DODD. Thank you very much. 

Dr. Ileana Arias is the Director of the CDC’s National Center for 

Injury Prevention and Control. She is responsible for the expansion 

of State programs for injury prevention, the development of surveillance for circumstances surrounding violent deaths, and new research in such areas as child maltreatment. 

Dr. Arias is a clinical psychologist with a research expertise in 

family violence, and we are truly honored to have you with us here 

this morning. I would just say to you, Doctor, and I guess everyone 

else, all of your statements and supporting documents and materials will be made a part of the record. 

So, thank you. 

STATEMENT OF ILEANA ARIAS, DIRECTOR, NATIONAL CENTER 

FOR INJURY PREVENTION AND CONTROL, ATLANTA, GA 

Ms. ARIAS. Thank you very much, Senator Dodd, Chairman Kennedy, and Senator Isakson. 

I am delighted to be here to talk to you about this important 

public health issue and then also join our partners in this endeavor 

who have been primarily responsible for the advances that you alluded to earlier. It is the case that unintentional injuries is the 

leading killer of American children, something that continues to be 

true in spite of the advances that we have made. 

6 

Motor vehicle-related crashes and traffic incidents are the primary cause of those deaths, followed very closely by drownings and 

fires. Of course, the deaths are just the beginning of the story as 

far as the toll and the burden of injuries among children. 

Non-fatal injuries are the leading reason or the main reason why 

children are brought to the attention of an emergency department. 

Primarily those are the results of falls. We are talking about kids 

who are being treated for broken bones, head concussions, and 

other injuries associated with falls, usually in the home or playgrounds. 

Not surprisingly, the costs are astronomical. In 2000, we estimated that the lifetime cost for children between the ages of 1 and 

14 of injuries that included both medical expenses and productivity 

losses over the lifetime is in excess of $51 billion, a significant ticket that we have to then pay on a continuing basis. 

That is the bad news. The good news, as you mentioned, is that 

these are largely preventable, and they are preventable because we 

know what works. We know how to prevent these injuries, which 

then accounts for the successes that we have made over the last 

couple of decades. 

At CDC, we are committed to making sure that children are safe. 

That is, we believe that they are entitled to a safe and healthy life 

and that every child has the right to live his or her life to the fullest potential. Our contribution to that is by supporting the work 

that needs to be done in order to decrease that significant challenge to that goal, and that is injuries. 

We essentially support research and then, importantly, making 

sure that that research goes out the door and implemented by communities in order to prevent those injuries. We want to make sure 

that all caregivers and parents are fully aware of what it is that 

they have to watch out for as far as their kids are concerned and 

what kinds of things they can do in order to maximize their safety. 

Over the past couple of decades, we have been primarily preoccupied with making sure that people understand what the burden is, that there is a problem, but then very importantly identifying what it is that they can do to prevent it. Where we are now 

is making sure that those tools get into the hands of individuals 

who are in a position to actually use them to accomplish the goal 

of furthering reducing the burden of injury among kids in the 

United States. 

As I said, we know what works. The issue now is making sure 

that that is widely disseminated and implemented. We recognize 

that we can’t do that on our own. In fact, we can’t do much of it 

on our own. We have to be very cognizant of the partnerships that 

are crucial to making that happen. Partnering with organizations 

such as Safe Kids, Home Safety Council, and then Government organizations, both at the State and local levels, as well as to make 

sure that it happens. 

I started off by sort of agreeing with you about the bad news. I 

agree with you that we do need to concentrate on the fact that 

there is some good news, that we have made a significant impact 

over the last two decades. More than that, that we actually do have 

the tools currently to improve upon that. So that, fortunately, the 

good news is that nowadays we can do more than cross our fingers 

7 

1 Injury in the U.S.: 2007 Chartbook, National Center for Health Statistics. 

and hope that when our kids leave home, when they get up in the 

morning, that they will be safe. We actually can ensure that they 

will be safe. 

I thank you for bringing this issue to the attention of the American public and calling attention to it, and I also thank you for the 

support that you have provided over these last years to make sure 

that what we are celebrating today actually is possible to celebrate. 

So I thank you very much, and then I am happy to answer any 

questions you may have. 

[The prepared statement of Dr. Arias follows:] 

PREPARED STATEMENT OF ILEANA ARIAS, PH.D. 

Good morning Chairman Kennedy, Ranking Member Enzi, and distinguished 

members of the committee. It is my privilege to appear before you as Director of 

the National Center for Injury Prevention and Control (NCIPC) at the Centers for 

Disease Control and Prevention (CDC). At CDC, we work to ensure that all people 

achieve their optimal lifespan with the best possible quality of health at every stage 

of life. We are equally motivated to ensure that individuals get a healthy start in 

life, and nowhere is this more important than in the lives of children. 

Regardless of gender, race, or economic status, injuries remain a leading cause of 

death for Americans. Unintentional or accidental injury and violence are particularly serious threats to the health and well-being of children and adolescents in the 

United States. CDC is leading the Nation’s efforts in reducing premature death, disability, human suffering and the medical costs associated with injuries and violence. 

Working with State and local governments, nonprofit organizations, professional societies, academic institutions, private entities, other Federal agencies and international organizations, CDC is documenting the numbers and identifying the causes 

of injuries, finding and developing effective prevention strategies, and promoting 

widespread adoption of these solutions. 

I will begin today by giving an overview of childhood injury and violence and explaining CDC’s unique public health role in their prevention. For many, we know 

how to prevent injury and death from occurring. I will also give an update on CDC’s 

research findings on specific childhood injuries and give a few examples of CDC efforts that illustrate how we contribute to a healthier nation. 

CHILDREN AND INJURIES: OVERVIEW

Infants and young children are at greater risk for many injuries than adults. This 

increased risk may be attributed to several factors. Children are curious and like 

to explore their environment, which may lead children to sample pills in the medicine cabinet, play with matches or venture into a family pool. Young children have 

immature physical coordination and cognitive abilities, and are at greater risk of 

falls from bicycles and playground equipment. Developing bones and muscles may 

make them more susceptible to injury in car crashes if they are not properly restrained. As pedestrians, children are particularly vulnerable because developmentally they cannot properly gauge the speed of traffic, and they lack the perceptual motor skills to avoid the path of on-coming traffic when they cross the road. 

In general, injuries are the leading cause of death for Americans aged 1 to 44 

years. In 2000, injury death and disability cost an estimated $406 billion in lifetime 

medical treatment expenses and lost productivity including lost wages and benefits 

as well as costs that are due to inability to perform household activities for an injury sustained in 2000.1 Of that total, injuries among children ages 0–14 account 

for $51 billion). Unintentional or accidental injuries remain the leading cause of 

death among young Americans, with the exception of Congenital Anomalies for children less than 1 year of age. Overall, motor vehicles and traffic-related accidents 

are the leading cause of injury by which children are killed, followed closely by 

drowning and unintentional fires. Additionally, unintentional injuries remain the 

leading cause of childhood non-fatal injuries treated in hospital emergency departments across the Nation. 

Below are leading causes of injury deaths by age group: 

8 

Age Range Leading Causes of Injury Death, 2005 

Less than 1 year ...................................... Unintentional suffocation; unintentional motor vehicle crashes; unspecified homicide. 

1–3 years ................................................. Unintentional drowning; unintentional motor vehicle crashes; unintentional fire/ 

burn. 

4–11 years ............................................... Unintentional motor vehicle crashes; unintentional fire/burn; unintentional 

drowning. 

12–19 years ............................................. Unintentional motor vehicle; homicide (firearm); suicide (firearm). 

ROLE OF PUBLIC HEALTH IN CHILDHOOD INJURY PREVENTION

To prevent childhood injuries, CDC uses a systematic public health approach. 

This approach has four steps: define the problem, identify the risk and protective 

factors, develop and test prevention strategies and assure widespread adoption of 

the best interventions. CDC achieves these primarily through surveillance and data 

sharing; research on possible interventions; community implementation and evaluation of interventions; and widespread adoption of proven interventions. 

CDC conducts surveillance to inform efforts in developing effective public health 

programs. By knowing the magnitude of the problem and the affected populations, 

resources can be directly applied and capacity adjusted to control or prevent the injury by utilizing and evaluating proven interventions. 

BURDEN OF CHILDHOOD INJURIES

CDC studies the burden of injury across the lifespan, but today I will focus on 

children and the leading causes of childhood injuries. 

Child Passenger Safety and Young Drivers 

Motor vehicle traffic-related injuries are the leading cause of death among children in the United States. During 2005, the National Highway Traffic Safety Administration (NHTSA) reported that 1,451 children ages 14 years and younger died 

as occupants in motor vehicle crashes, and approximately 203,000 were injured— 

an average of 4 deaths and 556 injuries each day. NHTSA also reported that of children ages 0 to 14 years killed in motor vehicle crashes during 2005, nearly half were 

unrestrained. However, many of these deaths can be prevented. We know that placing children in age- and size-appropriate restraint systems reduces serious and fatal 

injuries by more than half. CDC is currently evaluating State-based programs to increase booster seat use among children 4 to 8 years of age, in order to inform efforts 

in other States to address passenger safety issues among children. 

Because motor vehicle crashes are the leading cause of death for U.S. teens aged 

15–19, accounting for 35 percent of all deaths in this age group, research funded 

by the AAA Foundation for Traffic Safety suggests that the most strict and comprehensive graduated drivers licensing programs are associated with a 38 percent 

reduction in fatalities and a 40 percent reduction in injuries of 16-year old drivers 

due to crashes. CDC is building partnerships to promote and strengthen Graduated 

Driver Licensing (GDL) Systems in States. 

Child Maltreatment 

The true number of children who are victims of child maltreatment in the United 

States is unknown, but in 2006 the Administration on Children & Families (ACF) 

reported 905,000 cases of confirmed or substantiated cases of non-fatal child maltreatment each year in the United States. Child maltreatment includes physical, 

sexual, and emotional abuse and neglect, and is believed to be underreported. In 

2006, ACF data further showed that 1,530 child deaths were officially attributed to 

maltreatment. Child maltreatment through blunt trauma to the head or violent 

shaking (also known as shaken baby syndrome) is the leading cause of head injury 

among infants and young children. 

In addition to injuries and related health issues during childhood, child maltreatment can increase the risk factors for many of the leading causes of death among 

adults. CDC research shows that children who are maltreated are at an increased 

risk for a variety of health problems, including heart disease, cancer, chronic lung 

disease, liver disease, alcoholism, drug abuse and depression; and other forms of violence, such as intimate partner and family violence. Indeed, witnessing or experiencing abuse or neglect as a child can increase the risk factors for becoming a victim 

or perpetrator of violence. With the other work CDC is doing in violence and injury 

9 

2Tinsworth, D. and McDonald, J. (April 2001). Special Study: Injuries and Deaths Associated 

with Children’s Playground Equipment. Washington, D.C.: U.S. Consumer Product Safety Commission. http://www.cpsc.gov/LIBRARY/Playgrnd.pdf. 3 Conn JM, Annest JL, Gilchrist J. Sports and recreation-related injury episodes in the U.S. 

population, 1997–1999. Inj Prev 2003; 9(2): 117–123. 4 Non-fatal Traumatic Brain Injuries from Sports and Recreation Activities—United States, 

2001–2005; MMWR 2007. 

prevention, child maltreatment prevention represents an opportunity for CDC to 

have an impact across the lifespan. 

CDC has identified programs that teach parenting skills to promote safe, stable, 

nurturing relationships as one solution for this problem. These methods aim to motivate positive parent child interaction and teach parents to avoid neglectful and 

physically abusive behavior. 

Water Safety 

In 2005, of all children 1-14 years old who died, 6.6 percent died from drowning. 

Although unintentional drowning rates have slowly declined, fatal drowning remains the second-leading cause of unintentional injury-related death for this age 

group. In addition, for every child 14 years and younger who died from drowning 

in 2004, four received emergency department care for non-fatal submersion injuries. 

Research indicates that lack of supervision and proper barriers (such as pool fencing) are primary risk factors. CDC continues to promote water safety education to 

caregivers by providing information to parent groups, recreation centers and schools. 

Residential Fire-Related Injuries 

Pre-school children (age 5 and under) and older adults (age 65 and older) have 

the highest fire death rates in U.S.-home fires. Deaths from fires and burns are the 

sixth most common cause of unintentional injury deaths in the United States and 

the third leading cause of fatal home injury. Residential fires caused nearly $7 billion in property damage in 2006, with fire departments responding to 412,500 home 

fires in the United States. In that same year the lives of 2,580 people were lost and 

another 12,925 (not including firefighters) were injured. Approximately half of home 

fire deaths occur in homes without smoke alarms. 

Smoke alarms decrease the risk of death in a home fire by up to 50 percent. However, one-quarter of U.S. households lack working smoke alarms, and those least 

likely to have an alarm are often at higher risk of being injured in a fire. 

The smoke alarm installation and fire safety education programs—funded by CDC 

in 17 States—provide evidence that smoke alarm installation programs save lives. 

A review of homes participating in CDC-funded smoke detector installation and fire 

safety education programs found that nearly 1,600 lives have potentially been saved 

to date. Program staff have canvassed over 473,000 homes and installed nearly 

350,000 long-lasting or lithium-battery powered smoke alarms in high-risk homes, 

including those with children ages 5 years and younger and adults ages 65 years 

and older. Technology development, distribution of smoke alarms, and addressing 

risky behaviors are key to reducing the number of fire-related deaths in the United 

States. 

Recreational Injuries (Playground and Sports Safety) 

Children spend a lot of time participating in sports and recreation activities. 

While participation in sports, recreation, and exercise is an important part of a 

healthy, physically active lifestyle, the associated injuries present a significant public health problem. Injuries related to playground activities account for many of the 

injuries to youth aged 0–9. Although the mortality associated with these activities 

is not high (an average of 13 playground deaths per year from 1999–2001,2 more 

than 200,000 children visit emergency departments for treatment of a playground 

injury each year. 

According to the CPSC’s Public Playground Safety Handbook, 79 percent of playground injuries are due to falls from playground equipment. Fractures to upper 

limbs are the most common type of injury. Half of all playground injuries occur in 

schools and sporting facilities.3 For sports-related injuries, more than half are sustained by youth between the ages of 5–18, with boys having higher rates of injury 

than girls.4 Furthermore, CDC estimates that as many as 3.8 million sports and 

recreation-related concussions occur every year. A concussion is a brain injury 

caused by a bump or blow to the head, and can have severe long term consequences 

for children. According to the Consumer Product Safety Commission’s (CPSC) economic data, the medical costs of sports and recreational injuries to children under 

age 18 years were over $11 billion in 2003. Including parents’ work losses, pain and 

10 

5 CPSC Directorate for Economic Analysis 2000; CPSC 2003. 

suffering, and product liability and legal fees, this societal cost was approximately 

$121 billion in 2003.5

A CDC-sponsored School Health Taskforce produced recommendations to schools 

to develop, teach, implement, and enforce safety rules to address recreational injuries. Additionally, CDC has been instrumental in producing appropriate educational 

materials for parents and youth sports coaches in the assessment, management and 

prevention of traumatic brain injury or concussions. The ‘‘Heads Up: Concussion in 

Youth Sports’’ initiative offers information to youth sports coaches and parents to 

help ensure the health and safety of young athletes. Furthermore, CDC developed 

the Acute Concussion Evaluation (ACE), a tool for physicians to assess and manage 

patients with concussions. 

CONCLUSION

There is now a strong and growing scientific basis for childhood injury and violence prevention and control. Injuries and violence do not have to be an accepted 

risk—lives can be saved and injuries can be prevented. Public health can promote 

the use of effective prevention strategies; yet, where science-based interventions 

exist, they are too-often not widely disseminated. This is equivalent to developing 

a life-saving medication but not telling physicians or patients that it is available, 

not packaging the product for public use, not having skilled pharmacists to dispense 

the medication, and not providing guidance about the management of its effects. To 

save lives, consumers and providers need support for adopting and maintaining 

interventions over time. To effectively address the issue, CDC is developing national 

initiatives and other large-scale approaches to support and expand current research, 

improve program evaluation and promote widespread adoption and use of effective 

preventative measures. Most injuries are completely preventable and thus should 

never happen. 

Thank you for the opportunity to discuss these important public health issues 

today. Thank you also for your continued interest in and support of CDC’s injury 

prevention activities. 

I will be happy to answer any questions. 

The CHAIRMAN. Good. Well, thank you very much. 

Let me ask you, what do you think would be your estimate if 

each of the States were to put in an effective kind of program, what 

are we talking about in terms of sort of resources? What would be 

just round figures? 

Ms. ARIAS. CDC is currently funding 30 States to implement a 

myriad of intervention programs. One of the things that we are trying to do is focus on those child programs. We would like to be able 

to extend that to all 50 States and territories and would be happy 

to then get those numbers to you as a follow-up question. 

The CHAIRMAN. OK. Yes, would you? So you are in 36? 

Ms. ARIAS. Thirty. 

The CHAIRMAN. Thirty now, and if they had—do you have a 

model? Do you have a model program that you put— 

Ms. ARIAS. There are various—yes, we do. The State Territory 

Program Directors Association has come up with models for how it 

is that State departments can essentially set up those programs to 

be as effective not only in surveying and monitoring the issue of 

injury among kids over time, but also in then disseminating and 

supporting the implementation of those programs. 

We also have, with their help, gathered a number of success stories of States that have done a particularly excellent job and then 

can be replicated in other States as well. 

The CHAIRMAN. Let me ask you, how do you go about—do you 

get a hold of the States, the States get a hold of you, a mix of both? 

Do you look at States that haven’t been in touch with you recently 

and recommend that they do? Or how do you proceed? 

11 

Ms. ARIAS. That is a great question. We do a combination of both. 

We certainly make information available to all States of the resources that we do have and how those resources can be employed. 

Because we are not able to essentially directly support all States, 

what we do with the States we can’t support is reach out to them 

and find out what are technical assistance or other kinds of resources that we can make available to them. Also how is it that in 

future competitions, for example, they may be able to then compete 

more successfully to get that kind of funding. 

The CHAIRMAN. Just finally, how are we doing in Massachusetts? 

I know you never should ask a question you don’t know an answer 

to, but let me hear. How are we doing? What specifically—maybe 

just specifically, I will ask you for the record, but do you know offhand how we are doing up there and what we ought to be doing 

better? 

Ms. ARIAS. Yes. Massachusetts does quite well, and we can send 

you specific information about all the programs that we do—— 

The CHAIRMAN. OK. 

Ms. ARIAS [continuing]. Fund across the lifespan and in different 

settings. 

The CHAIRMAN. Yes, if you could, just give me what they are 

doing and the areas that you think can be strengthened. 

Ms. ARIAS. OK. 

The CHAIRMAN. I will be glad to get in touch with the Governor, 

too, and see if we can’t make some progress. 

Ms. ARIAS. Excellent. 

The CHAIRMAN. Thank you. 

Senator ISAKSON. Thank you very much, Chairman Kennedy. Did I hear your testimony correctly that the cost annually is $51 

billion? 

Ms. ARIAS. Those are lifetime costs. 

Senator ISAKSON. Those are lifetime costs? 

Ms. ARIAS. Yes. So if we project—— 

Senator ISAKSON. The results of those injuries, like the young 

lady I talked about who is a quadriplegic. The cost of her care the 

rest of her life, that is a part of that number? 

Ms. ARIAS. Yes, sir. Even changes in productivity as a result of 

those injuries. 

Senator ISAKSON. Right, and that is incalculable, I guess, in 

terms of the productivity loss. 

What is the most common accident today? 

Ms. ARIAS. It usually is motor vehicle crashes. So that really is 

the leading cause of deaths for sure. For the unintentional, it depends on the age range. For younger kids, it tends to be fall. But 

really, motor vehicle crashes and traffic-related issues are the primary contributor to those figures. 

Senator ISAKSON. Are you in CDC in Atlanta? 

Ms. ARIAS. Yes, we are. 

Senator ISAKSON. Good, well, welcome. We are neighbors. 

On reaching our kids and reaching, in many cases, our adults, 

when I chaired the State Board of Education in Georgia, we found 

out the best way to communicate was through the kids, and particularly starting at the elementary school, in terms of good diet, 

safety practices, even in the enrollment of kids in SCHIP. 

12 

When that first started back in 1996, and I chaired the Board 

of Education, we had a very low enrollment rate until we used the 

schools to educate the kids to go home and tell mom and dad, ‘‘hey, 

this insurance is available if you will go down and sign up’’. 

So an answer in response to Senator Kennedy’s question, I think 

the single-best conduit to get reinforced safety and good health 

practices and everything else is through the public schools and 

through public education. I know in Georgia, we have got Superintendent Kathy Cox, who has done a good job in a number of 

areas like that. I would recommend any time CDC can or your part 

of CDC can get that information and use the State centers of education, the better that information will get disseminated. 

Ms. ARIAS. Yes. No, that is an excellent point. Both on the unintentional side and even on violence issues related to safety in 

schools, we have traditionally focused significantly on school programs and how it is that those messages and what kind of tools 

teachers and other school personnel need in order to deliver those 

messages. 

The other is, of course, trying to deliver them as early as possible. So, if possible, working with elementary school-age kids so 

that they can then develop those behaviors very early so that by 

the time they reach high school, where they are a little more autonomous, are engaging in the kinds of behaviors that are going to 

safeguard them. 

Senator ISAKSON. I remember when my youngest son, Kevin, was 

in some elementary school grade, and he came home with a clay 

thing that he had made. It was an ashtray, and he gave it to me. 

At the bottom, he had written on it ‘‘don’t smoke.’’ You know, one 

of the great things for kids to do. But this is a very impressionable 

time in their lives, but also it helps us to make impressions on 

them that will save them from many dangers in the future. 

So we appreciate what you are doing, and thank you for being 

here. 

Ms. ARIAS. Thank you. 

Senator DODD. Doctor, just a couple of things. One is to what extent do you work at all with the entertainment industry? We talk 

about influences on children, and obviously there’s programming, 

cartoons, all sorts of things. To what extent, I mean, is there an 

awareness that a lot of repetition or imitation of important messages occurs? Obviously, parents have a responsibility to warn 

their children about what they can and cannot do. 

But do you get any cooperation? Are they helpful at all in this? 

Ms. ARIAS. They are very helpful, both in terms of working with 

us directly and then working through our partners as well, whether 

it is print media or television or others, trying to look for opportunities to deliver those safety messages. For example, a partnership 

with Parents magazine potentially this coming year on safety 

issues across the lifespan. 

We are now in the process of also reaching out to Sesame Street 

Workshop. Walt Disney, who has done an excellent job of addressing the issue, for example, of residential fires and the prevention 

of fires in the home. So that the entertainment industry has a significant and strong interest in being helpful in that way. 

13 

Senator DODD. It is an average of 430 deaths a month from accidental injury. Tell me about how those numbers have changed in 

the last few years. And do me a favor as well, break down that 

number. It seems like there is an inordinate amount of reporting 

lately on violence, gun violence and the like. Please share with us 

your thoughts on that and what CDC is doing about it and how cooperative are States being in some of the issues where you are trying to reduce the level of gun violence in our schools. 

Ms. ARIAS. The focus today was on unintentional injuries primarily because it is by far the most significant contributor to injuries and deaths among kids. However, violence is a significant 

issue for children and adolescents and young adults. For example, 

we know that homicide is the fourth-leading cause of death for kids 

between ages—— 

Senator DODD. Is what? I am sorry? 

Ms. ARIAS. Homicide is the fourth-leading cause of death—— 

Senator DODD. Fourth leading. 

Ms. ARIAS [continuing]. For children between the ages of 1 and 

9. So that is a pretty startling statistic. Most of that, of course, is 

the result of child maltreatment, which includes anything from 

physical abuse, sexual abuse, and then neglect. 

What we are doing, very similar to what we do with injuries, is 

trying to identify who are the kids who are at high risk for that 

or who are the families that are at high risks for those kinds of 

issues, and then what are the most effective ways of preventing 

those issues from happening? 

We know from the research and the science that we have supported at CDC and that others have conducted that parenting programs are significant in order to prevent child maltreatment and 

also to prevent a number of negative health outcomes for kids. 

That is, programs that essentially teach parents not only how to 

discipline their children, but also how to interact in a positive way 

with their children and sort of help them develop in the way that 

they want. 

In addition to those parenting programs, early home visitation 

programs have also been shown to be incredibly successful, looking 

at a reduction of about 40 percent in child maltreatment among 

families who have been enrolled in those programs. So that very 

similar to unintentional injuries, it is a big problem, but fortunately, we know what can be done. Currently, it is then a matter 

of making sure that communities are equipped to be able to address the issue by having those things available to them. 

Senator DODD. Yes. I wonder if you might address as well the 

current state of collaboration between the Federal agencies on coordinated injury prevention approaches, particularly between the 

CDC and HRSA. How is that working? 

Ms. ARIAS. It is working quite well. Usually, it winds up being 

topic specific, so that if we have an issue that we are pursuing— 

for example, whether it is shaken baby syndrome or car seats— 

finding other Federal agencies, either within the Department of 

Health or other Federal agencies who have a role in making sure 

that that happens. 

One of the things we do in public health is recognize that everything we do is multisectorial. It is not just about public health. 

14 

Usually there are a number of other sectors that have to essentially coordinate with what we are doing in order to be effective. 

From the very beginning, we reach out to them, make sure that we 

do coordinate. Otherwise, we are going to essentially hamper our 

chances of success in addition to then maybe getting in their way. 

Senator DODD. Is your general conclusion that they are receptive, 

the various Federal agencies? 

Ms. ARIAS. Yes, they are. What we try to do is be very clear 

about what is the value added that each of us brings to the table. 

In the case of CDC, we know that there are certain things that we 

do that usually are not replicated in other agencies and that we 

have particular expertise. 

Primarily, that has to do with the surveillance issues, making 

sure that we support the systems to collect the information to find 

out what the problem is, where the problem exists and, therefore, 

where we should be investing our resources. The other is in the 

evaluation of those programs. So that other agencies are ideally 

equipped and suited to be able to disseminate programs, but not 

necessarily support the evaluation of those programs once they are 

implemented in a community. 

Of course, we are very interested in making sure that we document the effect of those programs when they are implemented to 

make sure that we want to continue with that investment and not 

have to change it in order to improve success. 

Senator DODD. Yes. And last, let me just mention that Senator 

Kennedy raised this and I think Senator Isakson did as well, 

touched on it, and that is cost. We are looking—as a parent of 

these young children, just going out and buying car seats and other 

safety equipment, it is expensive. And if you are a family that is 

struggling, those costs can be astronomical and can become prohibitive in some cases. 

I know there are places you can go to get secondhand and used 

equipment, good equipment, by the way. It doesn’t mean it is faulty 

in any way. What recommendations and thoughts do you have? Because so many people today are struggling to make these ends 

meet. They want to keep their children safe, and yet these objects 

are—— 

Ms. ARIAS. Yes. We have explored various options for reducing 

those costs, again to make sure that everybody does have the benefit of the tools that are available to protect their children. Most 

of what we have looked at and actually have done is building those 

partnerships. 

So whatever resources we can bring to the table and then really 

focusing on the private sector as well so that we have supported 

programs, for example, where a Wal-Mart or a Target may actually 

donate the equipment. Health departments then basically take 

charge of distributing those and educating individuals about how 

to use that equipment. 

The other is to the extent to which medical services can actually 

cover the cost of that equipment. So we are looking at those models 

as a way of then making sure that these things are accessible to 

all families. 

Senator DODD. Thank you very much. 

Senator ISAKSON. Mr. Chairman, can I add something? 

15 

The CHAIRMAN. Please. 

Senator ISAKSON. Senator Dodd asked a question, I know, Dr. 

Arias, I believe you would be aware of this. But last year, there 

was an attempt by a member of the Senate to delete in the appropriations act for CDC a line item for what I call the Hollywood 

Help Desk at CDC. 

But CDC has, under Dr. Gerberding, established a working 

group that works with television writers and screenwriters to make 

sure that when they put health-related, safety-related, any type incident like that that is depicted in a film, to try and get them to 

depict it in the proper way, both negatively, if it is a bad thing for 

someone to do, as well as positively, if it is the right way to handle 

it. 

So CDC has been a leader in trying to communicate with Hollywood and television to make sure that what people are seeing and 

influenced by so much at least has credible information in it and 

that hopefully depict the type of outcome we would all want to 

have. 

The CHAIRMAN. That is good. That is useful. 

Let me just ask a final question, do you look at the Advertising 

Council, too? Have you tried the Advertising Council to get them 

sort of involved? They take on various projects, and they are— 

when they get behind it, they have got enormous resources and interests. But it seems to me there may very well be interest in the 

Ad Council. See if they would take on something like this, you 

might take a look. 

And we might inquire. Maybe that is a job for us to inquire of 

the Ad Council, and we might be back in touch with you about how 

that might be suggested, recommended. But if we could get them 

involved in it, too, it might be of value and use to all of the different groups that are doing a lot of good work. 

So I guess we will follow up. I am just rambling along here. But 

we will follow up with you and see if there is something that makes 

some sense. 

Ms. ARIAS. Most definitely. 

The CHAIRMAN. OK. Thank you very much. 

Senator DODD. Thank you, Doctor. 

The CHAIRMAN. Go ahead. You have got the second panel there. 

Senator DODD. Alan Korn, I want to welcome you. Alan, thank 

you for being here. He is the Director of Public Policy for Safe Kids 

Worldwide. 

We invite Justin to come on up and join us as well. Justin, come 

on up here. Justin is a student from The Boys Latin School in Baltimore, MD, and we thank Justin for joining us. 

Meri-K Appy, did I pronounce that correctly? Meri-K is President 

of Home Safety Council, and we thank you for being with us. 

Amber Williams is the Executive Director of State and Territorial 

Injury Prevention Directors Association in Atlanta, GA. You have 

got a lot of constituents here. 

Senator ISAKSON. Absolutely. We are on top of this. 

Senator DODD. I know. Justin, how are you? You doing okay? 

Good man. Good to have you with us. Got off school today. So we 

can keep you talking all day. You don’t have to go to school today. 

[Laughter.] 

16 

The CHAIRMAN. We have got some young observers here, back 

here. Do they want to stand up? Some young children, I see them 

in the second row. Are they your sisters? You are going to introduce them for us? Good morning. 

Senator DODD. Good morning. 

The CHAIRMAN. Thank you for being here. 

Senator DODD. Well, we will begin, Alan, with you. Thank you 

for being with us this morning. 

STATEMENT OF ALAN KORN, DIRECTOR OF PUBLIC POLICY, 

SAFE KIDS USA INTERNATIONAL, WASHINGTON, DC 

Mr. KORN. Sure. Thank you very much. 

There we go. Safe Kids appreciates the attention this committee 

has thrown toward this issue over the past 20 years. I would be 

remiss if I did not point out that this committee helped us at our 

launch 20 years ago—Senator Dodd, you were chair of that subcommittee when we did it—at our 10th, 15th, and now 20th anniversary. 

This committee has played a tremendous role in helping us with 

the good news that we reported earlier this week, with the help of 

a lot of groups and the Federal Government. It has been quite remarkable. 

Let me just say one other thing, if I didn’t point out—with your 

permission, Chairman Kennedy and Senator Isakson—point out 

Senator Dodd individually. Senator Dodd, you have been thinking 

about and acting on these issues for 20-plus years. It is, if I were 

to spend the time drawing down the list of things that you have 

done on behalf of injury prevention, we would eat up our entire 

time of the hearing. 

This committee in particular and Senator Dodd specifically, so 

we really do appreciate— 

The CHAIRMAN. Is this your witness, Senator Dodd? 

[Laughter.] 

Senator DODD. But he is going to be at every hearing that I—— 

Mr. KORN. You always risk pointing out one particular Senator, 

but it is well deserved. 

The CHAIRMAN. It is well deserved. 

Mr. KORN. I should say now to rebuild my reputation here a little bit, Senator Kennedy, no one has done more, too, for public 

health also. I mean, really. 

The CHAIRMAN. There you go. Something nice about Johnny 

Isakson over here, and he will—— 

[Laughter.] 

We can say the same about you, Mr. Korn. 

Mr. KORN. Thank you very much. 

The CHAIRMAN. Well known. So thank you. 

Mr. KORN. We are smack-dab in the middle of Safe Kids Week, 

which Congress has helped us celebrate for many, many years, and 

I will be very brief. I am not going to read my statement. I am just 

going to make a few points and try to make it as informal as possible. 

We released this report earlier this week on Monday here in 

Washington, DC. It has got absolutely, we believe, tremendous 

news in it. It is success that all of us here and all of our partners 

17 

can be very proud of, including the CDC, the CPSC, NHTSA, the 

U.S. Fire Administration, and this committee—and we can talk 

about some of the things that this committee has done under your 

leadership, Chairman Kennedy. 

Over the past 20 years, in two decades, we have seen a decrease 

of 45 percent in the death rate to children. We think that is remarkable. In fact, I can’t think of—there might be, but there is 

very few of a public health issue that has had that kind of success 

over that really short period of time. I mean, it seems like a long 

time, but two decades, and it is remarkable. 

It says to us that we know how to prevent these injuries. I 

brought a lot of visuals. If we get to them, I will be happy to talk 

about them. But we know how to prevent these injuries, and every 

single one of them is preventable, in our view. Always with the 

glass half full, there is a little space yet to go and it is half empty. 

For some reason, it is still the leading cause of death in this country. Unintentional injury is 5,200 deaths a year. 

In fact, is today May 1st? I think it is. We are starting trauma 

season in this country, which is May 1st to the end of August. Seventeen children a day will die in this country because of an accidental injury during that time period. The CDC and public health 

groups call it the trauma season, and it is for a reason. They are 

all preventable. 

We are celebrating Safe Kids Week this week with activities 

around the country, with our support of our founding sponsor, 

Johnson & Johnson, who, as you know, Senator Kennedy and 

Dodd, have been with us for so long in our efforts. Doing events 

in Massachusetts, in Connecticut, and Georgia—and here is my 

shout-out to Georgia. 

We have State and local offices all around the country. I think 

a lot of our staff here is in the audience, our very best ones are 

in Georgia. They really know how to do the job there. They are 

doing child safety seat—— 

The CHAIRMAN. Have you ever thought of running for office? 

[Laughter.] 

Senator DODD. As a Democrat. 

Mr. KORN. I see what happens, and I am not so sure I want to 

expose myself to that. But they are doing child safety seat checkup 

events. They are doing bicycle helmet checks this week and giveaways, personal flotation device giveaways, and they are very good. 

That is the type of thing that Dr. Arias was mentioning, about 

that collaboration, that partnership to get the job done. I will defer 

to my other colleagues here. 

[The prepared statement of Mr. Korn follows:] 

PREPARED STATEMENT OF ALAN KORN

My name is Alan Korn, and I am the Director of Public Policy and General Counsel for Safe Kids USA, a member country of Safe Kids Worldwide. Safe Kids thanks 

the Senate Health, Education, Labor, and Pensions Committee, and in particular 

Chairman Kennedy and Ranking Member Enzi for holding a hearing on childhood 

injury prevention. We have all come a long way over the past 20 years in protecting 

children from unintentional injuries and deaths. Despite the many successes, ‘‘accidents’’ are still the No. 1 killer of children ages 1–14 in the United States. Clearly 

there is so much more to do. Safe Kids hopes that the attention fostered by both 

the roundtable and the activities surrounding Safe Kids Week 2008 will prove to 

be the catalyst we all need to redouble those efforts that we know work, improve 

18 

upon others that missed the mark and try new initiatives, both government-based 

and otherwise, that hold the promise of saving children’s lives. 

I. HISTORY OF SAFE KIDS WORLDWIDE

Safe Kids Worldwide is the first and only international organization dedicated 

solely to addressing an often under recognized problem: More children ages 1–14 in 

the United States are being killed by what people call ‘‘accidents’’ (motor vehicle 

crashes, fires, drownings and other injuries) than by any other cause. Formerly 

known as the National SAFE KIDS Campaign, Safe Kids Worldwide unites more 

than 450 coalitions in 16 countries, bringing together health and safety experts, 

educators, corporations, foundations, policymakers and volunteers to educate and 

protect families against the dangers of accidental injuries. Our USA network includes coalitions in all 50 States and the District of Columbia, including outstanding 

programs in both Massachusetts and Wyoming. 

Founded in 1987 by the Children’s National Medical Center and with support 

from Johnson & Johnson, Safe Kids Worldwide and its member country, Safe Kids 

USA, relies on developing injury prevention strategies that work in the real world— 

conducting public outreach and awareness campaigns, organizing and implementing 

hands-on grassroots events, and working to make injury prevention a public policy 

priority. 

This year marks our 20th anniversary of our efforts, which has resulted in the 

significant reduction of accidental childhood injury-related deaths in the United 

States. We have, over the years, reinforced the ways that parents, caregivers, State 

and Federal policymakers, and communities can continue to promote children’s safety. We have released a comprehensive report to the Nation demonstrating how far 

we have come in 20 years, and how far we still have to go. In addition, the week 

of April 26–May 4, is Safe Kids Week and Safe Kids coalitions across the country 

will be holding local community outreach events to spread awareness about child 

safety, such as bike helmet rodeos, health fairs and car seat check up events. 

The ongoing work of Safe Kids coalitions reaching out to local communities with 

injury prevention messages has contributed to a decline in the childhood unintentional injury death rate since 1987. However, with more children dying from accidental injury than from cancer, heart disease and birth defects, Safe Kids Worldwide and its member countries remain committed to reducing unintentional injury 

by implementing prevention strategies and increasing public awareness of the problem and its solutions. 

Safe Kids has been proud to work with the Senate Health, Education, Labor, and 

Pensions Committee over the years to increase the knowledge and understanding 

of proper child safety practices. This committee has addressed childhood accidental 

injury through hearings and media outreach events for Safe Kids’ other milestones, 

such as our launch in 1988 and our 10th and 15th anniversary celebrations. We 

thank the committee once again for being a part of Safe Kids’ history and most importantly, for helping us to promote programmatic, educational and legislative interventions to ensure that every child in this country is protected from their most serious public health problem—accidental injury. 

II. FINDINGS FROM SAFE KIDS’ REPORT TO THE NATION: TRENDS IN UNINTENTIONAL

CHILDHOOD INJURY MORTALITY AND PARENTAL VIEWS ON CHILD SAFETY

A. Safe Kids USA’s 2008 Report 

Safe Kids marked our anniversary by releasing a comprehensive report to the Nation demonstrating how far we have come in 20 years, and how far we still have 

to go. Entitled, Report to the Nation: Trends in Unintentional Childhood Injury Mortality and Parental Views on Child Safety, the report examines accidental injury in 

the United States and its impact on children by age, gender and race, and reviews 

the changes in unintentional injury fatality rates for children ages 14 and under in 

areas such as motor vehicle occupant injuries, drownings and suffocation (which includes strangulation and choking). 

B. Major Findings 

Major findings from the report include: 

1. The unintentional childhood injury fatality rate among children ages 14 and 

under has decreased in the United States by 45 percent since 1987. 

2. Despite this decline, unintentional injury remains the leading cause of death 

among children ages 1 to 14 in the United States. In 2005, 5,162 children ages 14 

and under died from an unintentional injury, and 6,253,661 emergency room visits 

for unintentional injuries in this age group occurred in 2006. 

19 

3. The unintentional injury fatality rate has declined in most risk areas. Some of 

the greatest improvements have been made in prevention of bicycle injuries (down 

73 percent), fire/burn injuries (down 68 percent) and pedestrian injuries (down 62 

percent). The four leading causes of death from accidental injuries to children 14 

and under are suffocation (19 percent), motor vehicle occupant injuries (16 percent), 

drownings (16 percent) and pedestrian incidents (11 percent). 

4. Unfortunately, the suffocation rate has a documented increase of 21 percent. 

This is largely the result of a re-categorization of the cause of death driven by an 

improvement in the quality of death scene investigations that is occurring at various 

levels across the country. Previously, many of these deaths were categorized as Sudden Infant Death Syndrome (SIDS). With the improved investigations, more cases 

are being seen where a child suffocates from soft pillows, mattresses, or mattress 

coverings in his/her crib or from bed-sharing with a parent. 

5. Children ages 4 and under have the highest fatality rate as well as the highest 

number of deaths (2,747 in 2005). Between 1987 and 2005 there has been a 35 percent decrease in fatal unintentional injuries in this group. 

6. The fatality rate from unintentional injury is higher among males than females, as is the actual number of deaths. In 2005, approximately 3,000 boys and 

2,000 girls ages 14 and under died from unintentional injury. 

7. There are large disparities between the fatality rates among children of different races and ethnicities. American Indian/Alaskan Native children have the 

highest fatality rate from unintentional injury at 15.3 per 100,000, and Asian/Pacific 

Islander children have the lowest fatality rate at 4.24 per 100,000. These disparities 

have been consistent since 1987. 

8. Fatality rates from unintentional injury declined in each of the four regions of 

the United States between 1987 and 2005. The largest decrease, almost 60 percent, 

was in the Northeast, while the Midwest had the smallest decrease, 40 percent. 

Since 1987, the South has consistently had the highest rate of fatality, 10 per 

100,000 in 2005, and the Northeast has had the lowest, 4.56 per 100,000. 

III. ADVANCEMENTS IN CHILD SAFETY OVER THE YEARS

While the fatality rate in the United States from unintentional injury in children 

ages 14 and under has declined by 45 percent since 1987, and significant progress 

has been made in most risk areas, there is still a long way to go. Every year, more 

than 5,000 American children ages 14 and under die from unintentional injury. 

Deaths from suffocation, motor vehicle crashes and drowning still represent a majority of these deaths—and the vast majority of these deaths could have been prevented. 

A. Motor Vehicle Occupant Safety 

1. Problem: Car crashes pose a significant risk for injuries and death to children. 

Although the motor vehicle occupant death rate among children ages 14 and under 

declined 49 percent from 1987 to 2005, motor vehicle crashes remain the leading 

cause of death among children ages 3 to 14 in the United States. In 2005, an estimated 842 children ages 14 and under died unintentionally as motor vehicle traffic 

occupants. Additionally, in 2006 an estimated 190,346 emergency room visits were 

for motor vehicle traffic occupant injuries to children ages 14 and under. 

In addition to motor vehicle crashes, children are also at risk of injury or death 

from being left unattended in closed vehicles. Each year from 1998 to 2004, an estimated 33 children died from heat stroke after being left unattended in a vehicle. 

Between 1987 and 1998 there were 19 reported deaths to children under age 7 due 

to car trunk entrapments, where children were playing in the trunk and closed the 

door. Children can also be backed over by unknowing drivers; from 2001 to 2003 

approximately 7,475 children (2,492 per year) aged 1 to 14 years were treated for 

non-fatal motor vehicle backover injuries in emergency departments. Most backovers 

occurred at either home or in driveways or parking lots; 47 percent occurred at 

home, and 40 percent occurred in driveways or parking lots. 

2. Solution: The increased use of car seats has contributed to the reduction in 

injury and death rates from motor vehicle accidents. Adult seat belts do not adequately protect children under age 8 from a crash injury so car seats, when used 

appropriately, are the most effective safety devices to protect children. Research 

demonstrates that correctly installed car seats can reduce fatal injury by 71 percent 

for infants less than 1 year of age and by 54 percent for toddlers ages 1 to 4. Booster 

seats for older children reduce the risk of injury by 59 percent. It is recommended 

that children ride on booster seats, in the rear seats of a vehicle, until they reach 

4′9′′ in height and weigh between 80–100 pounds. Many children are moved prematurely to seat belts when they should still ride on booster seats. 

20 

a. Education: The nationwide proliferation of car seat education and distribution 

programs—and in particular, increased availability of child restraint inspection/ 

installation opportunities utilizing certified technicians—has increased the prevalence and proper usage of these vital safety devices. 

Safe Kids has a national program sponsored by General Motors to educate parents 

and caregivers about the importance of properly restraining children on every ride. 

Since 1996, the General Motors Corporation has served as Safe Kids Buckle Up’s 

exclusive funding source and helped build Safe Kids Buckle Up into a multifaceted 

national initiative, bringing motor vehicle safety messages to children and families 

through community and dealer partnerships. In October 2004, Chevrolet became the 

lead partner of Safe Kids Buckle Up, bringing an added dimension to the promotion 

of Safe Kids Buckle Up activities. 

Since the program’s inception, more than 13 million people have been exposed to 

Safe Kids Buckle Up events and community outreach efforts, and child passenger 

safety specialists have examined more than 915,250 seats and donated 365,000 

seats to families in need. The program includes car seat check up events, mobile 

car seat check up vans, child safety seat inspection stations, child safety seat distribution programs, technical child passenger safety trainings, educational workshops, legislative and enforcement efforts to enact or publicize child restraint laws 

and a toll-free hotline for parents and caregivers to access child safety information. 

b. Enactment and Enforcement: Over the years improvements in child occupant protection and safety belt laws have proven effective at increasing restraint 

use and protecting children. The first child occupant protection law was passed in 

Tennessee in 1978. Since then, all States have passed laws requiring young children 

be restrained in car seats in motor vehicles. The first booster seat law to protect 

older children went into effect in California on January 1, 2002. Since then, 43 

States, including Washington, DC, have improved upon their restraint law to require some older child passengers to ride properly restrained in a booster seat. Significantly, Massachusetts became the last State in the Northeast to pass a booster 

seat law. Governor Deval Patrick signed the bill into law on April 11, 2008. Wyoming passed their law in 2003 and has one of the strongest child passenger safety 

laws in the Nation. 

Primary enforcement of seat belt laws is also important. Currently, seat belt use 

laws in only 26 States and the District of Columbia are subject to primary enforcement. These laws allow a citation to be issued if a police officer simply observes an 

adult or child riding improperly without a safety belt. Primary enforcement has 

proven effective in increasing restraint use for both adults and children. In 2007, 

seat belt use was 87 percent in primary law States versus 73 percent in secondary 

law States. 

In addition, several States have enacted safety laws that protect children in and 

around cars, including 14 States that prohibit leaving children unattended in a 

motor vehicle. 

The National Highway Traffic Safety Administration has also contributed greatly 

to the success. Improvements to the Federal Motor Vehicle Safety Standard Number 

213, the LATCH system of car seat installation, ease of use ratings for child safety 

seats—along with their many government-funded public education campaigns supported by the 2005 Federal SAFETEA-LU (Safe, Accountable, Flexible, Efficient 

Transportation Equity Act: A Legacy for Users) law—have made child safety seats 

more effective, user-friendly and has helped Safe Kids spread the important message of consistent and correct car seat usage. 

In addition, the National Transportation Safety Board has helped promote this 

vital message. Their Most Wanted List of Traffic Safety Improvements has consistently included the recommendation for State governments to upgrade their child 

passenger safety laws. The Board has taken a strong role in encouraging these 

changes through their Advocacy Center. 

B. Bicycle and Wheeled Sports Safety 

1. Problem: Although the bicycle unintentional injury death rate among children 

ages 14 and under declined by 73 percent from 1987 to 2005, bicycle injury remains 

a major cause of child mortality and morbidity. In 2005, an estimated 121 children 

ages 14 and under died from unintentional bicycle injuries. Additionally, in 2006 an 

estimated 226,409 emergency room visits by children 14 and under were for unintentional bicycle-related injuries. 

Other wheeled sports such as skateboarding and skating continue to grow in popularity, and a significant rate of child injury is associated with these activities. According to the U.S. Consumer Product Safety Commission (CPSC), in 2004, more 

than 46,200 emergency room visits by children 5 to 14 years old were for injuries 

from inline skating and roller skating. In the same year, more than 43,100 emerVerDate Nov 24 2008 14:06 Nov 30, 2009 Jkt 035165 PO 00000 Frm 00024 Fmt 6633 Sfmt 6621 S:\DOCS\42290.TXT DENISE
21 

gency room visits by children 14 and under were for injuries involving non-powered 

scooters. Nearly 60,300 emergency room visits by children 5 to 14 years old were 

for skateboarding injuries. The most serious injuries and many of the deaths are 

due to head injuries. 

Quite simply, not enough children are wearing helmets and other protective gear 

when using bikes, scooters, in-line skates or skateboards. 

2. Solution: Public health interventions such as education about the proper use 

of a bicycle helmet, safety campaigns, and environmental changes, have likely 

helped reduce the child injury death rate from bicycle and other wheeled sports. Bicycle helmets can help protect children from head injuries while participating in bicycle and wheeled sports. In fact, bicycle helmets are 88 percent effective in preventing serious brain injury, yet fewer than half of bicycle riders wear one. 

a. Education: In addition to promoting helmet use, advocates and researchers 

recommend creating a comprehensive bicycle safety campaign that includes education about safe riding practices and provides helmets at a discounted cost to those 

in need. Community-based interventions that include making environmental 

changes, educating children about helmets and safe riding practices, and enforcing 

bicycle helmet laws, have proven to increase helmet use and decrease bicycle injuries. 

Environmental changes that make streets safer also protect children when they 

are biking, skateboarding, or skating. A nationwide coalition of diverse members 

and organizations is currently pushing for States, cities and towns to build road networks that include safety improvements. This coalition stated that a recent survey 

found 71 percent of adults walked or rode their bicycles to school as a child, but 

only 17 percent of their own children currently do so. Although decreased biking 

also decreases a child’s risk of injury, the goal is to increase participation in these 

activities among children in a safe way. More children are likely to bike to school 

when there are sidewalks or footpaths, safe street crossings, and when there are enforced school zones of vehicle speed. 

b. Enactment and Enforcement: Legislation requiring helmet use and strict enforcement has positively impacted bicycle helmet use among children. California had 

the first State helmet law, which became effective in 1987. The enactment and enforcement of mandatory helmet legislation for children (in 21 States, the District of 

Columbia and over 150 localities across the United States) has likely contributed 

to the decline in bicycle-related injuries and deaths from 1987 to 2000. 

Various studies have shown bicycle helmet legislation to be effective at increasing 

bicycle helmet use and reducing bicycle-related death and injury among children 

covered under the law. One study showed that in the 5 years following the passage 

of a State-mandatory bicycle helmet law for children ages 13 and under, bicycle-related fatalities decreased by 60 percent. Police enforcement increases the effectiveness of these laws. In addition, eight States and Washington, DC now require children to wear a helmet while participating in a wheeled sport (e.g., scooters, inline 

skates, skateboards). Other States should follow suit. 

Over the years, helmets used by children and required by State and local laws 

have become much more effective. In 1994, Congress required the CPSC to establish 

performance standards for bike helmets. These better engineered helmets have contributed to our success in lowering the injury death rate. 

In addition, the enactment of SAFETEA-LU included the establishment of Safe 

Routes to Schools, a federally funded program designed to make it safer for children 

to walk or bike to school. Through this program and with grant monies, States can 

fix sidewalks, execute traffic-calming and speed-reduction measures, improve pedestrian and bicycle crossings, and conduct public education campaigns to encourage 

children to walk or bike to school. 

C. Poisoning Prevention 

1. Problem: The childhood unintentional poisoning death rate among children 

ages 14 and under declined 42 percent from 1981 to 1987 and has continued to decline by 21 percent since 1987. However, unintentional poisoning is still a serious 

threat to young children. In 2005, an estimated 92 children ages 14 and under died 

from unintentional poisonings. Additionally, in 2006 an estimated—71,649 emergency room visits were for unintentional poisoning injuries to children 14 and 

under. In 2005 nearly 63,000 children under age 5 were treated for unintentional 

medication poisoning. More than 1.2 million unintentional poisonings among children ages 5 and under are reported to U.S. poison control centers. In addition, according to the Centers for Disease Control and Prevention, from 1999–2004, 135 

children ages 14 and under died from unintentional, non-fire related CO poisoning. 

Carbon monoxide is a hidden hazard for children and families. CO is produced 

when any fuel is incompletely burned—potentially resulting in flu-like illnesses, 

22 

such as dizziness, fatigue, headaches, nausea, and irregular breathing. Common 

fuel-burning appliances, like furnaces, stoves, fireplaces, clothes dryers, water heaters, and space heaters can produce lethal amounts of CO under certain conditions. 

Carbon monoxide poisoning mimics other illnesses so it can sometimes be difficult 

to diagnose. CO poisoning symptoms include headache, dizziness, weakness, nausea, 

vomiting, chest pain, confusion, loss of consciousness and death to unborn babies. 

Infants are more susceptible to the effects of CO. Carbon monoxide detectors are essential to have in homes and are effective in preventing deaths from carbon monoxide exposure. 

Lead paint poisoning is an additional danger to children. In children, lead poisoning can cause brain damage, impair mental functioning, retard mental and physical development and reduce attention span. Because the early symptoms of lead 

poisoning are easy to confuse with other illnesses, it is difficult to diagnose lead poisoning without medical testing. Early symptoms may include persistent tiredness, 

irritability, loss of appetite, stomach discomfort, reduced attention span, insomnia, 

and constipation. Failure to treat children in the early stages can cause long-term 

or permanent health damage. 

2. Solution: A multitude of factors have contributed to the reduced number of 

deaths from poisonings, including child-resistant packaging for medications and 

household cleaning products, educational programs, increased accessibility of poisoning prevention information, and treatment/care advances. For unintentional 

medication exposures, manufacturers are being encouraged to further improve container designs, allowing more convenient access for the user, especially seniors, 

while also serving as a barrier to children gaining entry. 

Intensive efforts to reduce lead in consumer products such as gasoline and paint 

have helped to protect children from lead poisoning. However, lead paint continues 

to be an issue in older homes, especially in low-income apartment buildings, where 

children can ingest paint chips or inhale paint dust. Children also can be poisoned 

by lead if they lick their fingers after they interact with products that are coated 

with lead paint. Recently, lead paint in toys has posed a risk to children. Significant 

news coverage and outreach by nonprofits about lead in toys has likely increased 

awareness of this issue. 

a. Education: The Nation’s 70 poison control centers historically operated with 

distinct phone numbers for each center. A big advancement has been the creation 

of a new nationwide toll-free number for poison control centers. The hotline (1–800– 

222–1222) was established through the passage of the Poison Control Center Enhancement and Awareness Act of 2000, a law which originated in the Senate HELP 

Committee with the leadership of Senators Kennedy and DeWine, among others. 

The hotline is available 24 hours a day and 7 days a week to provide assistance 

with poisoning emergencies, questions about a specific poison, or information about 

poison prevention, no matter where the caller is from. 

In addition to emergency response, these centers perform public education, professional education, data collection and referral resources—services which are all supported by the Federal Act. 

b. Enactment and Enforcement: The enactment of laws has protected children 

from unintentional poisoning. The Poison Control Center Enhancement and Awareness Act of 2000 also provided much needed funding to the centers which were on 

the verge of having their doors shut due to budget shortfalls. In addition, the 

issuance of the U.S. Food and Drug Administration regulation requiring iron-containing products to carry a warning about the acute poisoning risk to children has 

been important in protecting kids from poisoning. 

The Federal Government has also banned paint that contains a certain amount 

of lead. The ban protects children from lead poisoning that can occur by ingesting 

paint chips or inhaling paint dust. The regulation also includes toys or other children’s products as well as furniture with lead paint. 

The Poison Prevention Packaging Act of 1970, administered by the CPSC, mandated child resistant packaging for hazardous products such as drugs, certain household cleaners, and some residential use portable fuels. The purpose of the act is to 

protect children under age 5 from poisonings and deaths that occur when they open 

containers of hazardous products, and eat or drink the contents. The act has been 

credited with reducing prescription medication deaths in children less than 4 years 

of age by 45 percent from 1974 to 1992. 

In addition, 14 States and some local jurisdictions have passed legislation requiring the use of carbon monoxide detectors in some homes. However, most State carbon monoxide detector laws only apply to newly constructed residences, reinforcing 

the need for legislation that applies to all homes. 

23 

D. Fire and Burn Safety 

1. Problem: The unintentional fire/burn death rate among children ages 14 and 

under declined by 68 percent from 1987 to 2005, yet fire and burn injury remains 

the fifth leading cause of child unintentional injury-related death. In 2005, an estimated 467 children ages 14 and under died from unintentional fire/burn injuries. 

Fire and flames accounted for 460, or 99 percent, of these deaths. Additionally, in 

2006 an estimated 98,760 emergency room visits were for unintentional fire/burn injuries to children ages 14 and under including scald, thermal, chemical and electrical burns. Scald burns, caused by hot liquids or steam, are more common types 

of burn-related injuries among young children, compared to contact burns, caused 

by direct contact with fire, which is more prevalent among older children. 

The majority of scald burns children experience, especially in ages 6 months to 

2 years, are from hot foods and liquids spilled in the kitchen or wherever food is 

prepared and served. Hot tap water accounts for nearly 1 in 4 of all scald burns 

among children and is associated with more deaths and hospitalizations than any 

other hot liquid burns. Because younger children have thinner skin, their skin 

burns at lower temperatures and more quickly than adult skin does. 

2. Solution: There are many factors likely involved in the downward trend of the 

child death rate from fire and burn injuries. Most home fires started by children 

begin with playing with lighters or matches and the most common items ignited are 

mattresses, bedding, clothing, upholstered furniture, trash or papers. Fortunately, 

there has been a decline in the number of fires set by children playing with lighters 

and matches, most likely as a result of lighters being subject to a consumer product 

safety standard that requires them to be child resistant. However, parents still need 

to be educated to store matches and lighters out of children’s reach, preferably in 

a locked cabinet. 

a. Education: In addition, smoke alarms, which cut the chances of dying in a residential fire nearly in half, have been promoted as an invaluable tool for preventing 

fire and burn injury. According to data from the National Fire Incident Reporting 

System (NFIRS) and the National Fire Protection Association’s (NFPA) annual fire 

department experience survey, 96 percent of U.S. homes report having at least one 

smoke alarm. However, 47 percent of fire deaths in one- and two-family dwellings 

and 15 percent of apartment fire deaths resulted from fires with no smoke alarms 

present, reinforcing the need for continued promotion of smoke alarms in homes. 

Another factor involved in the downward trend of reduced fire and burn-related 

deaths include intensive public education campaigns by Federal agencies such as 

the CPSC and U.S. Fire Administration, non-profit advocacy groups like Safe Kids, 

the National Fire Protection Association, the Home Safety Council and the thousands of committed fire departments that promote residential fire safety and burn 

prevention. Efforts to educate parents about the importance of checking smoke 

alarm batteries monthly as well as grassroots activities that distribute smoke 

alarms have made a difference. These efforts must be continued, with the help of 

the Federal Government, since most of the deaths and injuries to children happen 

in residential fires in homes with no smoke alarms. 

Methods to reduce scald burns include lowering hot water temperatures to 120 

degrees and keeping hot fluids and liquids away from children, especially when 

cooking. Educational efforts around these messages to parents may have contributed 

to a decline in burn-related deaths. 

b. Enactment and Enforcement: The 1994 child-resistant lighter standard established by the CPSC and the agency’s regulations requiring that children’s 

sleepwear be flame resistant and self-extinguish if a flame causes it to catch fire 

have reduced fire-related deaths. Since the lighter standard has been in effect, the 

number of child-play lighter fires has declined 58 percent and the number of deaths 

and injuries associated with these fires has declined by 31 percent and 26 percent, 

respectively. 

For smoke alarms, all States and the District of Columbia have laws that require 

smoke alarms to be used in both new and existing dwellings. 

E. Drowning Prevention 

1. Problem: Although the childhood drowning death rate declined by 49 percent 

from 1987 to 2005, fatal drowning remains the second-leading cause of unintentional injury-related death for children ages 1 to 14 years. In 2005, 810 children 

ages 14 and under died from unintentional drowning, and in 2006, an estimated 

3,771 emergency room visits were for unintentional drowning injuries to children 

ages 14 and under. As many as 20 percent of near-drowning survivors suffer severe, 

permanent neurological disability. Infants less than 1-year-old drown in bathtubs, 

buckets, or toilets most often, while the majority of child drownings between ages 

24 

1 to 4 occur in residential swimming pools. Older children drown more often in open 

bodies of water. 

In swimming pools and spas, the suction from drain outlets is strong enough to 

cause entrapment of hair or body parts, and children cannot free themselves. From 

1985 to 2004, at least 33 children ages 14 and under died as a result of entrapment 

in a pool or spa drain, and nearly 100 children ages 14 and under were injured. 

However, because entrapment is generally a little-known risk for drowning, it is 

possible that many drowning deaths have not been classified as entrapment and as 

a result, the number of fatalities could be much higher than reported. 

2. Solution: Many factors have contributed to the decrease in the childhood 

drowning rate, including water safety public education efforts, the passage of critical 

pool/spa and boating safety laws and the decreased use of alcohol in and around 

water. Advances in emergency medical services and increased training of the public 

in cardiopulmonary resuscitation (CPR) for drowning incidents also have likely contributed to the downward trend. 

a. Education: Despite successes in reducing the death rate from drowning, there 

is still much that can be done to protect children. Nearly 9 out of 10 fatal drowning 

events occur during a brief lapse in supervision. Most children who drown in swimming pools were last seen in the home, had been missing from sight for less than 

5 minutes and were in the care of one or both parents at the time of the drowning. 

Very young children can drown when they wander outside and fall into their own 

or other’s backyard pools. These research results emphasize the need for pool fencing, swimming lessons for children, and active supervision by parents and caregivers. The installation and proper use of four-sided fencing could prevent 50 to 90 

percent of residential swimming pool drownings and near drownings of children. 

A specific type of pool/spa drowning known as entrapment cannot be prevented 

with supervision as the force of the drain’s suction is too strong for many adults 

to remove a child. Entrapments can be prevented by using proper devices, such as 

anti-entrapment drain covers, a safety vacuum release system, and a multiple drain 

or no-drain system. 

For children ages 10 to 14, recreational or open water settings (such as lakes, rivers, or the ocean) pose a higher risk representing the majority of drownings for this 

age group. From 1999 to 2003, it is estimated that 85 percent of boating-related 

drownings could have been prevented if the victim had been wearing a life jacket, 

however a Safe Kids 2007 Parent Survey showed that only 76 percent of parents 

consistently have their child wear a life jacket when they are in or near a lake, river 

or ocean. These statistics emphasize the need for educating parents and caregivers 

on the importance of consistent use of life jackets when children are boating or playing in or near open bodies of water. 

Life jacket loaner stations are an effective way for communities to provide education and safety devices to parents and children. The stations consist of life-jacket 

loaner boards from which families can borrow a life jacket for their child before 

heading out on the open water. In Alaska, 75 percent of children under 18 used life 

jackets at loaner sites compared to 50 percent at non-loaner sites and have reported 

12 lives saved. 

b. Enactment and Enforcement: There have been laws passed in many States 

to protect children from unintentional drowning. Ten States have safety laws requiring fencing around residential swimming pools and many local jurisdictions also 

have fencing or barrier ordinances. Five States have laws designed to prevent entrapment-related incidents for residential swimming pools. These generally consist 

of requiring anti-entrapment safeguards, such as the installation of drain covers or 

multiple drains. The Virginia Graeme Baker Pool and Spa Safety Act, a Federal law 

passed in December 2007, provides an incentive for States to pass comprehensive 

laws requiring safeguards for pools and spas, such as barriers/fences and antientrapment devices. The law also requires the establishment of a safety standard 

for anti-entrapment drain covers; public pools and spas to be equipped with antientrapment drain covers and other layers of protection, such as safety vacuum release systems; and a Federal Government-implemented national drowning prevention education program. 

Forty-seven States and the District of Columbia have enacted boating safety laws 

that require children to wear life jackets while participating in recreational boating 

and in 2002, the U.S. Coast Guard issued a rule requiring children under 13 wear 

life jackets while aboard recreational vessels in Coast Guard waters. 

IV. SAFE KIDS USA’S CALL TO ACTION

Despite the reduction in the child injury death rate, more work still needs to be 

done in order to address the leading killer of children ages 1–14 in this country. 

25 

Safe Kids USA is calling on national and State governmental leaders to recognize 

that accidental injury is the #1 threat to the Nation’s children, and in response, to 

marshal a multi-faceted effort (similar to what the Nation has done to address 

drunk driving and smoking cessation) to eliminate this serious public health threat. 

A. Federal Efforts Needed 

Specifically, Safe Kids is urging the Federal Government to implement a number 

of steps to keep kids safe: 

1. Congress and the President should continue and increase efforts to modernize 

the operations and facilities of the U.S. Consumer Product Safety Commission 

(CPSC) so that it can better fulfill its critical mission of protecting consumers, especially children, from dangerous products. This includes swift passage and enactment 

of the CPSC’s pending reauthorization legislation (H.R. 4040/S. 2663). 

2. Congress and the President should target increased funding to the several Federal agency programs charged with promoting and improving child safety. These include programs housed at agencies, such as the National Highway Traffic Safety Administration (NHTSA), the United States Fire Administration (USFA) and the National Center for Injury Prevention and Control (NCIPC) at the Centers for Disease 

Control (CDC). 

3. Congress should continue its aggressive oversight of the Federal agencies 

charged with protecting children from unintentional injury to ensure each agency 

is properly meeting its mission. 

4. Congress and the President should support full funding to the programs recently authorized by the Virginia Graeme Baker Pool and Spa Safety Act (P.L. 110– 

140). This would allow the CPSC to properly and fully implement the State law advocacy grant program that is designed to motivate States to pass or improve pool 

and spa safety laws by requiring ‘‘layers of protection’’ that prevent drowning and 

entrapments (i.e., four-sided isolation fencing, anti-entrapment drain covers, safety 

vacuum release systems, among other safety devices). Congress and the President 

should also provide the necessary funds to implement the critical pool and spa safety education program required by the law. 

5. Congress and the President should fully fund, and Federal agencies should continue to support, incentive grants programs that are designed to encourage States 

to pass child safety laws, such as primary safety belt enforcement, booster seat and 

pool/spa safety legislation. 

6. Congress and the President should, through existing programs and the creation 

of new authorities, ensure that life-saving child safety devices (car seats, carbon 

monoxide detectors, smoke alarms, pool/spa anti-entrapment drain covers, for example) are available at no cost (or low cost) to disadvantaged families that could not 

otherwise afford them. 

7. Congress, Federal agencies and injury prevention stakeholders should work together to improve consumer product recall effectiveness so that dangerous products 

are quickly removed from retail store shelves, homes, day care centers and re-sale 

shops. 

8. The U.S. Surgeon General, America’s chief health educator, should focus the 

Nation’s attention on childhood accidental injury by issuing an official public health 

report on unintentional injuries and deaths and how, collectively, we can prevent 

them. This report should be a catalyst to generate a major public health initiative 

in the Office of the U.S. Surgeon General. 

B. State Efforts Needed 

Safe Kids also believes that there is a role for State government officials to promote proper child safety practices: 

1. Safe Kids calls on State legislatures and governors to enact: 

a. Laws that require all children to be appropriately buckled in a child safety seat 

(infant seat, forward facing child safety seat or booster seat) or seat belt in the back 

seat of motor vehicles; and 

b. Laws that make it unlawful to leave a child unattended in a motor vehicle even 

for a short period of time. 

2. State legislatures should address bike crashes by passing or improving child 

helmet use laws in all 50 States for all wheeled activities (i.e., bicycles, scooters, 

skateboards and in-line skates). 

3. State legislatures should address carbon monoxide poisoning by passing carbon 

monoxide detector use laws in all 50 States that require detectors in all residences, 

day care centers, hotels/motels and schools. 

*Please note that the penalties for violations of these safety device use laws (items 

1–3) should be high enough to provide an economic disincentive for non-compliance. 

26 

4. State governors and legislatures should ensure that their respective State public health agencies have adequate funding streams to support the country’s injury 

prevention departments. For the last several years, funding has been reduced for 

State agencies to address unintentional injury prevention. An adequately funded 

State public health agency is the cornerstone of a State government’s commitment 

to preventing accidental childhood injury. 

V. CONCLUSION

As childhood unintentional injuries and deaths still exist and can be prevented, 

parents, caregivers, State and Federal policymakers, and communities must make 

children’s safety a priority. Safe Kids commends Chairman Kennedy and Ranking 

Member Enzi, along with the other members of this committee, for their support 

of child safety and safer environments for children. We look forward to working with 

this committee on any efforts designed to protect children from accidental injury 

and death. 

Senator DODD. Terrific. Great work. Good. 

Justin, welcome. 

STATEMENT OF JUSTIN BRUNS, STUDENT, THE BOYS LATIN 

SCHOOL OF MARYLAND, BALTIMORE, MD 

Mr. BRUNS. Good morning. My story starts, I was in 

Breckenridge with our friends the Mulroys. Shawn and I woke up 

early one morning, and we went to go get our lift tickets for the 

day. It was a beautiful day, and everything was going great. We 

were doing the terrain park all day, no problem. 

So our last run of the day, we decided that we wanted my dad 

to film us so we could put it on YouTube or something. So we were 

all tired, and it probably wasn’t a good idea to do one more run. 

We did the first two rails fine, and the last rail was the kinked 

rail, which is one of the toughest rails there. When you’re going up 

to a kinked rail, you have to be leaning forward, and I was leaning 

back, and the board slipped out from under me, and I nailed my 

head on the packed snow. 

I got knocked unconscious and woke up a few minutes later with 

all of the people around me, not really sure what was going on. 

They took me to the hospital, and they found trace blood in the left 

side of my brain. I was in the hospital for 3 days, not really feeling 

any pain because I was on morphine and all of these painkillers, 

luckily. 

But when I got out, all I could have was Tylenol, and I had headaches for at least 21⁄2 weeks after, and it was probably the worst 

couple weeks of my life. The pain was crazy, and in school, I only 

could go 2 to 4 hours a day because the doctor said the more you 

concentrate, the worse you can make the injury. 

So that was hard catching up. But the teachers, luckily, I have 

a good relationship with them, and they made it really easy for me 

to get back. My grades didn’t drop too much. So that was good. 

Excuse me, I was out of sports for 8 weeks and anything active. 

I am an athlete, and I like to go full all the time. So it was hard 

to stop doing that for 8 weeks. 

Luckily, I am back now, and I haven’t had a headache or anything in at least 5 weeks, or any symptoms. So I am happy I was 

wearing a helmet because it saved my life. 

[The prepared statement of Mr. Bruns follows:] 

27 

PREPARED STATEMENT OF JUSTIN BRUNS

Good Morning, my name is Justin Bruns. I am an eighth grader from Baltimore, 

MD. I want to thank Chairman Kennedy, Senator Enzi and other distinguished 

members of the HELP Committee for inviting me to testify about this important 

topic and tell my story of how a helmet saved my life in a snowboarding accident. 

This past winter my family and I went to Colorado for President’s Day weekend. 

We went to visit friends and family and go skiing/snowboarding. On Saturday, February 16, I got up early to go snowboarding with my friend Shawn. We were having 

a great day and the runs were amazing. As the end of the day neared we decided 

to film ourselves while boarding in the terrain park. My dad came along and offered 

to film the two of us. It was to be the last run of the day on probably the toughest 

rail of the day. It was a kinked downhill rail and it was very long. It was a little 

intimidating and I was a little freaked out. I guess I wasn’t leaning forward enough 

and the board slipped out from under me and I nailed my head on the snow. 

I don’t remember the fall or going up the rail for that matter. A few minutes later 

I came to and I was on a backboard with a neckbrace on being taken down the 

mountain by ski patrol. They took me to the local Medic Center. They did a CT scan 

and found traces of blood. The doctors decided I needed to go to the hospital in Denver—St. Anthony’s. I was admitted to the Trauma unit. I had to stay in the unit 

for 3 days and 2 nights. I was happy when I finally got released Monday afternoon. 

I went back to Baltimore the next day—Tuesday. My parents were really worried 

about how I was doing/feeling. I had headaches and was tired for the next couple 

of weeks. I was only allowed to take Tylenol to relieve the pain. My parents told 

my teachers about my accident. School was helpful and accommodating about how 

I was feeling. I had trouble with reading and taking notes. Doing both of these almost always gave me a headache in the first couple of weeks after the concussion. 

I had to see a couple of doctors over the next 4–5 weeks. I had to stay out of all 

sports until my doctor in Baltimore said it was okay to play sports. After 71⁄2 weeks 

I was finally told it was okay to play lacrosse. This was the worst time of my life 

but I am sure glad I had my helmet on. I can’t imagine what things would be like 

for me if I hadn’t. 

Senator DODD. Terrific. Well, that is great. Thank you very 

much. 

The CHAIRMAN. What do you think would have happened to you 

if you weren’t wearing your helmet? 

Mr. BRUNS. I probably wouldn’t be the same person, or the doctor 

said I could have died. 

The CHAIRMAN. Have you always worn your helmet? 

Mr. BRUNS. I have. My parents are ‘‘helmet Nazis.’’ 

[Laughter.] 

Senator DODD. Clean up that record here. 

[Laughter.] 

The CHAIRMAN. Good for them, I guess. OK, thanks. 

Do most of your friends wear helmets? 

Mr. BRUNS. No. Only one of them, who I just met like this school 

year. But besides that, none of my other friends wear them. 

The CHAIRMAN. What do they say? It is not cool, or what do 

they—— 

Mr. BRUNS. They don’t really say anything to me, but I just don’t 

like wearing one, I guess. I feel kind of weird wearing one. But now 

I do because I know what can happen. 

The CHAIRMAN. Do you feel now, do you ever suggest to any of 

these other kids that they might think about it, too? 

Mr. BRUNS. I don’t want to nag them about it, but I told them 

what happened, and I think they are a little more afraid. 

The CHAIRMAN. There you go. That is a nice way of doing it, too. 

You get the example that you set, and they see that you are having 

a good time and a safe time. It may make a difference to them. It 

certainly does. 

28 

We have your mom here. 

Mr. BRUNS. Yes. 

The CHAIRMAN. We want to thank you. You wrote a statement 

as well, and we are going to put that in the record. It is a wonderful, wonderful statement. Very, very appreciative of spelling this 

out. It was very powerful and very moving, and we are very, very 

grateful. It will be very helpful to the people. 

[The prepared statement of Ms. Bruns follows:] 

STATEMENT OF KATHLEEN BRUNS, MOTHER OF JUSTIN BRUNS

On February 16 of this year my husband and I experienced a situation I hope 

very few parents ever go through. Our 14-year-old son, Justin, had a snowboarding 

accident while boarding with his father and his friend Shawn. Justin took a hard 

spill off of a rail in a terrain park while boarding in Breckenridge, CO. Bob and 

I are adamant about helmet use and thankfully for Justin, he had his on. 

Justin suffered a stage 3 concussion. This means he was knocked unconscious and 

had some memory loss. In Justin’s case it was about 3–5 minutes. This stage is the 

highest degree of severity. As a result of this injury Justin had to spend 2 nights 

in the hospital, the first being spent in the trauma unit. The hospital performed CT 

scans that showed blood, which is one of the reasons they wanted to keep him for 

2 nights. The speech pathologist also gave Justin a cognitive test to test his brain 

function. The first time he took this test he missed passing by just a few points. 

The hospital decided to follow up with a second test Monday morning, which Justin 

passed. An MRI was also done Monday. Dr. Nichols, the Neurological Surgeon informed us it was clear and Justin was discharged in the early afternoon. 

Justin was told he would have headaches for some time and that he should take 

it easy. He had to be honest with how he was feeling since there were no clear outward signs of injury. Doctors had told him, if you had broken a bone everyone would 

immediately know because you would have a cast. In his case there was no outward 

sign to let others know what had happened. 

We contacted Justin’s teachers at school to let them know what had happened. 

We made it clear to them the symptoms that would be troubling Justin. The biggest 

indicator in his recovery was going to be how he was doing cognitively. Was he able 

to read, study, complete homework and class assignments and take tests. The first 

couple of weeks after the concussion Justin only went to school for about 41⁄2 hrs 

because he tired very easily and developed regular headaches. He was given some 

leeway by teachers, who allowed him to skip on some of the class work. Within 

about 3 weeks after the concussion Justin was reporting that he was headache free. 

By the end of the third week Justin was able to start exerting some energy on the 

elliptical at home for 15–20 minutes. Dr. Andy Tucker, our doctor in Baltimore, allowed Justin to slowly increase his workouts over the next 3 weeks. On the school/ 

cognitive front, by the 6th week after the accident Justin was finally caught up on 

all assignments and tests. 

During the time, immediately after the head trauma, Justin was not allowed to 

participate in any physical activities. He was not even allowed to be in the same 

vicinity as kids who were playing catch with a football, playing basketball, or roughhousing in any way. He was not allowed to risk having any kind of trauma to his 

head, so soon after the accident, or it could have very disastrous repercussions to 

the level of his brain function. As a member of 2 lacrosse teams he was not even 

to be near the field to watch his teams practice for fear of an errant ball coming 

his way and hitting him in the head. 

It took 71⁄2 weeks for Justin to be cleared for full contact physical activity. This 

seemed like much longer to all of us and was very difficult to get through. Justin 

will continue with the activities he has always done, but with a greater understanding of how a $70 helmet kept him ‘‘the Justin we know and love.’’ His helmet 

truly saved his life! 

The CHAIRMAN. OK. Meri-K, please. 

STATEMENT OF MERI-K APPY, PRESIDENT, HOME SAFETY 

COUNCIL, WASHINGTON, DC 

Ms. APPY. Good morning. I feel very fortunate. I grew up in Connecticut. My children were born and raised in Massachusetts. 

The CHAIRMAN. There you go. 

29 

Ms. APPY. Henry will graduate from U-Mass next month. My 

dear oldest brother lives in Georgia. So, I feel—How do you like 

that, Alan? 

[Laughter.] 

Thank you so much for letting me be here today, and congratulations to Safe Kids for their 20 years of service to our shared purpose. 

I am Meri-K Appy, President of the nonprofit Home Safety Council. HSC’s mission is to prevent accidental injuries in and around 

the home. This is a serious public health problem, resulting in 

nearly 20,000 deaths and more than 21 million medical visits in 

America every year. 

Far too many of these tragic events involve children, and we believe, as does Safe Kids, almost all of them could be prevented. Our 

dream is to help kids learn safety lessons today so they grow up 

being safer parents and caregivers in the future. 

We make safety fun, hands on, and high impact. For example, 

our Great Safety Adventure, or GSA, is an incredible field trip on 

wheels. We have two 1,000-square foot vehicles that travel across 

America, visiting schools and communities free of charge at events 

throughout the year. More than 1 million kids, family members, 

and teachers have experienced GSA with proven results. 

Our Safety Ranger Classroom program—Senator Isakson, I loved 

what you said earlier—developed through a partnership with 

Weekly Reader, have reached more than 75 million teachers, students, and family members. Our method is to engage teachers, 

local safety experts, and parents to help children develop positive 

safety habits. 

CodeRedRover.org is the Home Safety Council’s educational Web 

site for kids, and it was recognized by USA Today as an Education 

Best Bet Award winner. 

The Home Safety Council loves teaching children about safety. 

But when you think about it, family safety is really an adult responsibility. Unfortunately, many parents and caregivers are missing this message. HSC is convinced that part of the problem lies 

in how we have all been communicating that message. 

Here is a shocking statistic I would like to share with you. More 

than 93 million adults in America read at or below basic levels. 

This has huge implications when we think about educating the 

caregivers about how to take care of their children. 

The Home Safety Council and our partner, Pro Literacy Worldwide, has launched an award-winning home safety literacy project 

in 2005. It teams up local literacy tutors and teachers with firefighters and other safety experts. They use our specially designed 

materials to teach basic safety lessons and even install devices 

such as smoke alarms as the adults are learning to read in 

English. So it is taking care of two huge societal issues at the same 

time. 

I would like to thank you so much. We were thrilled to be included in this August lineup this morning. We are thrilled to be 

contributing to the safety of our children, particularly in the place 

we all would like them to be safest—their homes. 

[The prepared statement of Ms. Appy follows:] 

30 

PREPARED STATEMENT OF MERI-K APPY

Chairman Kennedy, Ranking Member Enzi, and members of the committee, I very 

much appreciate the opportunity to share my comments on keeping children safe 

by preventing childhood injuries. I am Meri-K Appy, president of the Home Safety 

Council. 

Good morning and congratulations to SAFE KIDS for their 20 years of service to 

the safety of our Nation’s children. 

The Home Safety Council’s mission is to prevent accidents in and around the 

home. This is a serious problem, resulting in nearly 20,000 deaths and 21 million 

medical visits on average each year in America. Far too many of these tragic events 

involve children, and most can be prevented. 

Our dream is to help kids learn injury prevention lessons early in life so they can 

grow into a future generation of safer adults and caregivers. We make safety fun, 

hands-on, and high-impact. For example: 

Our Great Safety Adventure (GSA) is an incredible ‘‘safety field trip on 

wheels.’’ Two 1,000-square foot traveling exhibits visit schools and community 

events across America. More than 1 million kids and family members have toured 

GSA since the tour began in 1999, with proven success. 

HSC’s ‘‘Safety Ranger’’ classroom programs, developed through a partnership 

with Weekly Reader, have reached more than 75 million teachers, students, and 

family members with documented results. We engage teachers, local safety partners, and parents to help children develop positive safety habits that will last a lifetime. 

CodeRedRover.org, the Home Safety Council’s Web site for children, is an interactive, educational site offering games, activities, home safety checklists, and tips 

for children and the adults who care for them. The site was recognized by USA 

Today as an ‘‘Education Best Bet’’ award winner. 

The Home Safety Council loves teaching children about safety. But it’s really the 

responsibility of adults to create a safe environment for our kids. HSC learned 

something that frankly shocked us: more than 93 million adults in America 

read at or below basic levels. 

So HSC and our partner, ProLiteracy Worldwide, launched the Home Safety Literacy Project. This program teams local literacy tutors and teachers with firefighters and emergency managers who use our specially-designed educational materials to teach basic safety lessons and even install free smoke alarms. 

These are just a few of the programs of the Home Safety Council we’ve implemented to help prevent injuries to our children. 

Thank you for inviting me to be here today. On behalf of the Home Safety Council, here’s to another 20 years of progress for SAFE KIDS and all of us in the injury 

prevention world. 

The CHAIRMAN. Great. 

Ms. Williams. 

STATEMENT OF AMBER N. WILLIAMS, EXECUTIVE DIRECTOR, 

STATE AND TERRITORIAL INJURY PREVENTION DIRECTORS, 

ATLANTA, GA 

Ms. WILLIAMS. Thank you, Mr. Chairman, for the opportunity to 

be here today. 

My name is Amber Williams, and I am the Executive Director of 

the State and Territorial Injury Prevention Directors Association, 

which is also known as STIPDA. We are based out of Atlanta, but 

we represent State public health injury and violence prevention 

programs across the United States. 

We are also pleased to celebrate with our colleagues and partners 

the tremendous advances that have been made in preventing unintentional injuries to children, or what are commonly referred to as 

accidents. And I am pleased to tell you about the role that State 

health departments have played in those reductions. 

They have, first, helped us to truly understand what has been 

going on, how children have been injured, who is at risk for certain 

31 

injury types, and have been involved in developing effective interventions and disseminating those widely to those at the local level. 

One example of State leadership in this area has been in preventing residential fire-related injuries and deaths. In the State of 

Oklahoma, the injury prevention program identified an area that 

had a much higher than average rate of fire-related injury death. 

They went in, did a smoke alarm distribution program and educated the residents and, following that, saw an 81 percent decrease 

in the rate of residential injury and fire-related death. 

That is incredible. At the same time in Oklahoma, there was only 

a 7 percent decline. 

The CHAIRMAN. Can you give that to me again? I missed the significance. 

Ms. WILLIAMS. They saw an 81 percent decline in residential injury/fire-related deaths, while in the rest of Oklahoma there was 

only a 7 percent decline. 

The CHAIRMAN. What is that, why—what is that attributed to? 

Ms. WILLIAMS. They distributed and installed smoke alarms. 

The CHAIRMAN. Smoke alarms, good. 

Ms. WILLIAMS. This program has since been replicated across the 

United States with support from the Centers for Disease Control, 

and we have had similar successes, and the program has been credited with saving 1,500 lives. We have seen similar progress, obviously, in the areas of child passenger safety and bicycle safety. 

Today, our economy is uncertain. We are facing growing 

healthcare rates—healthcare crisis, and the cost of injuries are one 

of the top 10 most expensive medical conditions, along with cancer 

and heart disease. But injuries are predictable, they are preventable, and our prevention efforts are cost-effective. Most of all, children deserve our help in keeping them safe. 

So I thank you again for the opportunity to be here, and I look 

forward to any questions you may have. 

[The prepared statement of Ms. Williams follows:] 

PREPARED STATEMENT OF AMBER N. WILLIAMS

SUMMARY

Thank you, Mr. Chairman, for the opportunity to participate in this hearing on 

childhood injury prevention along with our colleagues and partners at the National 

Center for Injury Prevention and Control at the Centers for Disease Control and 

Prevention, Safe Kids Worldwide, and the Home Safety Council. My name is Amber 

Williams and I am the Executive Director of the State and Territorial Injury Prevention Directors Association, also known as STIPDA. STIPDA is the only membership association representing State public health injury and violence prevention programs and has more than 300 members who are professionals working at the State, 

territorial and local levels to prevent injuries and violence. During this hearing, I 

will share examples of how State public health departments have contributed to the 

declines we have seen in deaths due to unintentional injuries among America’s children, as well as offer our perspective on future opportunities to keep our children 

safe. 

If those of us working in the field of injury and violence prevention had been 

asked to share our progress regarding childhood injury prevention 20 years ago, we 

would have only been able to tell you that we know children were dying unnecessarily in car crashes, falling off bikes, in residential fires and other unintentional 

or ‘‘accidental’’ ways. At the time, however, we didn’t understand enough about the 

problem. Fortunately, today my colleagues and I can sit before you and share the 

tremendous progress we have made collectively in reducing deaths related to unintentional childhood injuries. This progress is partly through the efforts of State 

health departments which have helped us better understand how children are being 

32 

injured, what children are at greatest risk for injuries, what interventions are best 

to prevent these injuries, and ensure the widespread adoption of these interventions. State health departments have also been strong allies of Safe Kids coalitions, 

and often serve as the lead agency for State coalitions. Through these relationships, 

State health departments provide data, technical assistance, training, and often financial and in-kind support. 

Today I would like to share with you some of the specific ways State injury and 

violence prevention programs are preventing unintentional childhood injuries. The 

Georgia State Injury and Violence Prevention Program has been able to document 

at least 56 lives potentially saved since 2006 through a child safety seat distribution 

program and unique partnership with the Emergency Medical Services (EMS). The 

New York Injury and Violence Prevention Program was able to document reductions 

in bicycle-related injuries and traumatic brain injuries following the implementation 

of a statewide comprehensive bicycle helmet program that culminated in a bicycle 

helmet law passing easily through the State legislature. Finally, the Oklahoma Injury Prevention Service was able to identify a high-risk area in Oklahoma City for 

house-related fire injuries. In response, they conducted a smoke alarm distribution 

program. After the program, Oklahoma saw an 81 percent decline in residential fire 

injury-related deaths in the target population while rates declined only 7 percent 

in the rest of Oklahoma during the same time period. 

As we look to the future, we see that so many childhood health issues are interrelated and that really what truly is needed is an investment in healthy communities. In healthy communities, children can walk to school without fear of being hit 

by a car, or becoming the target of bullies or other violence; they have access to safe 

equipment that will allow them to participate in sports and other recreational activities while being protected from a variety of injuries, including head and brain 

injuries. We need to expand our focus to building communities where American families can live active, safe and healthy lives. 

ABOUT STIPDA

Good morning Mr. Chairman, Senator Enzi, and other distinguished members of 

the committee. It is my pleasure to appear before you as the Executive Director of 

the State and Territorial Injury Prevention Directors Association (STIPDA). We appreciate the opportunity to participate in this hearing and to share the stories of 

the success we’ve seen in preventing unintentional injuries and deaths among America’s children from the perspective of State public health injury and violence prevention programs. Formed in 1992, STIPDA is the only organization that represents 

public health injury prevention professionals in the United States and has a membership of more than 300 professionals committed to strengthening the ability of 

State, territorial and local health departments to reduce death and disability associated with injuries and violence. To accomplish this, STIPDA engages in activities 

to increase awareness of injury, including violence, as a public health problem; provides training and technical assistance; supports policies designed to advance injury 

and violence prevention; and works to enhance the capacity of public health agencies to conduct injuries and violence. 

THE ROLE OF STATE PUBLIC HEALTH INJURY AND VIOLENCE PREVENTION PROGRAMS IN

REDUCING CHILDHOOD UNINTENTIONAL INJURIES AND DEATHS

State governments have a responsibility to protect the public’s health and safety. 

A comprehensive injury and violence prevention program at the State health department provides focus and direction, coordinates and finds common ground among the 

many prevention partners, and makes the best use of limited injury and violence 

prevention resources. State public health injury and violence prevention programs 

apply the public health approach to help understand, predict and prevent injuries 

and use a population-based approach to extend the benefits of prevention beyond individuals. 

State injury and violence prevention programs use surveillance data to determine 

how injuries occur, who is most at risk, and what other factors contribute to whether or not an individual will be injured and to what degree. We have also come a 

long way in our understanding of how to prevent injuries and look beyond just the 

personal behaviors that lead to an injury to also investigate to the products that 

people use, the physical and social environment, and the organizational and governmental policies that affect the safety of our environments. 

State programs have also contributed to the dissemination of effective practices 

through partnerships with injury control research centers, local health departments, 

local coalitions and other organizations. State programs provide training and technical assistance to local injury prevention efforts every day. 

33 

Although we have seen successes in many areas of childhood unintentional injury 

prevention, three areas that stand out include improvements in child passenger 

safety, bike and wheeled sports injury prevention, and residential fire-related injury 

prevention. 

CHILD PASSENGER SAFETY

When you get into your car, do you automatically secure your children (or grandchildren) in car seats before buckling up yourself ? Chances are, like most Americans, you do. However, just a few short decades ago this wasn’t the case. Today it 

is more the exception than the rule for Americans not to buckle up—or to not use 

car seats for their children. In fact, when a celebrity recently drove with her infant 

in her lap, the public was outraged. Motor vehicle crashes are the leading cause of 

death for children and by putting a child in an appropriate restraint—whether it’s 

a car seat turned to the rear of the vehicle for an infant or a belt-positioning booster 

seat for a young child—you can reduce serious and fatal injuries by more than half. 

However, there is still work that must be done to ensure everyone is restrained 

properly for every ride in the car and that car seats and boosters seats are used 

correctly. 

It’s evident that collectively, we have made incredible strides in reducing the 

number of children who die or are injured in car crashes by increasing the number 

of children who are restrained properly in car seats until they are able to properly 

fit in a car’s seat belt. In fact deaths have decreased 32 percent during the last two 

decades. This success have been achieved using a number of strategies including: 

by strengthening laws that require children to be properly restrained and enforcing 

those laws, training child passenger safety technicians to work with parents and 

help them to use car seats properly, distributing car seats to low-income families, 

and increasing awareness of the need for car seats. We have changed the ‘‘norm’’ 

for riding in cars so that today there is an outcry when anyone is found driving with 

infants in their laps or turning their child’s car seat to face the front of the car before the child’s first birthday. 

State injury and violence prevention programs are often involved in efforts to 

raise awareness, distribute car seats, conduct car seat checkpoints, and strengthen 

organizational policies: 

• Over the last several years, the Georgia Injury and Violence Prevention Program has conducted a car seat distribution program to low-income families in 109 

of the 159 counties in Georgia in partnership with local health departments, Safe 

Kids coalitions, and other organizations. Each seat distributed through the program 

has a teddy bear sticker that EMS personnel look for on the scene of car crashes. 

The State health department has documented at least 56 potential lives saved 

through this program so far between 2006 and March 2008. 

• In New York State, the Bureau of Injury Prevention conducted a program called 

‘‘Gimme a Boost’’ in three counties to determine the barriers to booster seat use and 

how to best increase use among 4–8 year olds. Through interviews with parents and 

guardians of 4–8 year olds, the Bureau was able to determine that reasons for nonuse included: New York State law does not require use by 4–8 year olds, the belief 

that their child was too big or old for a booster seat, lack of knowledge about the 

need for booster seats and the injury risks associated with only using safety belts, 

and child resistance to using a booster seat. Booster seat distribution, public awareness campaigns, and school-based programs were implemented in the three counties 

to determine which combination(s) might be associated with increase booster seat 

use. Comparison to a control county that received none of the interventions found 

that the combination of all three interventions led to the largest increase in booster 

seat use from 21 percent to 53 percent. Using this information, as well as injury 

hospitalization and death data, communities educated their policymakers in support 

of legislation requiring the use of booster seats for children 4–6 years of age. The 

booster seat law was enacted in 2005. 

• The Michigan Injury Prevention Program was able to identify that because the 

child passenger safety law did not include older children, parents were not using 

booster seats. Through a targeted educational effort, the Michigan Injury Prevention 

Program was able to demonstrate an increase in booster seat usage by 300 percent. 

These efforts and many others have translated into the support needed to strengthen the child passenger safety law to include older children and was signed by the 

Governor just this year. In fact, there are four new booster seat laws this year— 

bringing the total to 43 States—which now protect older children in some form 

through child passenger safety laws. 

• The Utah Department of Health conducted a statewide program to increase 

booster seat usage among children ages 4–8 years from 2002–2005. Through partVerDate Nov 24 2008 14:06 Nov 30, 2009 Jkt 035165 PO 00000 Frm 00037 Fmt 6633 Sfmt 6621 S:\DOCS\42290.TXT DENISE
34 

nerships with local health districts, the Utah Department of Health conducted 

awareness and media activities, distributed more than 2,000 child safety seats, conducted more than 120 car seat checkpoints to ensure families were using car seats 

correctly, and implemented booster seat policies in pre-schools and daycare centers. 

As a result, an estimated 44 Utahans are alive today and the death rate decreased 

6 percent from 2002 to 2004 while booster seat usage increased by 10 percent from 

2002–2005. Every $1 spent on child safety seats saves $41. In 2005, distributing 

2,000 child safety seats in Utah saved approximately $3.3 million. • In Colorado, the Injury and Violence Prevention Program conducted a booster 

seat program between 2001 and 2004. During this program, booster seat use by children ages 4–8 increased significantly in Colorado from 2001–2004. In 2001, adults 

reported that 86 percent of the 4- to 8-year-olds in their household always used a 

restraint while riding in a vehicle. Of those who always used a restraint, 15 percent 

used a booster seat. In 2004, the percentage of children who always used a restraint 

remained high at 89 percent, but booster seat use increased to 45 percent. 

Today, motor vehicle crashes remain the leading cause of injury death for children, but the collective efforts of those working has lead to a 32 percent decrease 

in this rate over the last two decades. Future efforts should continue to focus on 

older children ages 4–8 who are still not ready for a vehicle’s lap and shoulder belt 

as well as effort to ensure all States have laws that appropriately protect our youngest riders. 

BICYCLE AND OTHER WHEELED SPORTS

Bicycling and participating in other wheeled sports, such as skateboarding, riding 

scooters and in-line skating, are excellent ways to increase physical activity and 

combat obesity and other chronic health conditions. Although these activities provide healthy exercise, they are not without risk of injury, with head injuries accounting for 60 percent of bicycle-related deaths and more than two-thirds of 

bicycle-related hospital admissions. Extensive research has shown that use of helmets can reduce the risk of head and brain injury by 70 percent to 88 percent. Survivors of head injuries can have severe physical, emotional or cognitive problems 

that result in a long-term disabilities including difficulties with learning and activities of daily living. 

Universal use of bicycle helmets by children ages 4 to 15 could prevent between 

135 and 155 deaths, between 39,000 and 45,000 head injuries, and between 18,000 

and 55,000 scalp and face injuries annually. If 85 percent of all child cyclists wore 

helmets every time they rode bikes for 1 year, the lifetime medical cost savings 

could total between $134 million and $174 million. 

Over the last two decades, deaths have declined from 389 deaths to 132 deaths 

in 2004. State injury and violence prevention programs have contributed to the reduction in these injuries and deaths by providing data to partners, raising awareness, distributing bicycle helmets and supporting efforts to require the use of bicycle 

helmets by law. Today 21 States, the District of Columbia and over 140 localities 

have enacted some form of mandatory child bicycle helmet legislation. Efforts of 

State injury and violence prevention programs have included: 

• From 1991–1995, the New York State Injury Prevention Program conducted a 

statewide multifaceted bicycle helmet safety program featuring a Teenage Mutant 

Ninja Turtle character. The program included a public service campaign, prescription pads for New York State pediatricians and family practice physicians to prescribe helmet use for children seen in the practice, and the development of 77 community-based programs. Community coalitions distributed more than 30,000 bicycle 

helmets to children from families and need. With so much public attention and support, in 1994, State legislation was enacted requiring all bicyclists under the age 

of 14 to wear a bicycle helmet. School-based and observational surveys documented 

an increase in helmet ownership and usage between 1989 and 1993, and the New 

York State injury and violence prevention program has found a steady decline in 

bicycle-related deaths since the implementation of the program. 

• The Louisiana Injury Prevention Program has provided information to advocates such as Safe Kids, Think First, the Governor’s Highway Safety Commission, 

and other public and professional groups. These advocates have used the information to educate State legislators, inform their constituencies, and promote appropriate injury prevention behaviors. These activities led to establishment of a law requiring the use of bicycle helmets, and re-establishing a law requiring the use of 

motorcycle helmets. 

• After learning that children ages 5–14 have the highest rate of bicycle-related 

hospitalization and 32 percent of these hospitalized children sustain a brain injury, 

the Colorado Injury and Violence Prevention Program implemented a bicycle helmet 

35 

program. Survey results indicate that the percent of Colorado children ages 5–14 

who were reported as always wearing a helmet when bicycling increased slightly, 

from 40 percent in 1999 to 49 percent in 2005. • In California, bicycle helmet legislation, which led to an increase in helmet use, 

resulted in an 18 percent reduction in the proportion of traumatic brain injuries 

among young bicyclists. • The Florida Injury and Violence Prevention Program provided data on bicyclerelated injuries comparing one county with the rest of the State of Florida upon request in January 2006 to the administrator of local health department. The administrator used the data to present to county commissioners, who finally opted to enforce the State’s bike helmet law for riders under age 16—the last county in the 

State to do so. • From 1993–2000, the Oklahoma Injury Prevention Service collaborated with numerous national, State, and community partners and with funding provided by the 

National Center for Injury Prevention and Control, implemented bicycle helmet programs in several Oklahoma communities. These comprehensive, community-based 

efforts targeted children at greatest risk of bicycle-related TBIs, those 5–12 years 

of age. Mini-grants were awarded to county health departments, schools, police departments, civic organizations, and injury prevention coalitions to implement bicycle 

helmet distribution and education programs throughout the State. These bicycle helmet programs have been conducted in more than 90 communities and more than 

100,000 bicycle helmets have been distributed. According to the OSDH Behavioral 

Risk Factor Surveillance System (BRFSS), from 1992 to 1998, reported bicycle helmet use among children increased from 6 percent to 25 percent. 

RESIDENTIAL FIRE

Finally, we have seen a lot of progress in preventing injuries and deaths due to 

residential fires through smoke alarm distribution programs. Children, especially 

those in rural areas, are at high risk for injuries and deaths due to residential 

fires—partly due to their greater likelihood of starting fires as well as their greater 

need for assistance in escaping fires. It is well established that smoke alarms are 

extremely effective at preventing fire-related injuries and deaths. An individual’s 

chance of dying in a residential fire is reduced by half when a smoke alarm is 

present. 

In the late eighties and early nineties, the Oklahoma Injury Prevention Service 

led the way in establishing the best practices for preventing fire-related injuries and 

deaths through an innovative smoke alarm distribution program that involved developing a strong partnership with local firefighters, identifying areas at highest 

risk for fires, canvassing these areas and installing smoke alarms outside sleeping 

areas and on each floor of high-risk homes. 

The work in Oklahoma led to the development of a residential fire injury prevention program through the National Center for Injury Prevention and Control to provide funding to State health department injury and violence prevention programs 

to conduct smoke alarm distribution and installation programs. Through this funding, State health departments, in partnership with local firefighters, have been able 

to reach 185,000 high risk families, install more than 348,000 smoke alarms and 

potentially save more than 1,500 lives. Overall, deaths related to fires and burns 

have decreased nearly 60 percent over the last 20 years. 

State successes have included: 

• In Washington State, firefighters installed a smoke alarm in the mobile home 

of a Shoreline mother and her 3-year-old son. Weeks later the alarm woke the mother, who found a portion of her home ablaze. She woke her sleeping child and escaped before the home became fully engulfed. She was treated for smoke inhalation 

and released; her son was unharmed. 

• In Georgia, firefighters visited a home in Moultrie, installed smoke alarms in 

the proper places, and educated the family about a fire escape plan. When wires 

shorted and ignited the old wood home, a teenage boy awoke in the night to the 

alarm, alerted his mother and two younger siblings, and followed the fire escape 

plan. Although the fire damage was extensive, no injuries occurred. 

• Between 1998 and 2006 in New York, the Bureau of Injury Prevention canvassed approximately 39,732 homes in communities across New York State, installed more than 21,000 smoke alarms, and documented 379 lives saved in 165 fire 

and severe smoke incidents. 

OPPORTUNITIES FOR THE FUTURE

We must continue to invest in the prevention efforts that have demonstrated so 

much success over the last 20 years, such as child passenger safety, residential fire 

36 

injury prevention, and bicycling and other wheeled sports. Additionally, State injury 

and violence prevention programs must continue to study the patterns of injuries 

to identify new injury concerns—such as the recent rise in unintentional poisonings/ 

drug overdoses, as well as translate new research into community-based practices. 

As we learn more about what puts children at risk for injury, we must also consider the reality that children today are less active, more likely to be overweight 

or obese, and at increased risk for chronic diseases in adulthood. Yet parents are 

fearful of allowing their children to walk to and from school or to play outside due 

to the dangers of traffic and crime. America’s children deserve to live in communities where they can be healthy and active without the fear of violence or ‘‘accidental’’ injury. Investments in healthy communities and smart growth initiatives 

are one of the strongest ways we can work together to improve the overall health 

and safety of America’s children. 

We believe that with appropriate investments for continued and new injury prevention efforts, we will be able to see even more dramatic declines when we meet 

again to celebrate 25, 30 and 40 years of preventing unintentional injuries to children. 

The CHAIRMAN. Very good. 

Let me, if I could, just a few—do you have to go, Chris? Do you 

have questions? 

Senator DODD. No, just this, and I thank all of you—I apologize 

slipping out a little early. I just can’t thank you enough, and we 

will just keep working. Give us more ideas on how we can deal 

with these issues. 

Just one question, you mentioned how you—that last run, you 

wanted your father to film you on that run. Did he film you on that 

run? 

Mr. BRUNS. He did, yes. 

Senator DODD. Well, that is not a bad idea. Have you shown that 

to your pals? 

Mr. BRUNS. Ah, yes. They all laughed. 

Senator DODD. That is not a bad way maybe of convincing them 

of what can go wrong. Maybe put it on YouTube. 

Mr. BRUNS. I already put a song with it. So—— 

Senator DODD. Did you? Put a song to it, too. 

This is the father here, too. I am getting him in a lot more trouble. You are not from Connecticut, are you? 

[Laughter.] 

Well, thank you very, very much, and I apologize again for leaving early. Appreciate your testimony. Thanks. 

The CHAIRMAN. Mr. Korn, let me ask you, Safe Kids attribute 45 

percent decline in the unintentional death rate for children over 

the last 20 years. Do you want to tell us, what do you attribute 

that to? 

Mr. KORN. Well, 20 years ago—I am 43 years old and rode a bike 

and never wore a bike helmet. When I used to ride in my father’s 

car, I used to stand up. He had a convertible. I used to stand up 

in the center between my mother and father. There was no car 

seats. 

So the devices that you hear about today, that I brought with me 

today, have made a real difference. Twenty years ago, these type 

of things didn’t exist. Or if they did, they weren’t nearly as good 

as they are today. So we have seen the consciousness of parents 

raised quite remarkably. Second, they have had the devices that 

they need—smoke alarms, carbon monoxide detectors, personal flotation devices—to use when out doing their winter or summer activities. 

37 

The other thing I will mention just real quickly. Twenty years 

ago, there was no such thing as a bicycle helmet law. Georgia has 

a bicycle helmet law now. So does Massachusetts. Twenty years 

ago, there was no such thing as a State child safety seat law. Massachusetts, I think it was April 11th, just improved their child restraint law to include booster seats. Georgia has had one for a 

while. 

Twenty years ago, those didn’t exist, which is a good motivation 

to get parents to not only use the devices, but use them as a custom pattern and practice over time. 

The CHAIRMAN. Well, what is your answer to those that would 

say we are just coddling our children on these? 

Mr. KORN. Yes. You know, Safe Kids—and I know STIPDA and 

the Home Safety Council are the same way on this. We are not 

suggesting that you need to wrap kids in bubble paper every time 

they go out. You want them out there enjoying the summer, swimming, biking. You are even going to fall off your bike and scrape 

your knee, a little stitch in your elbow. Those are badges of honor. 

Maybe his small concussion is a badge of honor, maybe. 

But we are talking about serious traumatic injuries here. We 

want the kids out there enjoying summer. So my response to those 

people is, these are the things that are preventable. These are the 

things that we know how to take charge of and prevent from happening in the first place. It is not preventing the little scratch. It 

is preventing the concussion that will kill you or the drowning that 

will happen when 100 parents are standing around a pool. A kid 

goes under, that is the end of it. 

Or a smoke alarm. When there is smoke, it rings, and you are 

out of the house. These are serious injuries, not those smaller injuries. 

The CHAIRMAN. Your report points out that accidental injuries 

disproportionately affect minority children. Can you tell us why 

that is the case and what suggestions you have to do something 

about it? 

Mr. KORN. I think Senator Isakson and Dodd both referenced to 

it. One of the reasons is the cost associated with these items. A 

bike helmet is now $15, down a lot over the past 10 years. But still, 

when you are choosing between a gallon of milk, which is increasing now, and a bicycle helmet, a family—and I, quite frankly, don’t 

blame them—choose the gallon of milk. 

So it is incumbent upon groups like ours and the Federal Government to make sure that we are giving away free bicycle helmets, which we do each year, or that we are giving away free 

smoke alarms, which I know the Home Safety Council does each 

year. So these are the types of things that we need to do to reach 

those underserved populations. 

The other thing is maybe getting additional funding through the 

CDC, the U.S. Fire Administration, the National Highway Traffic 

Safety Administration, to buy these devices, to make sure we can 

give them away without charge to those families. 

The CHAIRMAN. Amber, what are the biggest barriers at the 

State and local level to implementing programs to address childhood injury? 

38 

Ms. WILLIAMS. I think, first of all, it is a resource issue. As 

Ileana said at the beginning, CDC funds 30 States to do basic injury prevention for the entire State, and that figure is about—just 

over $100,000 for a State to do coordinated injury prevention. 

So when you take that and you are trying to do surveillance, you 

are trying to do interventions, you are trying to distribute safety 

products to folks, it doesn’t go very far. So, we really have to do 

a lot to engage States and private industries to help us in getting 

those devices into the hands of the public. 

I think the other part of it is that from a State perspective, they 

are really charged with truly understanding what is going on because it does vary from State to State and from community to community. Our ability to do the surveillance that we need to is limited by the quality of the external cost coding and hospital discharge data. 

So that is another challenge, and just one further challenge is 

overall the public health workforce. There is a shortage of workers 

in the public health workforce, and I am sure you are familiar with 

that issue as well. 

So there are a number of challenges from the workforce to resource issues to be able to take what is known about preventing 

injuries and doing that at the State and community levels. 

The CHAIRMAN. OK. Senator Isakson. 

Senator ISAKSON. Thank you, Mr. Chairman. 

Mr. Korn, I remember in the 1970s or 1980s, when I was in the 

State legislature, we passed a mandatory helmet law for motorcycle 

operation in Georgia. There was a tremendous lobby against mandatory helmet law. Do those lobbies still exist today? 

Mr. KORN. They sure do. In fact, there has been a retraction in 

the helmet use laws in some States around the country. The childhood injury prevention movement doesn’t quite have the organized 

opposition that the motorcycle helmet law has, but we do run into 

that same issue like kind of Government’s role is overstepping its 

bounds a little bit. 

My response to that, when it comes to the children, we always 

have to keep the best interest of children in mind, and there are 

so many examples of that, adoption and child abuse. You always 

keep the best interest of the children in mind. 

When it comes to these types of State laws that happen, the bicycle helmet laws, the personal flotation device laws, the smoke 

alarm laws, we are talking about children. That helps us cross that 

hurdle that the motorcycle helmet efforts and advocates run across 

from that very organized lobby that does still exist today. 

Senator ISAKSON. I remember my predecessor, Senator Coverdell 

from Georgia, who was in the Senate before Zell Miller was here 

in the seat I hold, he actually was the driving force behind the 

mandatory seatbelt law in Georgia, which also was taking place in 

that same time period. The compelling argument that finally broke 

the opposition in terms of intervention versus freedom was the impact, cost impact to society on the lost productivity, which was testified to earlier, as well as the medical cost and the treatment cost 

and the rehabilitation cost. 

That was the argument that finally broke the opposition on those 

two pieces of legislation. 

39 

Mr. KORN. Thankfully, Justin is with us here today. I mean, if 

he had been seriously injured, the medical costs would have been 

astronomical, and we all would have paid that. The family couldn’t 

have afforded that. Instead, it was a $15 helmet that saved his life. 

So those costs, as if protecting and saving the child’s life isn’t 

enough—I think it is—but now we can also make the cost effectiveness argument in addition to that, and that helps us combat what 

little opposition there is. We do have opposition, but it helps us get 

over that hurdle. 

Senator ISAKSON. Justin, I am not a snowboarder. So you are 

going to have to—you were snowboarding, right? 

Mr. BRUNS. Yes. 

Senator ISAKSON. What is a rail? 

Mr. BRUNS. A rail, it is like something that you grind on with 

your board. 

Senator ISAKSON. That you grind? 

[Laughter.] 

Mr. BRUNS. Yes. I can’t really explain it. But go to YouTube. 

Senator ISAKSON. Well, I know the Summer Olympics are coming 

up, and this is a Winter Olympic example. But snowboarding has 

become a huge part of Olympic sports. The Olympics do a good job 

of mandatory helmet requirements of all participants, don’t they? 

Mr. BRUNS. Yes, everyone has to wear a helmet. 

Senator ISAKSON. Snowboarding looks particularly—to somebody 

my age, snowboarding looks particularly dangerous to start with. 

So I want all the protection that I could get. But your testimony 

is outstanding. I want to encourage you to be an advocate and use 

your personal story because kids influence kids more than anybody 

else. 

When you can tell your story and tell them that you got to come 

to the U.S. Senate and advocate on behalf of what a helmet did for 

you, you can save somebody else’s life. So what you are doing today 

is very important, and we commend you for being here and what 

you are doing. 

I commend all of you for your advocacy on behalf of safety for 

kids. 

The CHAIRMAN. Good. Thank you. 

Just a final couple of questions, and I join—thanking Senator 

Isakson for making that point and just underline it. Your example 

is key in terms of the future. It will make a real difference to other 

children’s safety. So good for you. 

Let me ask Meri-K about hidden hazards in the home that parents should know about. Do you want to just talk about that for 

a minute? 

Ms. APPY. I would love to. The Home Safety Council has done a 

number of studies, including the most definitive one, the State of 

Home Safety in America, followed up by a series of smaller studies 

to get an idea about what parents are thinking about out there. 

About 90-plus of the caregivers we surveyed indicated that they 

do think about safety quite a bit, but they are not acting really. We 

wanted to know why. Many of them said they don’t know what actions to take, or they don’t have enough time to do it, or home improvements are too expensive. 

40 

I think our challenge here is to really help make it very clear 

what the hazards are that you may not know about. I will give you 

one specific example. Hot water tap burns, scalding burns. When 

we surveyed parents, we found that hardly any of them knew what 

the temperature of the water coming out of the tap really is. Yet 

at temperatures of 140, 150 degrees, a child can be devastatingly 

scalded in just seconds. 

We worked with a mother actually from Georgia, come to think 

of it, Shelly McCammon, who has been helping us raise awareness 

of the dangers of hot water tap burns. Her story actually inspired 

the private sector to create a tool that can prevent that. It is called 

Hot Stop. It has got sensing devices in the tub spout and shower 

head so that if the water reaches a dangerously high level, it shuts 

it off to just a trickle. It only costs $25 to replace this tub spout. 

When I talked with Shelly, this mother, she looked me right in 

the eye and said, ‘‘Meri-K, I am a conscientious mom. David and 

I baby-proofed everything. Nobody ever told us that hot water could 

do this to Leah.’’ Her baby died of third-degree burns. 

So I think part of what we have to do without scaring the parents too much, we have to kind of point out these are the things 

that can happen, these are the things you can do to prevent it from 

happening, and if you do these things, you know what, it will work. 

Once we complete that circle, thinking always about the ones 

who may not be able to read that brochure. They may not see the 

notice that there is a free smoke alarm distribution. They may be 

falling through the cracks. So working harder to get into those 

homes, I really believe we can make a tremendous difference. 

The CHAIRMAN. That is an enormously interesting. I think all of 

us have had over our life experience that same sort of situation 

where that just scalding hot water comes out of the taps. 

Ms. APPY. Exactly. 

The CHAIRMAN. Could I ask you just about the key elements of 

the Home Safety Council, home safety, the literacy project? Do you 

want to just tell us, could you speak to that for a minute? 

Ms. APPY. Yes, you see me smiling. I have been a safety educator 

for more than 25 years. I don’t know if you know, Senator, I spent 

13 years at the National Fire Protection Association in Massachusetts, in fact. So I have really devoted my life to safety education 

programs, particularly school-based programs for children, which I 

love. 

However, in thinking about who makes safety changes at home, 

it became clear it is really the adults. When we did some research 

on most of the information going home to families, we learned that 

much of it, if not most of it, is written at a level the parents can’t— 

many parents cannot read. 

So the idea behind the Home Safety Literacy Project is to identify adults in the community who come forward to learn to read as 

they are adults. As they are learning to read in English, we integrate basic safety lessons into that process. So you join forces with 

literacy experts and safety experts to really get into some of the 

homes where families are of lower income levels and education levels. Those tend to be families at highest risk. 

So it is very efficient. Thread the needle into some of those 

homes we really can’t reach any other way. 

41 

The CHAIRMAN. Good. Alan, finally, just on those props that you 

have there, do you want to give us one, a little visual there? 

Mr. KORN. Sure. Your question of hidden hazards, one of which 

we are concerned with is carbon monoxide. This is a carbon monoxide detector that you put up in your home. The sources of carbon 

monoxide are your car, gas heaters, anything—a combustible natural source of fuel in the home, a fireplace. 

If you don’t have a carbon monoxide detector in your home, there 

is no way you can detect that it exists. It is odorless. It is tasteless. 

It doesn’t have any smell, unlike fire. 

So this is a newer, relatively newer device out there, and we 

could use the help, maybe through your Poison Control Enhancement Act, which I know you have passed out of this committee and 

I think is up for some reauthorization. This is a hidden hazard in 

the home that we are actually taking an extra look at and making 

some more efforts at. 

We are starting the summer season and drownings are of particular concern to me. Notwithstanding what I do for a living, I am 

not that tightly wound as a parent. I want my child out there playing. But when it comes to pools, when it comes to hot tubs, watching your children every step of the way when they are in the water 

makes such a big difference because drowning does not happen like 

it does in the movies. 

There isn’t a ‘‘help, help, I’m drowning’’ and plenty of time to 

react. A 2-year-old or 4-year-old goes under, that is the last you see 

of them. So we kind of work with a water watcher program, where 

you assign a parent to a pool to watch. You want to avoid the situation where everybody is watching the pool, but nobody is watching 

the pool. It is this type of device and those types of hidden hazards 

that we are going to work toward preventing. 

The CHAIRMAN. OK. I want to thank—Senator Isakson, anything 

further? 

Senator ISAKSON. I would just thank the panelists for being here. 

The CHAIRMAN. Panelists, very helpful. We will want to hear 

from you another time, another year or so, find out the progress 

that is being made. We are always interested in any suggestions 

you have for us about what we can do to help. 

Where we stand ready, we can do both sort of legislatively or if 

you have some suggestions about things that we ought to know 

about and that we ought to be involved in, I hope you will feel free 

to let us know. We congratulate all of you for the difference that 

you make. 

The committee will stand in recess. 

[Additional material follows.] 

42 

ADDITIONAL MATERIAL 

PREPARED STATEMENT OF SENATOR ENZI

Good morning and thank you for joining us today to discuss preventing childhood injuries. Our Nation has come a long way in reducing childhood injuries and making parents and others aware of 

ways they can help keep their kids safe. Today, we will take a look 

at where our Nation has been, where we are today, and where we 

need to be in the future for child injury prevention. 

Unintentional injuries are the leading cause of death among children in the United States with nearly 100,000 deaths a year. Those 

injuries include motor vehicle accidents, bicycle accidents, fires, 

poisonings, burns, falls, and playground injuries, among many others. While the number of deaths is startling, we also need to put 

that into perspective. 

Twenty years ago, parents generally didn’t secure an infant or 

young child in a safety seat when driving. Today, all 50 States and 

the District of Columbia require infants and toddlers to be in a 

child safety seat, and 43 States have child booster laws. The childsafety seat campaign has proven to be one of the most successful 

campaigns in child injury prevention. We also have requirements 

that motor vehicles are designed to make child-safety seats more 

effective and to allow for installation to be much easier. These efforts, accomplished by a partnership with State governments and 

the Federal Government, have significantly decreased the number 

of unintentional deaths caused by car accidents. Since 1975, deaths 

among children aged less than 5 years have decreased 30 percent 

to 3.1 per 100,000 population. 

We’ve not only taken action in our cars but also in our homes. 

Through city ordinances requiring fire and carbon monoxide detectors to additional Federal standards for safer pools to increased use 

of bicycle helmets, we have significantly reduced the number of 

childhood injuries. As each of these cases demonstrates, the public 

health actions are not simply those made by the Federal Government. In fact, States and localities have traditionally had the most 

successful efforts. 

Sometimes, what the Federal Government can do is simply ensure that we have the right information to parents. Last year, as 

part of the FDA Amendments Act, we reauthorized the Best Pharmaceuticals for Children Act (BPCA) and the Pediatric Research 

Improvement Act (PRIA). BPCA and PRIA act as a ‘‘carrot and 

stick’’ to ensure that parents have the right information about the 

drugs kids take. Kids aren’t little adults. They metabolize drugs 

differently than adults. Because of BPCA, over 300 studies have 

been performed to see how drugs affect kids. 

The local police and fire fighters play a large role in preventing 

and responding to unintentional child injuries and are much more 

effective because of their relationship with the community and ability to react more quickly than any program the Federal Government could create. Child injury prevention must continue to be the 

responsibility of the State first and, when needed, the Federal Government may support their efforts. 

Between 1987 and 2000 we have seen a 40 percent decline in the 

injury death rate. The decline is a result of successful prevention 

43 

campaigns with child-safety seats, a reduction in alcohol-related 

motor vehicle deaths and many other child injury prevention efforts. All 50 States have come a long way in injury prevention yet 

we still see over 100,000 deaths per year caused by unintentional 

injuries. We must continue to reduce these numbers through public 

education and messaging, new devices to eliminate risk and continued support for prevention programs across the country. 

I look forward to hearing from our witnesses today to better understand how far we have come to reduce the number of deaths, 

where we need to be in the future and how to address the challenges we see ahead. 

[Whereupon, at 11:37 a.m., the hearing was adjourned.] 

Æ