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Background


How large is the injury problem?

In the United States during a typical year, injuries are responsible for more than 147 thousand deaths, 2.6 million hospitalizations, and 36 million emergency department visits (1). Injuries are responsible for more deaths among children, adolescents, and young adults than all other causes combined (2). When thinking about injuries it is useful to distinguish intentional injuries (homicide, suicide) from unintentional injuries (most burns, falls, motor vehicle crashes, etc.) because of the great differences in the implications for preventing these tragedies. These policy recommendations will be limited to those that primarily address unintentional injuries. Intentional injuries will be addressed in a future, separate section.

Injuries are an especially serious problem among the young. Approximately 37 children and adolescents die from unintentional injuries in the US every day (2, 3). For every death there are scores of nonfatal injuries that cause permanent disabilities or disfigurement. Each year in the United States 1 in 5 children receives medical care as a result of an injury. Injuries are the leading cause of medical spending for children and adolescents in the United States(4). The unintentional injuries to this population in 1996 alone resulted in an estimated $14 billion in lifetime medical spending (5).

What is an injury and how do they occur?

An injury is defined as damage or harm to the body caused by

  • exposure to energy in an amount that is too great for the body to handle; or
  • from a blocking of the body from using energy, as with suffocation, drowning, or cold exposure (6).
For example, excess thermal energy may lead to heatstroke, burns or scalds; excess kinetic (mechanical) energy from a motor vehicle crash or fall can lead to fractures or wounds; and excess chemical energy, as from household cleaning liquids, can lead to burns or poisoning.

Injuries are not "accidents" in that they don't simply befall an individual from fate or bad luck. Injuries have causes. They are predictable and preventable. What about this word accident? According to the American Heritage Dictionary (Second College Edition), an accident is "an unexpected and undesirable event, especially if resulting in injury; an event that occurs without foresight or expectation, that proceeds from an unknown cause, or is an unusual effect of a known cause; fortune or chance". Because research has shown that injuries can be analyzed and averted, the word "accident" is clearly not appropriate for an intelligent discussion of injury prevention. Random events and bad luck cannot be prevented.

The term injury refers to an adverse health outcome, such as a leg fracture, rather than an event such as a motor vehicle crash. This distinction is important. Although it may be impossible to prevent all adverse events, it is often possible to prevent the adverse consequences of unavoidable events. For example, seatbelts, shoulder restraints, airbags, and the car's energy absorbing frame and body work together to reduce the likelihood of a serious injury resulting from an unavoidable collision.

Injury Prevention

There are a number of ways to prevent injuries. Ideally, most of these will work in concert. For much of the first half of the 20th century, injury prevention efforts focused on correcting careless or indifferent behavior through education. Although being informed of risks is important, there are other ways to prevent injuries. In the early 1940s it was recognized that products could be made safer through better engineering and design. Enactment and enforcement of laws regulating behavior and the establishment of policies, rules, and standards are also effective at reducing the number and severity of injuries. Economic incentives, (vouchers for safety seats, smoke alarms, or bike helmets; tax breaks for retrofitting home pools with isolation fences, etc.) are useful in minimizing barriers imposed by the cost of safety devices. Finally, the consequences of injuries may be reduced if the injured person receives timely, skilled emergency medical care.

Example: Motor vehicle crash
No matter how educated I am about safe driving and how carefully I drive, I am exposed to other drivers who may not be as cautious. The enactment and enforcement of speed limit laws are likely to influence most drivers to drive more slowly. Thus, if there is a crash the amount of harm is reduced. Some drivers don't obey the speed limit laws. If another driver exceeds the safe speed and crashes into my vehicle, I am protected by the engineering and design of my automobile. Cars are designed with several layers of energy absorption. Crumple panels, airbags, and passenger restraints all absorb some of the force of impact so that the severity of any injury is reduced. If I am injured severely enough to require medical attention, the long-term consequences of my injuries may be minimized through timely access to skilled emergency medical professionals.

Injury Policy

Research has shown that education alone is unlikely to have a long-lasting impact on people's behavior and thus, the occurrence of injuries. This is particularly true for children and adolescents. Young children are developmentally incapable of recognizing and evaluating the consequences of risk-taking. They are impulsive and cannot be trusted to exercise caution at all times. Children or their parents may not recognize potential hazards from toys, cribs, clothing, etc. Adolescents seek independence by taking risks. Thus, it is important for everyone to ensure the safety of children through policies and standards that minimize the risk of childhood injury.

The ideal policy is a prudent course of action selected from among the alternatives to guide present and future decisions and behavior. It is an idea or plan of what to do in a particular situation that has been agreed to by a group of people, a business, or a government. Thus, although laws are policies, not all policies are laws.

A committee of injury prevention experts has selected the policies selected for this series. This collection is not intended to be an exhaustive list. We have limited this list to policies that address unintentional injuries. The policies posted here are only the first of many. Check back frequently to find additional statements.

1. Fingerhut LA, Warner M. Injury Chartbook. Health, United States 1996-1997. Hyattsville, MD: US Department of Health and Human Services, National Center for Health Statistics, 1997.

2. National Center for Health Statistics. Compressed Mortality Files. Viewed online via CDC-WONDER (http://wonder.cdc.gov), April 10, 2000.

3. US Centers for Disease Control, National Center for Injury Prevention and Control. 10 Leading Causes of Death, United States, 1997. Viewed online at http://www.cdc.gov/ncipc/, April 10, 2000.

4. Children's Safety Network Economics and Insurance Resource Center. Childhood Injury: Cost and Prevention Facts. Landover, Maryland: National Public Services Research Institute, 1997.

5. Miller TR, Romano EO, Spicer RS. The cost of childhood unintentional injuries and the value of prevention. The Future of Children; 10(1): 137-163, 2000.

6. Gibson JJ. The contribution of experimental psychology to the formulation of the problem of safety. In: Behavioral Approaches to Accident Research. New York: Association for the Aid of Crippled Children, 1961.

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Last modified: 14-July-2000.