Chapter 13

If we want more evidence-based practice, we need more practice-based evidence.*

Chapter 13
Community Injury Control

Table of Contents


REFERENCES                                                                                                                                                                                       DEBATE TOPICS


Part four of the text begins with this chapter on injury control as an environmental concern rather than primarily as a behavioral concern as it has been treated in the past. The environmental approach to injury control recognizes that the typical circumstances of injury (sudden and unexpected) make them difficult to control behaviorally, so environmental protection is the intervention of choice. Furthermore, many injuries are perpetrated by individuals against other individuals, as in drunk driving and violence. Regulatory measures are therefore more easily justified. An enlightened public is needed to support the passage of such regulations, so public education is still essential. The student should understand that a balanced approach to most community and population health problems is needed, but here the balance needs to be tilted toward environmental measures.


The opening definitions and epidemiological examination of injuries reveal the growing concern with innocent victims, mostly young people whose losses add more significantly to the potential years of productive life lost than do deaths from chronic diseases. These facts make protective measures a community responsibility that cannot be handed off to the victims to "prevent accidents." Types of injuries, settings and agents such as vehicles, guns and equipment point to specific protective measures that can be taken in the community.


Helmet bill surfaces as motorcycle death figures surge in Maine. Associated Press, Jan 23, 2005.


Indiana: Bill would close state’s seat-belt loophole. “Seat belt pressure tightens”. Northwest Indiana TimesJan 3, 2005.

New Year's celebratory gunfire deaths and injuries (Morbidity and Mortality Weekly Reports 50(53):1174, Dec 24, 2004). Firing guns into the air during celebrations such as New Year's eve causes unknown numbers of deaths and injuries. An epidemiological investigation by CDC in San Juan, Puerto Rico found one death and 19 injuries, mostly to women and children, and mostly in densely population housing areas, during the Dec 31, 2003-Jan 1, 2004 celebrations of the New Year.  See also:

  • Ordog GJ, Dornhoffer P, Ackroyd G, et al. Spent bullets and their injuries: the result of firing weapons into the sky. J Trauma 1994;37:1003--6.

California to ban chemicals used as flame retardants: Component tied to learning disorders in Children. New York Times, Aug. 10, 2003. Polybrominated diphenyl ethers (PBDE's), developed in the 1960s, will be phased out of products including some plastics, foams, and curtains in which they were added as a flame retardant.

Massachusetts legislature considers fire-safe cigarette law.  From 1990 to 2000, fires caused by cigarettes have accounted for 195 deaths, 844 civilian injuries, 738 firefighter injuries, and more than $84 million in direct property damage in Massachusetts.  Cigarettes are the leading cause of fire related deaths in the United States. 

Hospital Discharge Data Can Give Clearer Picture of Gun Injuries  Jan. 2, 2003.

Protection Orders Curb Partner Violence, But Few Seek Them  Jan. 2, 2003.

House Opponents to Gun Controls Seek to Make Bill Unacceptable to Advocates. WASHINGTON (Wall Street Journal, June 18, 1999). US House of Representatives opposing stricter gun control are amending the recent legislative proposal with measures that would weaken existing rules on background checks at gun shows. This will likely result in failure of the Bill to pass because anti-gun Representatives will oppose it with these measures. See Staff Reporter Jefrey Taylor's story on http:///

Smoking Increases Fire Mortality. A common scenario is of elderly, debilitated, sometimes bed-bound persons accidentally igniting themselves and/or innocent bystanders with cigarette or cigarette lighter ignited fires. Much of US, and probably, increasingly China, fire mortality is made up of the elderly burned in cigarette smoking fires. Much of that data is at Fire in the United States (1985 - 1994, Ninth Edition) or .

EPA, FBI Argue Over Chemical Data. WASHINGTON (AP, Feb. 11, 1999) - The Environmental Protection Agency is exploring ways to provide sensitive chemical accident information to the public, yet keep it out of the hands of potential terrorists, an agency official said Wednesday. The release of information about so-called "worst-case" accident scenarios at chemical plants has been a subject of intense negotiations between the EPA and security officials for months. Critics, including FBI terrorist experts, have raised concern that the widespread availability of information such as likely chemical release points and potential casualties could be a "road map" for a terrorist attack.

Adverse Events Associated with Ingestion of Gamma-Butyrolactone MINNESOTA, NEW MEXICO and TEXAS, (1998-1999). Morbidity and Mortality Weekly Report, Vol. 48/No. 7, Feb. 26, 1999. View the full text of this week's MMWR as a web page at: Products containing gamma-butyrolactone (GBL) are marketed for many claimed purposes, including to induce sleep, release growth hormone, enhance sexual activity and athletic performance, relieve depression, and prolong life. GBL is converted by the body into gamma-hydroxybutyrate (GHB), a drug banned outside of clinical trials approved by the Food and Drug Administration (FDA). Recognized manifestations of GHB toxicity include bradycardia, hypothermia, central nervous system depression, and uncontrolled movements. This report describes seven cases of GBL toxicity involving the product "Revivarant," which is labeled as containing 1.82 g of GBL per fluid ounce, reported from two hospital emergency departments in Minnesota during October-December 1998 and summarizes an additional 34 cases of GBL toxicity reported to poison centers in New Mexico and Texas during Oct. 1998 to Jan. 1999.

For related news stories, please click here


Flood Preparation Resources

FloodSmart Community Resources: 

Red Cross Disaster Safety Checklist: 

How to Protect Your Home From Flood Damage: 

Emergency Planning - Protect Your Pet: 

How to Avoid Flood Damaged Cars: 

STEM Challenge for Kids - Building Flood Resistant Homes: 

Homeowner's Guide to Lightning Safety: 

Websites on Injury Prevention

Websites on Violence Prevention

Review of preventing child abuse for the Child Abuse Training and Technical Assistance Centers. You can download the article in PDF format at:

Websites on Children's Safety

International Traffic Safety:

The Traffic Safety Center at UC Berkeley hosted a distinguished lecturer series, featuring Dinesh Mohan, Transportation Safety Coordinator of the Institute of Technology in New Delhi, India. He shares his international expertise in an online video interview, available at:

The World Health Organization has designated its theme for the next World Health Day (April 7, 2004) as Road Safety. On this day around the globe, hundreds of organizations will host events to help raise awareness about
road traffic injuries and help spread the word about how such injuries can be prevented. For information on how to get involved, visit:


Journal References

From the journal, Safety Research, vol. 43, 2005 (click on titles for abstracts):

  1. Car safety and social differences in traffic injuries among young adult drivers: a study of two-car injury-generating crashes in Sweden
Pages 1-10
L. Laflamme, M. Vaez, M. Hasselberg and A. Kullgren
  2. Desirability of advanced driver assistance from road safety perspective: the case of ISA
Pages 11-27
V.A.W.J. Marchau, R.E.C.M. van der Heijden and E.J.E. Molin
  3. Deaths related to housing in 1999 Chi-Chi, Taiwan, earthquake
Pages 29-37
Yen-Hsiung Liao, Shu-Fang Lin, Wan-Huey Liao, Jen-Hsuan Huang, Maurice Shen, Chia-Hong Lin and Che-Hsin Huang
  4. Safety culture in railway maintenance
Pages 39-60
Trudi Farrington-Darby, Laura Pickup and John. R. Wilson
  5. Towards an international limit value for occupational trauma risk: industrial exposures associated with occupational trauma, permanent impairment and fatalities in a five-year national claims material
Pages 61-71

Books and Reviews

Helfer, M. A., Kempe, R. S., & Krugman, R. D.  (Eds.) (1997).   The Battered Child - 5th ed., Chicago, Ill, University of Chicago Press. 672pp., with illus, $45, ISBN  0-226-32627-6.
    In 1997, the National Center on Child Abuse and Neglect (NCCAN) reported that in the United States 3 million cases were reported to Child Protective Services in 1995. Of these, more than 1 million children were identified as victims of abuse or neglect; 52% suffered neglect, 25% physical abuse, 13% sexual abuse, 5% emotional abuse, 3% medical neglect, and 14% other problems. Nationwide, there were an estimated 110 child fatalities per 100,000 child victims of maltreatment in 1995. Child maltreatment is a global issue, and the statistics from the United States only emphasize the need for a comprehensive treatise on child abuse and neglect.
In 1961, Henry Kempe, in a presentation at the Annual Meeting of the American Academy of Pediatrics, introduced the term "battered child," which drew national attention to the severe manifestations of nonaccidental injuries to children. The first edition of The Battered Child, by Ray Helfer and Henry Kempe, was published in 1968. Since then, awareness of the seriousness and widespread prevalence of child abuse and neglect has increased tremendously, not only in the United States but globally. The current fifth edition of The Battered Child is a comprehensive and multidisciplinary review of child abuse and neglect.

Other References

CDC. National Child Passenger Safety Week, February 9--15, 2003. MMWR 52(4): 69, Jan 31, 2003.  

In 2001, a total of 1,579 children aged <15 years died as occupants in motor-vehicle crashes in the United States, an average of 30 deaths per week (1.). National Child Passenger Safety Week, February 9--15, 2003, will focus on efforts to improve the safety of children riding in motor vehicles, especially the importance of appropriate restraints such as child safety seats for infants and toddlers, booster seats for children aged 4--8 years who have outgrown their forward facing seats, and safety belts for children who have outgrown their booster seats (2). Additional steps to improve the safety of children riding in vehicles include placing children in the back seat when possible and avoiding placing children in rear-facing child seats in the front seat of vehicles equipped with passenger-side airbags (1).

The proper restraint of child passengers is improved through the combination of increased public education, strong child passenger safety laws, and rigorous enforcement of these laws. Additional information about National Child Passenger Week activities and child passenger safety is available from the National Highway Traffic Safety Administration (NHTSA), Office of Communications and Outreach, 400 Seventh St., SW, NTS-21, Washington, DC 20590; fax 202-493-2062,; and from CDC at


Homemade Chemical Bomb Events and Resulting Injuries---Selected States, January 1996--March 2003.  Morbidity and Mortality Weekly Report, 52(28), July 18, 2003.

  1. U.S. Department of Transportation, National Highway Traffic Safety Administration. Traffic safety facts 2001; publication no. DOT HS 809 471.
  2. CDC. National child passenger safety week---February 14--20, 1999. MMWR 1999;48:83--4.

Injuries Among Railroad Trespassers --- Georgia, 1990--1996. Morbidity and Mortality Weekly Reports 48 (25), July 2, 1999.
    Railroad trespassers are persons on railroad property whose presence is prohibited or unlawful. Most trespassers are walking along or across railroad tracks. In 1997, fatalities to railroad trespassers became the leading cause of railroad-related deaths in the United States. In 1998, 513 persons were injured and 536 persons were killed while trespassing (Federal Railroad Administration, unpublished data, 1999). This report presents three incidents in which trespassers were injured or killed and summarizes a study of fatal and nonfatal injuries to railroad trespassers in Georgia from 1990 through 1996.

Firearm-Associated Deaths and Hospitalizations --- California, 1995--1996. Morbidity and Mortality Weekly Reports 48(23), June 18, 1999.
    During 1995-1996, 27% of recorded injury-related deaths in California involved firearms (California Department of Health Services [CDHS], unpublished data, 1995-1996). In 1996, CDHS began passive surveillance of "severe" firearm-related injuries (i.e., resulting in death or hospitalization) with resources provided by the California Wellness Foundation (1). To characterize firearm-related injuries in California, CDHS analyzed death records and hospital discharge records for 1995 and 1996 (the most recent years for which population data are available to calculate rates). This report summarizes the results of the analysis, which indicate that most of the 21,985 firearm-related injuries and deaths resulted from assault. Reference cited:

  1. Kim AN, Trent RB. Firearm-related injury surveillance in California. Am J Prev Med 1998;15(3S):31-7.
  2. Annest JL, Mercy JA, Gibson DR, Ryan GW. National estimates of nonfatal firearm-related injuries, beyond the tip of the iceberg. JAMA 1995;273:1749-54.
  3. Cherry D, Annest JL, Mercy JA, Kresnow M, Pollock, DA. Trends in nonfatal and fatal firearm-related injury rates in the United States, 1985-1995. Ann Emerg Med 1998;32:51-9.
  4. Kellermann AL, Rivara FP, Lee RK, et al. Injuries due to firearms in three cities. N Engl J Med 1996;335:1438-44.
  5. Mercy JA, Ikeda R, Powell KE. Firearm-related injury surveillance: an overview of progress and the challenges ahead. Am J Prev Med 1998;15(3S):6-16.
  6. Hayes R, LeBrun E, Christoffel KK. Missing in action: health agencies lack critical data needed for firearm injury prevention. Chicago, Illinois: Handgun Epidemic Lowering Plan Network, Children's Memorial Medical Center, February 1999.

Deaths Resulting from Residential Fires and the Prevalence of Smoke Alarms -- United States, 1991-1995. Morbidity and Mortality Weekly Report, October 1, 1998/Vol. 47/No. 38.   See or click here for more complete story.

Unesco: Natural Disasters, be prepared! Unesco Courier October 1997.
    This edition looks at a wide range of natural disasters that have caused considerable damage to both humans and their possessions. The authors provide suggestions for preparedness and strategies for communities to deal with unforeseen events.


1. Injury case study. Conduct an interview with case study of an injury victim, for example, someone injured in a car, on the job, or as a victim of violence. Describing the personal, economic, and social costs of the injury.

2. Drunk driving. Interview a law enforcement officer to determine how drunk driving is controlled in the student’s state/province or community. What is the current legislation and how is it being enforced? What level of alcohol is tolerated? How many drinks does this involve? Have the student make calculations for their own height and weight to understand their own drinking limits.

3. Preventing emergencies. Invite an emergency room nurse, physician, or first aid squad volunteer to address the class regarding recent serious injuries that have occurred in your community. What community health efforts might be employed to prevent future tragedies of this nature?

4. Product safety. Consult a recent issue of the FDA Consumer. Report on a product or service that has been identified as unsafe. Specify consumer protection laws and agencies associated with the problem, and state their functions.

5. Planning for injury prevention. Draw a diagram of the environment in which you live, work, or conduct recreational activities. Identify those areas which would be particularly hazardous to a child, elderly person, or handicapped individual. Suggest measures for preventing injuries.

IHPR homeReturn to Community & Population Health Home Page
Back to topReturn to the top of this page