Child Pedestrian Injury in an Urban Setting: Descriptive Epidemiology

This study describes the epidemiology of pedestrian injuries to children and adolescents (ages <20) in an urban setting, providing analyses of environmental and pedestrian variables. Anonymous data were obtained for all motor vehicle crashes occurring in New York City over a 7-year period (1991-1997). Among 693,283 crashes, 97,245 resulted in injuries to 100,261 pedestrians of whom 32,578 were under age 20. Using census counts for the denominator, the overall incidence of pediatric pedestrian injuries was 246/100,000 per year, and the case fatality rate was 0.6%. Incidence rates peaked in the 6-14 year age group, and showed a modest annual decline during the study period. Younger children were more likely to be struck mid-block and during daylight hours, whereas adolescents were more likely to be struck at intersections and at night. For younger children, there was a sharp peak in incidence during the summer months. Road and weather conditions did not appear to affect injury risk. These results help identify priorities for child pedestrian injury prevention and education, inform public health policy, and direct emergency medical health services resource allocation

Emergency department visits for traumatic brain injury in a birth cohort of medicaid-insured children

Objectives: To analyse emergency department-based data on paediatric traumatic brain injury (TBI). Methods: This study constructed a retrospective cohort of 493 890 children who were born in New York City between 1999–2007 and who were enrolled in the New York Medicaid programme at the time of their birth and followed these children from birth to the end of 2007. Results: There were 62 089 injury-related emergency department visits, of which 1290 had ICD-9 codes consistent with TBI. Children with TBI were more likely to be male (59.4% vs 51.4%) and Hispanic (43.9% vs 26.3%) than those in the underlying birth cohort and were more than twice as likely to be admitted to the hospital for inpatient care (RR = 2.4, 95% CI = 2.2, 2.6). The most commonly listed cause of injury was falls (58.3%). Spatially-smoothed risk estimates indicated that some areas of the city are associated with a greater risk of paediatric TBI than others. Conclusions: Emergency department data can be used to describe paediatric TBI in ways not easily available through more routinely collected administrative health data. This information can be used to target prevention and control efforts

Public Health Department Training of Emergency Medical Technicians for Bioterrorism and Public Health Emergencies: Results of a National Assessment

Hypothesis: The public health system has a specialized body of knowledge and expertise in bioterrorism and public health emergency management that can assist in the development and delivery of continuing medical education programs to meet the needs of emergency medical service providers. Methods: A nationally representative sample of the basic and paramedic emergency medical service providers in the United States was surveyed to assess whether they had received training in weapons of mass destruction, bioterrorism, chemical terrorism, radiological terrorism, and/or public health emergencies, and how the training was provided. Results: Local health departments provided little in the way of training in biologic, chemical, or radiological terrorism to responders (7.4%- 14.9%). State health departments provided even less training (6.3%- 17.3%) on all topics to emergency medical services providers. Training that was provided by the health department in bioterrorism and public health emergency response was associated with responder comfort in responding to a bioterrorism event (OR = 2.74, 95% CI = 2.68, 2.81). Conclusions: Local and state public health agencies should work with the emergency medical services systems to develop and deliver training with an all-hazards approac

National Safe Routes to School program and risk of school-age pedestrian and bicyclist injury

Purpose Safe Routes to School (SRTS) was a federally funded transportation program for facilitating physically active commuting to and from school in children through improvements of the built environment. There is evidence that SRTS programs increase walking and bicycling in school-age children, but their impact on pedestrian and bicyclist safety has not been adequately examined. We investigate the impact and effects of the SRTS program on school-age pedestrian and bicyclist injuries in a nationwide sample in the United States. Methods Data were crash records for school-age children (5–19 years) and adults (30–64 years), in 18 U.S. states for a 16-year period (1995–2010). Multilevel negative binomial models were used to examine the association between SRTS intervention and the risk of pedestrian and bicyclist injury in children aged 5–19 years. Results SRTS was associated with an approximately 23% reduction (incidence rate ratio = 0.77, 95% confidence interval = 0.65–0.92) in pedestrian/bicyclist injury risk and a 20% reduction in pedestrian/bicyclist fatality risk (incidence rate ratio = 0.80, 95% confidence interval = 0.68–0.94) in school-age children compared to adults aged 30–64 years. Conclusions Implementation of the SRTS program appears to have contributed to improving traffic safety for school-age children in the United States

The Willingness of U.S. Emergency Medical Technicians to Respond to Terrorist Incidents

A nationally representative sample of basic and paramedic emergency medical service providers in the United States was surveyed to assess their willingness to respond to terrorist incidents. EMTs were appreciably (9-13%) less willing than able to respond to such potential terrorist-related incidents as smallpox outbreaks, chemical attacks, or radioactive dirty bombs (p < 0.0001). EMTs who had received terrorism-related continuing medical education within the previous 2 years were twice as likely (OR = 1.9, 95% CI 1.9, 2.0) to be willing to respond to a potential smallpox dissemination incident as those who indicated that they had not received such training. Timely and appropriate training, attention to interpersonal concerns, and instilling a sense of duty may increase first medical provider response rates

The Association of Light Trucks and Vans with Pediatric Pedestrian Deaths

We investigated the hypothesis that relative to cars, light trucks and vans (including sports utility vehicles) are more likely to result in fatal pediatric pedestrian injury. It was further hypothesized that this increased risk is a result of head injuries. The study sample consisted of 18,117 police records of motor vehicles involved in crashes in which one or more pedestrian aged 5 to 19 years old was injured or killed. Frequencies and case fatality ratios for each vehicle body type were calculated. We conducted a logistic regression analysis with light truck or van versus car as the exposure variable and fatal / non-fatal pedestrian injury as the outcome variable. After controlling for driver age, driver gender, vehicle weight, road surface condition and presence of head injury, 5 to 19 year-olds struck by light trucks or vans were more than twice as likely to die than those struck by cars (OR = 2.3 95% CI 1.4, 3.9). For the 5 to 9 year-old age group, light trucks and vans were four times as likely to be associated with fatal injury (OR = 4.2 95 % CI 1.9, 9.5). There was an association between head injury and light trucks and vans (OR=1.2, 95% CI 1.1, 1.3). We conclude that vehicle body type characteristics play an important role in pediatric pedestrian injury severity and may offer engineering-based opportunities for injury control

Analyzing Postdisaster Surveillance Data: The Effect of the Statistical Method

Data from existing administrative databases and ongoing surveys or surveillance methods may prove indispensable after mass traumas as a way of providing information that may be useful to emergency planners and practitioners. The analytic approach, however, may affect exposure prevalence estimates and measures of association. We compare Bayesian hierarchical modeling methods to standard survey analytic techniques for survey data collected in the aftermath of a terrorist attack. Estimates for the prevalence of exposure to the terrorist attacks of September 11, 2001, varied by the method chosen. Bayesian hierarchical modeling returned the lowest estimate for exposure prevalence with a credible interval spanning nearly 3 times the range of the confidence intervals (CIs) associated with both unadjusted and survey procedures. Bayesian hierarchical modeling also returned a smaller point estimate for measures of association, although in this instance the credible interval was tighter than that obtained through survey procedures. Bayesian approaches allow a consideration of preexisting assumptions about survey data, and may offer potential advantages, particularly in the uncertain environment of postterrorism and disaster settings. Additional comparative analyses of existing data are necessary to guide our ability to use these techniques in future incidents

Preparing Health Professions Students for Terrorism, Disaster, and Public Health Emergencies: Core Competencies

The recent increased threat of terrorism, coupled with the ever-present dangers posed by natural disasters and public health emergencies, clearly support the need to incorporate bioterrorism preparedness and emergency response material into the curricula of every health professions school in the nation. A main barrier to health care preparedness in this country is a lack of coordination across the spectrum of public health and health care communities and disciplines. Ensuring a unified and coordinated approach to preparedness requires that benchmarks and standards be consistent across health care disciplines and public health, with the most basic level being education of health professions students. Educational competencies establish the foundation that enables graduates to meet occupational competencies. However, educational needs for students differ from the needs of practitioners. In addition, there must be a clear connection between departments of public health and all other health care entities to ensure proper preparedness. The authors describe both a process and a list of core competencies for teaching emergency preparedness to students in the health care professions, developed in 2003 and 2004 by a team of experts from the four health professions schools of Columbia University in New York City. These competencies are directly applicable to medical, dental, nursing, and public health students. They can also easily be adapted to other health care disciplines, so long as differences in levels of proficiency and the need for clinical competency are taken into consideration