SAC360

1. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.
CHAPTER 17
Injuries Are Not
Accidents

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2021
by
Jones
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Learning,
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Categories of Injury Death
 Unintentional
 Intentional
– Homicide
– Suicide

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2021
by
Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
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www.jblearning.com
Epidemiology of Injuries
 Injuries are the U.S.’s third leading cause of death.
 They are the leading cause of death for ages <50.
 Higher injury rates exist for groups with lower SES.
 Many injuries are not fatal, but fatal injuries are the ones that are most reliably
reported.
 Injuries, especially to head and spinal cord, resulting in long-term disability are
especially costly to society.
 Males have higher injury rates than females.
 Blacks have lower injury mortality than whites.
– Except, blacks have higher homicide rates.

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2021
by
Jones
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Learning,
LLC
an
Ascend
Learning
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www.jblearning.com
Leading Causes of Injuries
 Poisoning
 Motor vehicle injuries
 Firearm injuries
 Falls
 Suffocation
 Drowning
 Fires/burns
 Cuts/pierces

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by
Jones
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Bartlett
Learning,
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Ascend
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www.jblearning.com
Injury Pyramid
 Deaths
 Hospital discharges
– Including long-term disability
 Emergency department visits
 Episodes of injuries reported

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2021
by
Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Analyzing Injuries
 Injuries are generally brought on by human behavior, but injury researchers
have sought to understand the environment’s role.
 The public health approach to injury control analyzes in terms of chain of
causation—similar to infectious diseases.
– Host, agent, environment
 Primary prevention
– Conditions prevailing before the event
 Secondary prevention
– Conditions prevailing during the event
 Tertiary prevention
– Availability and quality of emergency care

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2021
by
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Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
The “Three Es” of Injury Prevention
 Education
 Enforcement
 Engineering
 Insights were first applied to the auto industry but have been successfully
applied to prevention of many other kinds of injuries, especially childhood
injuries.

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2021
by
Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Motor Vehicle Injuries
 Motor vehicle injury is the second leading cause of injury death at around
34,000 deaths per year.
 Ralph Nader published in 1966, Unsafe at Any Speed: The Designed-In
Dangers of the American Automobile.
– NHTSA was created and empowered to set standards for auto safety.
 Motor vehicle fatalities decreased by more than 40% since 1968 despite more
cars and more miles driven.
 Engineering changes to make cars and highways safer are important.

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2021
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Learning,
LLC
an
Ascend
Learning
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www.jblearning.com
Motor Vehicle Injuries (cont.)
 Education and enforcement include:
– Speed limits
– Seat belts
 Alcohol plays a major role in fatal crashes.
 Second leading factor is youth and inexperience.
– Graduated driver’s licenses
– Zero tolerance for blood alcohol levels above the safe limit
 Distracted driving contributes to crashes.
– Cell phone use, especially text messaging

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2021
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Jones
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Learning,
LLC
an
Ascend
Learning
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www.jblearning.com
Pedestrians, Motorcyclists, and Bicyclists
 Pedestrians—16% of all people killed in motor vehicle crashes
– 19% over 65 years old
– Elderly people have the highest risk of being killed.
 Motorcyclists—5,172 deaths in 2017
– 19 states and D.C. require helmets
– 28 more states require helmets for younger riders
 Bicyclists — 777 deaths in 2017
– 7% under age 15
– 21 states and D.C. require helmets for children

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Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Poisoning
 Poisoning is the leading cause of injury death.
– Recent increase is largely from unintentional deaths, recreational use of
prescription pain relievers.
– Inappropriate prescription of controlled substances is an issue.
 Prevention
– Strict regulation by DEA
– Drug tracking
 Suicide by poisoning most commonly involves psychoactive drugs.
 New York attorney general proposed an online drug tracking system that would
reduce the risk of patients’ obtaining multiple prescriptions for opiate drugs.

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Learning,
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an
Ascend
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www.jblearning.com
Firearms Injuries
 Firearm injuries are third leading cause of injury death at nearly 40,000 deaths
in 2017.
– 61% suicides, 37% homicides, others unintentional
 Homicide rates are 2 to 20 times higher in the U.S. than other developed
countries.
 Violence is traditionally thought of as a criminal justice issue rather than a
public health issue.
 Gun control legislation is strongly opposed by the National Rifle Association,
which has clout in Congress.
 41% of U.S. households surveyed possess at least one firearm.
 Residents of a household with a gun are three times more likely to die in a
homicide.

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2021
by
Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Occupational Injuries
 Occupational Safety and Health Administration (OSHA): Regulatory agency
 National Institute of Occupational Safety and Health (NIOSH): Research
agency
 5,147 deaths in 2017 from occupational injuries
 Motor vehicle injuries are the leading cause of occupational injury death.
– Highway crashes
– Overturned farm or industrial vehicles
– Falls, falling object/equipment, caught in equipment, electrocution
 Logging and fishing are most dangerous occupations.

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2021
by
Jones
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Learning,
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an
Ascend
Learning
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www.jblearning.com
Domestic Violence Injury
 Child abuse
– 1,640 children under 18 died from maltreatment in 2012.
• 70% were younger than age 3.
– 686,000 children were victims of maltreatment in 2012.
– Childhood physical or sexual victimization is a risk factor for future victimization and
perpetration.
 Adult intimate partner violence
– This includes rape, physical violence, and stalking.
– More than 12 million are affected each year.
– More than 2,300 such deaths occurred in 2007.

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2021
by
Jones
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Learning,
LLC
an
Ascend
Learning
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www.jblearning.com
Nonfatal Traumatic Brain Injuries
 2.9 million Americans per year are treated in hospital emergency departments
for nonfatal traumatic brain injuries (TBIs).
 Mild TBI is a concussion.
 Severe TBIs can lead to changes in thinking, sensation, or language and may
cause permanent disability.
 CDC recommends primary and secondary prevention.

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2021
by
Jones
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Learning,
LLC
an
Ascend
Learning
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www.jblearning.com
Tertiary Prevention
 For any kind of serious injury, promptness and quality of emergency care play a
significant role in whether a victim survives and in the extent of permanent
disability.
– Special trauma centers
– Use of helicopters

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2021
by
Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 1
 Think of an injury you or a family member has suffered and analyze the injury
using host, agent, and environment.

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Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Questions 2
 Conduct a survey in class. How many classmates do each of the following?
– Use seatbelts
– Wear bicycle or motorcycle helmets
– Adhere to speed limits
– Have a smoke detector at home
– Have a firearm at home

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2021
by
Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 3
 Using the ecological model (see Chapter 14), design a program to prevent
firearms injuries in your community.

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2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 4
 Visit the CDC’s injury mapping website, www.cdc.gov/injury/wisqars/wisqars-
mapping-module.html.
 Using national maps, determine which states have the highest homicide rates.
 Which have the highest suicide rates?
 Create an injury map for your state.
 Are mortality rates for specific kinds of injury especially high in any parts of the
state?

21. Copyright
©
2021
by
Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 5
 Visit the website of the National Highway Traffic Safety Administration,
www.nhtsa.dot.gov.
 Review the news items and determine what safety issues the agency is focused
on.

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©
2021
by
Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 6
 Visit the Occupational Safety and Health Administration website, www.osha.gov.
 Review the news releases for the past month.
 What types of fatal accidents have occurred during this period, and what
hazards were investigated?

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©
2021
by
Jones
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Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 7
 Visit the website of the National Safety Council, www.nsc.org.
 What recommendations does this organization make for making driving safer,
especially for young people?
 Do you agree with the recommendations?