Decreasing residential fire death rates and the association with the prevalence of adult cigarette smoking — United States, 1999–2015

IntroductionEach year from 1999 through 2015, residential fires caused between 2,000 and 3,000 deaths in the U.S., totaling approximately 45,000 deaths during this period. A disproportionate number of such deaths are attributable to smoking in the home. This study examines national trends in residential fire death rates, overall and smoking-related, and their relationship to adult cigarette smoking prevalence, over this same period.MethodsSummary data characterizing annual U.S. residential fire deaths and annual prevalence of adult cigarette smoking for the years 1999–2015, drawn from the National Vital Statistics System, the National Fire Protection Association, and the National Health Interview Survey were used to relate trends in overall and smoking-related rates of residential fire death to changes in adult cigarette smoking prevalence.ResultsStatistically significant downward trends were identified for both the rate of residential fire death (an average annual decrease of 2.2% – 2.6%) and the rate of residential fire death attributed to smoking (an average annual decrease of 3.5%). The decreasing rate of residential fire death was strongly correlated with a gradually declining year-to-year prevalence of adult cigarette smoking (r = 0.83), as was the decreasing rate of residential fire death attributed to smoking (r = 0.80).Conclusions and practical applicationsDecreasing U.S. residential fire death rates, both overall and smoking-related, coincided with a declining prevalence of adult cigarette smoking during 1999–2015. These findings further support tobacco control efforts and fire prevention strategies that include promotion of smoke-free homes. While the general health benefits of refraining from smoking are widely accepted, injury prevention represents a potential benefit that is less recognized.     

The direct costs of fatal and non-fatal falls among older adults — United States

IntroductionThis study sought to estimate the incidence, average cost, and total direct medical costs for fatal and non-fatal fall injuries in hospital, ED, and out-patient settings among U.S. adults aged 65 or older in 2012, by sex and age group and to report total direct medical costs for falls inflated to 2015 dollars.MethodIncidence data came from the 2012 National Vital Statistics System, 2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, 2012 Health Care Utilization Program National Emergency Department Sample, and 2007 Medical Expenditure Panel Survey. Costs for fatal falls were derived from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System; costs for non-fatal falls were based on claims from the 1998/1999 Medicare fee-for-service 5% Standard Analytical Files. Costs were inflated to 2015 estimates using the health care component of the Personal Consumption Expenditure index.ResultsIn 2012, there were 24,190 fatal and 3.2 million medically treated non-fatal fall related injuries. Direct medical costs totaled $616.5 million for fatal and $30.3 billion for non-fatal injuries in 2012 and rose to $637.5 million and $31.3 billion, respectively, in 2015. Fall incidence as well as total cost increased with age and were higher among women.ConclusionMedically treated falls among older adults, especially among older women, are associated with substantial economic costs.Practical applicationWidely implementing evidence-based interventions for fall prevention is essential to decrease the incidence and healthcare costs associated with these injuries.     

Emergency room evidence on the role of alcohol intoxication in injury at work in the U.S.

Alcohol is a known risk factor for many kinds of injuries, but past research has failed to implicate alcohol intoxication as a major cause of work injuries in the U.S. Local and regional studies have indicated that alcohol-related injuries are relatively less common in work settings than non-work settings. In a six-month study, the National Electronic Injury Surveillance System collected the first national sample data on alcohol and injuries presenting to hospital emergency rooms. The study included both work injuries and product-related non-work injuries. Alcohol intoxication was ascertained by emergency room chart review. Alcohol involvement was much lower than in other studies, probably because of poor sensitivity in ascertainment, and it was 10 times lower among work injuries than non-work injuries. “Non-work activities at the time of injury” were a significant risk factor for alcohol-related injuries (odds ratio = 7). Thus, results of this national study are consistent with previous research in finding that alcohol poses a greater risk for nonwork injury than for work injury.     

Assessing the number of fire fatalities in a defined population

IntroductionFire-related fatalities and injuries have become a growing governmental concern in Sweden, and a national vision zero strategy has been adopted stating that nobody should get killed or seriously injured from fires. There is considerable uncertainty, however, regarding the numbers of both deaths and injuries due to fires. Different national sources present different numbers, even on deaths, which obstructs reliable surveillance of the problem over time. We assume the situation is similar in other countries. This study seeks to assess the true number of fire-related deaths in Sweden by combining sources, and to verify the coverage of each individual source. By doing so, we also wish to demonstrate the possibilities of improved surveillance practices.MethodData from three national sources were collected and matched; a special database on fatal fires held by The Swedish Contingencies Agency (nationally responsible for fire prevention), a database on forensic medical examinations held by the National Board of Forensic Medicine, and the cause of death register held by the Swedish National Board of Health and Welfare.ResultsThe results disclose considerable underreporting in the single sources. The national database on fatal fires, serving as the principal source for policymaking on fire-prevention matters, underestimates the true situation by 20%. Its coverage of residential fires appears to be better than other fires.ConclusionsSystematic safety work and informed policy-making presuppose access to correct and reliable numbers. By combining several different sources, as suggested in this study, the national database on fatal fires is now considerably improved and includes regular matching with complementary sources.     

Assessing regulatory effectiveness with exogenously declining risk: a case study of the CPSC's 1973 mattress standard

INTRODUCTION: This paper examines the contribution of the U.S. Consumer Product Safety Commission's (CPSC) 1973 cigarette ignition mattress flammability standard to reduce mattress fires since 1980, when the U.S. Fire Administration's National Fire Incident Reporting System became fully operational. METHOD: The paper attempts to separate the effect of the cigarette ignition standard from the declining trend in mattress fires that would have resulted without the standard. We analyze the impact of the 1973 cigarette standard on smoking material ignition fires, deaths, and injuries as well as its effect on fires, deaths, and injuries from all ignition sources (smoking material ignitions, open-flame ignitions, and other ignition sources). Impacts on Industry: The results suggest that the 1973 mattress standard has effectively reduced the mattress fire risk and that further reductions in risk via actions tied specifically to cigarette ignition are likely to be difficult to achieve.     

Injuries associated with the use of riding mowers in the United States, 2002-2007

Context: To examine injuries among patients treated in an emergency department (ED) related to the use of a riding lawn mower.Design and Setting: Data were obtained from the National Electronic Injury Surveillance System for the years 2002-2007. National estimates of ED visits for injuries associated with the use of a riding lawn mower were analyzed. Narrative text entries were categorized to provide a detailed record of the circumstances precipitating the injury. Average annual rates were calculated and logistic regression analyses were employed to determine risk estimates for patient disposition and demographic characteristics related to ED visits for injuries associated with riding mowers.Results: From 2002 through 2007, there were an estimated 66,341 ED visits for injuries related to the use of riding lawnmowers in the U.S., with an average annual rate of 6.0 ED visits per 100,000 males, and 1.6 ED visits per 100,000 females. Older adults had higher rates of ED visits for injuries (7.2/100,000) than younger age groups. The most common injuries involved contusions (24%); sprains/strains (22%) and fractures (17%). The majority of patients (90%) were treated and released the same day. Results of logistic regression analyses revealed that older adults were more likely to be hospitalized when compared to younger age groups; and incidents involving rollovers [OR = 5.45 (95% CI = 3.22-9.23)] and being run over [6.01 (95% CI 3.23-11.17)] were more likely to result in hospitalization when compared to all other circumstances of injury.Conclusions: Riding mowers present injury patterns and circumstances that are different than those reported for push mowers. Circumstances related to injuries and age groups affected were varied, making prevention of riding mower injuries challenging. Application/Impact: Findings support the need to increase awareness and/or change the design of riding mowers with respect to risk of rollover injuries.     

Youth on racial minority operated U.S. farms, 2008: Demographics and injuries

IntroductionTo obtain injury surveillance data for youth on racial minority operated farms, the National Institute for Occupational Safety and Health developed the Minority Farm Operator Childhood Agricultural Injury Survey (M-CAIS) in collaboration with the U.S. Department of Agriculture.MethodsUsing a regionally stratified telephone survey of U.S. minority operated farm households, M-CAIS data were collected for youth less than 20 years of age.ResultsThere were an estimated 37,443 youth living on racial minority operated U.S. farms in 2008, almost half (46%) of these youth worked on the farm. Racial minority farm operators hired 6,443 youth, and reported an estimated 775,991 youth relative and other visitors on the farm. These youth suffered an estimated 516 injuries (5.9 injuries/1000 farms).ConclusionsHousehold youth had an injury rate of 7.8 injuries/1000 household youth and a work-related injury rate of 6.9 injuries/1000 working household youth.Practical applicationsThe research enables agricultural safety and health researchers, practitioners, and educators to identify priorities and design trainings and interventions to minimize the risk of farm hazards to youth on racial minority farm operations in the United States.     

Fatal injuries among Hispanic workers in the U.S. construction industry: Findings from FACE investigation reports

IntroductionIdentifying and understanding the characteristics of workplace accidents can provide vital information required to clarify their causes and prevent similar accidents from happening in the future. The Hispanic workforce represents a significant segment of the U.S. construction labor force that is projected to continue increasing in population. The government statistical data show higher rates of fatalities among Hispanic workers when compared to other ethnic groups.MethodThis study aims to provide details about the trends of fatal injuries among Hispanic workers. The study examined 92 government investigation reports to reveal the general trends, then an examination of fatal fall injuries within the study sample was conducted since falling is the predominant cause of fatal injuries.ResultsThe findings suggest differences in accident characteristics between Hispanic workers and all workers, which could indicate a need for different interventions to improve the overall site safety. The study also revealed the dire need to propose revised investigation procedures that would help identify the root causes of accidents, which in turn leads to better recommendations and interventions.     

Disability among adults injured in motor-vehicle crashes in the United States

INTRODUCTION: Little population-based information exists about the long-term effects of motor-vehicle crash-related injuries. METHOD: We analyzed data from the 1995 National Health Interview Survey Disability (NHIS-D) Supplement to estimate the prevalence of crash-related disability among noninstitutionalized U.S. adults aged 18 years and older. RESULTS: More than 1.2 million adults were living in their homes with the disabling effects of motor-vehicle crash-related injuries in 1995. The prevalence of crash-related disability was highest for persons in their mid-life years, ages 35-64. Half of the respondents had sustained the injuries more than 5 years before the interview. Forty-one percent of working-aged individuals reported being unable to work because of their disability. CONCLUSIONS: Because crash-related disability is most prevalent during the mid-life years, quality of life and productivity may be affected for decades. These findings highlight the personal and societal burden associated with motor-vehicle crash-related disability in the United States.     

高校宿舍火灾数值仿真模拟

高等院校的学生人数众多,住宿比较密集,存在不少安全隐患,宿舍火灾对学生的自身安全和财物安全构成重大威胁。宿舍灭火以及人员疏散的关键在于掌握火灾发生中的重要参数变化。笔者采用美国国家标准和技术研究院（NIST）开发的FDS（Fire Dynamic Simulator）软件,建立高校宿舍模型,对宿舍火灾进行全尺寸模拟。通过模拟实验给出了火灾发生过程中烟气运动、纵向温度变化和氧气浓度变化的规律,最后笔者提出一种有效的灭火防灾方案,并进行模拟和验证,为学校防火防灾决策提供有力的依据。     

Fun ride or risky transport: Golf cart-related injuries treated in U.S. emergency departments from 2007 through 2017

Introduction: Golf cart-related injuries constitute a substantial source of morbidity, most notably in pediatric populations. Despite the high rate of injuries, there have been no meaningful changes in golf cart design or legislation to reduce the overall burden of these injuries. This study sought to characterize the epidemiology of golf cart-related injuries treated in United States hospital emergency departments. Method: A retrospective analysis was conducted by using data from the National Electronic Injury Surveillance System for patients of all ages who were treated in emergency departments (EDs) (2007–2017) for a golf cart-related injury. Results: From 2007 through 2017, an estimated 156,040 (95% CI = 102,402–209,679) patients were treated in U.S. EDs for golf cart-related injuries. The average rate of traumatic brain injuries (TBIs) in children (1.62 per 100,000 children) was more than three times that of TBIs in adults (0.52 per 100,000 adults; rate ratio = 2.38; 95% CI = 2.36–2.41) and nearly twice that of TBIs in seniors (1.11 per 100,000 seniors; rate ratio = 1.21; 95% CI = 1.19–1.22). The rate of injuries in seniors increased significantly by 67.6% from 4.81 per 100,000 seniors in 2007 to 8.06 per 100,000 seniors in 2017 (slope = 0.096; p = 0.041). Conclusions: Golf cart use remains an important source of injury for people of all ages, especially in children. As use continues to increase, it is unlikely that golf cart-related injuries will decrease without substantial changes to product design, regulation, and/or legislation. Practical Applications: Use of golf carts pose a considerable risk of injury and morbidity; safety recommendations should be followed.     

Self-reported falls and fall-related injuries among persons aged>or=65 years--United States, 2006

PROBLEM: In 2005, 15,802 persons aged>or=65 years died from fall injuries. How many older adults seek outpatient treatment for minor or moderate fall injuries is unknown. METHOD: To estimate the percentage of older adults who fell during the preceding three months, the Centers for Disease Control and Prevention (CDC) analyzed data from two questions about falls included in the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. RESULTS: Approximately 5.8 million (15.9%) persons aged>or=65 years reported falling at least once during the preceding three months, and 1.8 million (31.3%) of those who fell sustained an injury that resulted in a doctor visit or restricted activity for at least one day. DISCUSSION: This report presents the first national estimates of the number and proportion of persons reporting fall-related injuries associated with either doctor visits or restricted activity. SUMMARY: The prevalence of falls reinforces the need for broader use of scientifically proven fall-prevention interventions. IMPACT ON INDUSTRY: Falls and fall-related injuries represent an enormous burden to individuals, society, and to our health care system. Because the U.S. population is aging, this problem will increase unless we take preventive action by broadly implementing evidence-based fall prevention programs. Such programs could appreciably decrease the incidence and health care costs of fall injuries, as well as greatly improve the quality of life for older adults.     

Characteristics of work-related injuries involving forklift trucks

Industrial lift trucks or forklift trucks are a common source of occupational injuries. In 1983, over 13,000 workers' compensation claims for lost-workday injuries involving forklift trucks were filed in 30 states. An estimated 24,000 forklift-related injuries were treated in U.S. emergency rooms in 1983, and an estimated 34,000 in 1985. This paper presents the results of an analysis of forklift injuries reported in two occupational injury databases — the National Electronic Injury Surveillance System (NEISS) and the Bureau of Labor Statistics (BLS) Supplementary Data System (SDS). Characteristics of these injuries (e.g., type of injury, diagnosis, body part affected) and of the injury victims (e.g., age, sex, occupation) are described, and scenarios of typical forklift injuries in various occupations are presented. Trends in forklift injuries from 1983–1985 are also discussed.     

An evaluation of the effectiveness of a baby walker safety standard to prevent stair-fall injuries

PROBLEM: During the early 1990s the number of baby walker injuries treated in U.S. hospital emergency departments averaged almost 25,000 annually; about 80% resulted from falls down stairs. After initiating a regulatory proceeding in 1994, the U.S. Consumer Product Safety Commission staff worked with industry to develop requirements to address the stair-fall hazard. This study evaluates the effectiveness of the stair-fall requirements, which became effective in 1997 as part of a revised voluntary standard. METHOD: Annual baby walker emergency department injury rates were constructed for the 1981-2002 study period. A multivariate negative binomial regression model was used to estimate the effectiveness of the stair-fall requirements in reducing the injury rate. RESULTS: The stair-fall requirements reduced the emergency department injury rate by an estimated 63% (95% CI, 52% to 71%). IMPACT ON INDUSTRY: Given the substantial reduction in walker injuries, and the high level of industry conformance with the stair-fall requirements, the Commission terminated its regulatory proceeding in May, 2002. The success of the baby walker project highlights the ability of government and industry to work together cooperatively to develop effective safety improvements for consumer products.     

Does employee safety influence customer satisfaction? Evidence from the electric utility industry

ProblemResearch on workplace safety has not examined implications for business performance outcomes such as customer satisfaction.MethodIn a U.S. electric utility company, we surveyed 821 employees in 20 work groups, and also had access to archival safety data and the results of a customer satisfaction survey (n = 341).ResultsIn geographically-based work units where there were more employee injuries (based on archival records), customers were less satisfied with the service they received. Safety climate, mediated by safety citizenship behaviors (SCBs), added to the predictive power of the group-level model, but these two constructs exerted their influence independently from actual injuries. In combination, two safety-related predictor paths (injuries and climate/SCB) explained 53% of the variance in customer satisfaction.DiscussionResults offer preliminary evidence that workplace safety influences customer satisfaction, suggesting that there are likely spillover effects between the safety environment and the service environment. Additional research will be needed to assess the specific mechanisms that convert employee injuries into palpable results for customers.Impact on IndustryBetter safety climate and reductions in employee injuries have the potential to offer payoffs in terms of what customers experience.     

Record linkage for road traffic injuries in Ireland using police hospital and injury claims data

IntroductionThe study of non-fatal road traffic injuries is growing in importance. Since there are rarely comprehensive injury datasets, it is necessary to combine different sources to obtain better estimates on the extent and nature of the problem. Record linkage is one such technique.MethodIn this study, anonymized datasets from three separate sources of injury data in Ireland: hospitals, police, and injury claims are linked using probabilistic and deterministic linkage techniques. A method is proposed that creates a ‘best’ set of linked records for analysis, useful when clerical review of undecided cases is not feasible.ResultsThe linkage of police and hospital datasets shows results that are similar to those found in other countries, with significant police understatement especially of cyclist and motorcyclist injuries. The addition of the third dataset identifies a large number of additional injuries and demonstrates the error of using only the two main sources for injury data.Practical applicationThe study also underlines the risk in relying on the Lincoln–Petersen capture–recapture estimator to provide an estimate of the total population concerned.ConclusionThe data show that road traffic injuries are significantly more numerous than either police or hospital sources indicate. It is also argued that no single measure can fully capture the range of impacts that a serious injury entails.     

高层住宅火灾风险综合评估体系研究

火灾风险评估对于高层住宅的火灾事故预防有着重要意义。本文分析了高层住宅火灾风险因素,并结合现行的建筑设计防火规范,建立了高层住宅火灾风险评价指标体系,将高层住宅火灾风险评价指标分为三级,一、二级指标采用重要性排序的方法,三级指标采用专家打分的方法,各指标权重使用结构熵权法进行计算。最后,利用该方法进行实例分析,对高层住宅的实际火灾风险进行评估,得出其火灾等级,验证了所提评估方法的可行性。对制定高层住宅火灾控制方案有着重要的意义。     

Factors related to injury of shiftworking fire fighters in the Northeastern United States

Fire fighters, who provide society with an essential and life-saving service, are subjected to the effects of shiftwork and to the demands (physical and mental) and dangers of their profession, all of which can contribute to injuries. To identify factors involved in injuries to fire fighters, the timing, frequency, types, and places of occurrence of injuries sustained by fire fighters in three different municipal fire departments were examined. Data was obtained from analysis of Workers' Compensation forms. The most frequent injuries involved inhalation of hazardous materials and lacerations. Ninety-two percent of the injuries occurred at the fire scene, and their causes were related to fire fighting duties, such as rescue, extinguishment and overhaul. Although only 54% of fire alarms nationwide occurred from 12:00 to 16:00 and from 18:00 to 24:00 (42% of a 24 hour day), 68% of the injuries sustained by the fire fighters studied occurred during these time periods. Per alarm, at meal time or on the night shift fire fighters were more likely to be injured. Serious injuries were more prevalent at standardly accepted meal-times. The timing of the highest frequencies of injuries suggests that, due to the shiftwork nature of firefighting, both disruption of eating patterns and fatigue increase the risk of work-related injury to fire fighters. By understanding the contribution of factors, especially human ones, such as altered metabolism (due to disruption) and fatigue (due to time elapsed since awakening, alteration/disruption of sleep-wake pattern, or hypoglycaemia), interventions can be developed, which should decrease the incidence of injuries to fire fighters.     

Reporting occupational injuries: The first step

Attempts to evaluate occupational injury surveillance systems have centered on employer compliance. Surveillance systems also rely on employees reporting injuries, and the reliability of such reporting is unknown. In this study of hospital environmental service workers, 29.2% (108 of 372) recalled having been injured in the previous year, and of these, 38.9% (42 of 108) had not reported one or more injuries. Among those injured, older workers (mean age 40.6 years vs. 36.2 years; p = 0.024) and those having worked longer at the same job (mean duration 6.7 years vs. 4.3 years; p = 0.032) were more likely to not report an injury. The most frequently cited reason for not reporting was that the injury had seemed too minor, though 64.4% of unreported injuries required medical care and 44.1% resulted in lost work time.     

基于FDS的居民楼火灾烟气远距离传播过程研究

利用大涡模拟软件FDS对某居民楼火灾发生发展和烟气传播过程进行数值模拟,探讨烟气质量浓度在侧间-走廊建筑的分布情况。在不同房间的目标位置设置探测点,分析烟气质量浓度、CO体积分数分布。结果表明,距离火源位置最远的房间烟气质量浓度、CO体积分数最高且在短时间内达到致死浓度;烟气更容易在最远的房间聚集,在特定的时间段内,始终比其他房间的危险性要高。对于此类居民楼建筑火灾中的人员安全而言,最远端房间的危险性最高,火灾时要着重注意此区域的疏散。此外,在走廊顶棚上间隔适当的距离设置了挡烟垂壁,并且模拟了该工况下烟气质量浓度分布。结果表明,加入挡烟垂壁后走廊的烟气蔓延相对均匀,各个房间烟气质量浓度更为接近,最大烟气质量浓度也有明显降低,从而延缓了整个建筑达到危险状态的时间。