Fire fighter fatalities 1998-2001: overview with an emphasis on structure related traumatic fatalities.

OBJECTIVE: To review the causes of all fire fighter line-of-duty-deaths from 1998 through 2001, and present recommendations for preventing fatalities within the specific subgroup of structure related events. METHODS: Fire fighter fatality data from the United States Fire Administration were reviewed and classified into three main categories of injury. Investigations conducted through the National Institute for Occupational Safety and Health (NIOSH) Fire Fighter Fatality Investigation and Prevention Program provided the basis for the recommendations presented in this paper. RESULTS: During the time period from 1998-2001, there were 410 line-of-duty deaths among fire fighters in the United States, excluding the 343 fire fighters who died at the World Trade Center on 11 September 2001. The 410 fatalities included 191 medical (non-traumatic) deaths (47%), 75 motor vehicle related fatalities (18%), and 144 other traumatic fatalities (35%). The latter group included 68 fatalities that were associated with structures which commonly involved structural collapse, rapid fire progression, and trapped fire fighters. CONCLUSIONS: Structural fires pose particular hazards to fire fighters. Additional efforts must be directed to more effectively use what we have learned through the NIOSH investigations and recommendations from published experts in the safety community, consensus standards, and national fire safety organizations to reduce fire fighter fatalities during structural fire fighting.

Young workers.

Until recently, today's occupational safety and health experts have paid little attention to safety and health concerns of working youth. Yet with millions of children and adolescents employed each year, young workers are indeed a special population at risk deserving special attention. Occupational safety and health professionals have critical knowledge and skills to contribute to researching special issues for young workers and promoting safe and healthful work for youth. Unique opportunities for intervention hold the potential for new and rewarding partnerships with, for example, pediatricians and adolescent health specialists, child labor regulators, child injury prevention professionals, maternal and child health professionals, educators, and community leaders. Lessons learned in targeting young workers can have important implications for reaching other special populations that have not been well addressed through conventional approaches to occupational safety and health.

Occupational injury deaths of 16 and 17 year olds in the US: trends and comparisons with older workers.

OBJECTIVE: To examine patterns of occupational injury deaths of 16 and 17 year olds in the United States for the three year period 1990-2, examine trends since the 1980s, and compare fatality rates with those of older workers. METHODS: Occupational injury deaths were analyzed using the death certificate based National Traumatic Occupational Fatalities (NTOF) surveillance system. Fatality rates were calculated using estimates of full time equivalent (FTE) workers based on data from the Current Population Survey, a monthly household survey. RESULTS: There were 111 deaths of 16 and 17 year olds for the years 1990-2. The average yearly rate was 3.5 deaths/100,000 FTE. The leading causes of death were motor vehicle related, homicide, and machinery related. All causes occupational injury fatality rates for 16 and 17 year olds were lower than for adults for 1990-2. Rates for the leading causes of death (motor vehicle related, homicide, and machinery related) were comparable or slightly higher than the rates for young and middle aged adult workers. Although rates decreased dramatically from 1980 to 1983, the decreasing trend attenuated in later years. CONCLUSIONS: Comparisons of youth fatality rates to those of adult workers should address differences in patterns of employment, most importantly hours of work. Comparisons to narrow age groupings of adults is preferable to a single category of all workers 18 years and older. Increasing compliance with federal child labor regulations could help reduce work related deaths of youth. Other measures are needed, however, as there are many work hazards, including those associated with homicides, that are not addressed by United States federal child labor law regulations.

A detailed analysis of work-related injury among youth treated in emergency departments.

Telephone interviews were conducted with 146 14- to 16-year-olds who incurred an occupational injury treated in an emergency department during the period July through September 1992. Thirty-two percent of the injuries occurred as the result of using equipment. Over half the workers reported not having received prior training on how to avoid injury. The injury limited normal activities for at least 1 day for 68% of the youth and for more than a week for 25%, corresponding to an estimated 6,208 (95% CI: 4,277, 8,139) and 2,639 (95% CI: 1,580, 3,699) youths nationwide, respectively. Employment in retail trades, equipment use, lack of training, and burn injuries were associated with increased limitation of normal activities. Nineteen percent of the youths appear to have been injured in jobs declared to be hazardous, or typically prohibited for their age (14- and 15-year-olds) under federal child labor laws. The prohibited job directly contributed to the injury in 64% of these cases.

Occupational injury deaths of 16- and 17-year-olds in the United States.

Data from the National Traumatic Occupational Fatalities surveillance system were used to analyze occupational injury deaths of civilian 16- and 17-year-olds during 1980 through 1989. There were 670 deaths; the rate was 5.11 per 100,000 full-time equivalent workers. The leading causes of death were incidents involving motor vehicles and machines, electrocution, and homicide. Workers 16 and 17 years old appear to be at greater risk than adults for occupational death by electrocution, suffocation, drowning, poisoning, and natural and environmental factors. Improved enforcement of and compliance with federal child labor laws, evaluation of the appropriateness of currently permitted activities, and education are encouraged.

Adolescent occupational injuries requiring hospital emergency department treatment: a nationally representative sample.

Data from a nationally representative sample of emergency departments for the 6-month period July through December 1992 were used to examine nonfatal occupational injuries sustained by adolescents aged 14 through 17 years. There were 679 occupational injuries, corresponding to an estimated 37,405 injuries nationwide. Males constituted 65.8% of the injury victims. The injury rate for males was 7.0 per 100 full-time employees, compared with 4.4 for females. Lacerations to the hand or finger accounted for 25.6% of all injuries. The majority of injuries occurred in retail trades (53.7%), which also had the highest rate (6.3 per 100 full-time employees). Seventy-one percent of the injuries in retail trade occurred in eating and drinking establishments.

Industries and occupations at high risk for work-related homicide.

Homicide is the third leading cause of injury death in the workplace. The death certificate-based National Traumatic Occupational Fatalities surveillance system and estimates of annual employment were used to calculate average annual rates of work-related homicide for detailed industries and occupations for the nation for 1980 to 1989. Workers in the taxicab industry had the highest rate of work-related homicide (26.9 per 100,000 workers). High rates were also identified for workers providing public and private security, and in a number of retail trade and service industries. For many high-risk industries, the risk was excessive for male workers only. Differences between rates for black and nonblack workers varied across industries and occupations. Immediate efforts to protect workers, and long-term efforts to describe and study work-related homicide thoroughly and to evaluate interventions are needed.

Children at work: prevention of occupational injury and disease.

Because children are an isolated population that generally lacks a collective political voice, it is up to the rest of society to look after their well-being. The grim economic circumstances that plague impoverished nations around the world have resulted in many young children having to work to help their families survive. Often, these children have no choice but to work in dangerous places and under generally appalling conditions. Even in wealthy countries like the United States, the problems associated with child labor are a legitimate threat to our single most important investment for the future--the safety and health of our children.

Comparison of motor vehicle occupant injuries in restrained and unrestrained 4- to 14-year-olds.

This study compares injuries of restrained and unrestrained 4- to 14-year-olds in nine emergency rooms and the Coroner's office in Orange County, California from 1983 to 1989. Analyses were performed separately for 4- to 9- and 10- to 14-year-olds because of differences related to the fit of the seat belt. Significantly fewer intracranial injuries and a significantly lower mean Injury Severity Score (ISS) were seen between the restrained and unrestrained for 10- to 14-year-olds in the front passenger and back seats; but for 4- to 9-year-olds in the back seat only. These same differences were noted between restrained 4- to 9-year-olds in the back compared with those in the front passenger seat. Except for 4- to 9-year-olds in the front passenger seat, our findings are consistent with similar studies of occupants of all ages. Our results suggest that lap-shoulder belts (primary restraint in front seat) may provide less protection for 4- to 9-year-olds than for 10- to 14-year-olds and adults.

On-lap travel: still a problem in motor vehicles.

National observational studies indicate that infants who are not restrained in child safety seats (CSSs) in motor vehicles are usually riding on the lap of another occupant. This study was undertaken to determine the conditions under which children travel on-lap. The extent to which injuries would be reduced if these children were restrained in CSSs was also examined. Data were taken from a multihospital monitoring system for pediatric occupant injuries and from the coroner's office in a single urban county (1980 through 1989). One hundred ten children younger than 1 year of age evaluated in the monitored emergency departments after involvement in a crash had been traveling on-lap. On-lap travel did not appear to result from overcrowding. Eighty-eight percent were riding in vehicles with five or fewer occupants; 83% were in the front seat; 58% sustained injury; 22% of those evaluated were hospitalized; and 15% sustained intracranial injury. A 30% reduction in overall injury, a 75% reduction in hospitalization, and a 69% reduction in intracranial injury were projected for those riding on-lap, had they been restrained in CSSs. Applying national rates of on-lap travel (16.8%) to National Highway Traffic Safety Administration estimates of the number of infants injured in crashes each year indicates that approximately 2218 of these children would be on the lap of another passenger. Substantial savings in terms of injury and associated costs can be realized if children traveling on-lap were in CSSs. Parent education as well as strict enforcement of CSS laws must be implemented.(ABSTRACT TRUNCATED AT 250 WORDS)

Pedestrian injuries to children younger than 5 years of age.

Historically, research on pediatric pedestrian injuries has analyzed children younger than 5 years of age as a single group. However, in this study, these children were divided into two age groups which were reflective of differences in behavior and development. The data demonstrate differences in the circumstances of the pedestrian injury events between toddlers (0 through 2 years and ambulatory) and preschoolers (3- and 4-year-olds). Toddlers were more likely to be injured in nontraffic events whereas preschoolers were more frequently injured in traffic situations. A high proportion of toddler injuries occurred in residential driveways and were caused by vehicles backing up. The majority of preschoolers, often without supervision, were injured while crossing/darting midblock on residential streets near their homes. Reflecting these differences in circumstances and also developmental differences between toddlers and preschool children, there is a need for age-specific interventions to reduce pedestrian injuries in children younger than 5 years of age.

Pediatric injuries in the back of pickup trucks.

Travel in the back of pickup trucks has not been adequately addressed as an occupant protection issue. This study compares injuries sustained by children riding in the back of pickup trucks with those of children riding in the cab. Data were obtained from a multihospital monitoring system and the coroner in a single urban county. The series of injured children consisted of 290 children 0 through 14 years of age, 201 of whom had been riding in the cab and 89 in the back. Age distribution of the children demonstrated that it is most frequently the 10- to 14-year-olds who travel in the back. Children riding in the back were more frequently injured in noncrash events (absence of a collision), had more ejections, had more injuries, and sustained more severe injuries as measured by the Maximum Injury Score. With increased restraint use in the cab, it is likely that even greater differentials in injury severity and patterns would be realized. Education regarding the hazards of travel in the back of pickups and stronger legislation limiting the transport of children in the back of trucks are recommended.

Limitations of data compiled from police reports on pediatric pedestrian and bicycle motor vehicle events.

Police reports were compared to the information provided by a hospital monitoring system for children under 15 years old injured as pedestrians and bicyclists by moving motor vehicles in Orange County, California. The analysis was limited to identifying caveats in the police report database. Underreporting by police was conservatively estimated at 20% for pedestrians and 10% for bicyclists. Comparison of the pedestrian databases suggested underreporting by police of incidents involving 0-4-year-olds, nontraffic incidents, incidents in which the vehicle was backing up, and cases not involving a child crossing a street. Comparison of the bicyclist databases indicated an underreporting by police of nontraffic cases. These caveats, in part, are related to police agency reporting requirements. The police injury severity scale was found to correlate poorly with a scale based on medical diagnoses, and substantial underreporting by police of serious injuries was demonstrated. We suggest that utilization of police injury severity scales be limited to categories of fatal, injured, and not injured (when available).