The economic burden of all-terrain vehicle related adult deaths in the U.S. workplace, 2003-2006.

The objective of this study was to estimate the societal economic burden associated with work-related ATV fatalities among civilian persons more than 17 years of age in the U.S. from 2003 through 2006. ATV death data were obtained from the Bureau of Labor Statistics' annual Census of Fatal Occupational Injuries. Costs were estimated using a model employing a cost-of-illness method developed by the National Institute for Occupational Safety and Health. From 2003 to 2006, a total of 129 work-related ATV deaths occurred among persons more than 17 years of age in the U.S., nearly doubling from 20 deaths in 2003 to 39 deaths in 2006. The collective lifetime cost of the deaths was $103.6 million (M), with a four-year mean of $803,100 and a four-year median of $772,100. Decedents age 35 to 54 years accounted for one-third of the deaths (n = 41) at a cost of $50.1 M. Montana had the most deaths (13). Fifty-two percent of the deaths were overturns costing $48.3 M. Eighty-four (65%) of the deaths were workers in agricultural production at a cost of $62.3 M. Short-term investment in prevention measures, such as training and helmets for workers, could provide lasting dividends by preventing work-related ATV deaths and reducing their economic impact.

Occupational all-terrain vehicle deaths among workers 18 years and older in the United States, 1992-2007.

The objective of this study was to summarize basic information on the characteristics of work-related A TV deaths among civilian persons 18 years of age or older in the U.S. from 1992 through 2007. Work-related ATV death data were obtained through the Bureau of Labor Statistics' annual Census of Fatal Occupational Injuries. From 1992 to 2007, 297 work-related ATV deaths occurred among persons over 17 in the U.S. Ninety-two percent were male, 93% were white, 23% were ages 18 to 34, 51% were ages 35 to 64, and 26% were ages > or = 65. Half of the fatal incidents involved overturns resulting in head and chest injuries. Sixty percent of crashes occurred on farms and 20% occurred on highways. The fatality rate among agricultural production workers was significantly higher than the rates in all other industries. While more in-depth analysis of incident and exposure data for this growing problem will more clearly define personal risk and causal factors in the long term, in the short term, stronger emphasis must be placed on the development of prevention strategies, particularly focused on older workers in the agriculture production industry.

Evaluating the impact of an intervention to reduce injuries among loggers in West Virginia, 1999-2007.

The purpose of this study was to evaluate the efficacy of a video-based safety training intervention (VBSTI) to reduce injuries among loggers over an 8-year period. WV Workers' Compensation data were used to assess the trend in injury rates, medical and indemnity costs due to logging injuries. There were 1,435 logger injury claims reported and a modest decline in the minor nature of injuries. There was no significant decline in total injury rates or in "struck by object" incidents emphasized in the VBSTI. Among the severe injuries, "head and neck" injuries showed a statistically significant decrease (p = 0.0454), but "falls" showed a statistically significant inverse change (p < 0.05). Medical and indemnity costs showed a statistical significant decrement (p < 0.05). Due to potential confounding, it is inconclusive whether the modest decreases in the claims can be attributed to the VBSTI. There still remains a need to improve the safety of workers in this high-risk employment.

Impact of helmets on injuries to riders of all-terrain vehicles.

BACKGROUND: Although helmet use has been shown to be effective in reducing traumatic brain injuries (TBIs) due to motorcycle and bicycle crashes, it is unknown whether helmet use is associated with different injury patterns and severity for users of all-terrain vehicles (ATVs). OBJECTIVES: To compare likelihood of injury and death between helmeted and unhelmeted riders of ATVs. METHODS: The National Trauma Data Bank for years 2002-2006 was used to examine the records of 11 589 patients hospitalized for injuries resulting from ATV use. The likelihood of receiving a TBI diagnosis or a significant injury to other body regions and differences in injury severity and in-hospital mortality between helmeted and unhelmeted ATV riders were compared. RESULTS: After multivariable adjustment, compared with helmeted riders, unhelmeted riders were significantly more likely to sustain any TBI (OR 1.62, 95% CI 1.49 to 1.76, p<0.001) and major/severe TBI (OR 3.19, 95% CI 2.39 to 4.25, p<0.001). Unhelmeted riders were significantly more likely to die while in hospital than were helmeted riders (OR 2.58, 95% CI 1.79 to 3.71, p<0.001). Significant injuries to the neck and face regions were also significantly more likely in unhelmeted riders (OR 3.53, 95% CI 1.28 to 9.71, p = 0.015, and OR 1.94, 95% CI 1.32 to 2.84, p = 0.001, respectively). CONCLUSIONS: ATV riders who do not wear helmets are more likely to receive significant injuries to the head, face, and neck. Prevention strategies and enforceable policy interventions to increase helmet use among ATV riders appear warranted.

Endotracheal intubations in rural pediatric trauma patients.

BACKGROUND/PURPOSE: Evidence from urban trauma centers questions the efficacy of pediatric field endotracheal intubations (ETIs). It is recognized that in the rural environment, discovery, transport delays, and a paucity of pediatric expertise contribute to higher pediatric trauma mortality rates compared with urban environments. The purpose of our study was to determine the effectiveness of field ETI in rural pediatric trauma patients. METHODS: ETI attempts (field, referring hospital, trauma center [TC]) in trauma patients less than 19 years old were included. Prehospital and TC charts, including demographics, injury mechanism, indication, location, person performing, number of attempts, Glascow Coma Scale (GCS), complications from ETI, and outcome, were assessed. RESULTS: Between 1991 and 2000, 105 of 2,907 patients met study criteria. Paramedics, trauma flight nurses (field ETIs), emergency physicians, surgeons, and anesthesiologists performed the ETI. One hundred fifty-five ETIs (1 to 6 per patient) were attempted in 105 children. Fifty-seven percent of the ETIs were attempted in the field, 22% in transferring hospital, and 21% at the TC. Successful intubation on first attempt was 67% (field), 69% (referring hospital), and 95% (TC). Subsequent ETI attempts had failure rates of 50% (field) and 0% (referring hospital, TC). Indication for ETI included fear of losing airway control (37%), closed head injury (36.1%), respiratory rate less than 10 or greater than 40 (11.2%), cardiopulmonary arrest (6.5%), respiratory arrest (4.6%), and airway obstruction 4.6%. Only 9.3% of children could not be oxygenated or ventilated by bag valve mask (BVM) before ETI. Twenty-three percent had complications directly related to ETI (eg, aspiration). The relative risk of an airway complication was 2.5x higher with more then one ETI attempt (P <.05). Four percent of the airway complications occurred in TC, 29% (transferring hospital) and 66% (field, P <.05), respectively. Airway complications and multiple ETIs were associated with transport delay, lower GCS, longer hospital stay, and lower discharge GCS (P <.001) but independent of injury severity score, sex, age, and survival (P >.05). CONCLUSIONS: Multiple ETI attempts are associated with significant complications and may offer limited advantage over BVM and possibly may affect outcome. Indications for field intubations may require review especially in rural pediatric trauma.

Assessing safety awareness and knowledge and behavioral change among West Virginia loggers.

OBJECTIVE: To determine if a video used during logger training influences safety attitude, knowledge, and workplace habits. METHOD: From April 2002 to October 2003, loggers receiving training through the West Virginia Division of Forestry were given a new safety module. This consisted of a pre-training survey, viewing video, brief introduction to field safety guide, and an immediate post-training survey. Six months after training, loggers were contacted by telephone to assess workplace behavioral changes. RESULTS: 1197 loggers attended 80 training sessions and completed surveys; 21% were contacted at follow up. Pre-training surveys indicated that half said "accidents" were part of the job and had experienced a "close call" in their work. An overwhelming majority felt that safety management and periodic meetings were important. Over 75% indicated they would not take risks in order to make a profit. Several statistically significant improvements were noted in safety knowledge after viewing the video: logger's location in relation to the tree stump during fatal incidents and the pictorial identification of an overloaded truck and the safest cutting notch. At follow up, many of the loggers said they related to the real life victim stories portrayed in the video. Further, the field guide served as a quick and easy reference and taught them valuable tips on safe cutting and felling. CONCLUSIONS: Significant changes in safety knowledge and attitude among certified loggers resulted from viewing the video during training. Subsequent use of the video and field guide at the worksite encouraged positive change in self reported work habits and practices.

Work-related fatalities in west virginia. A summary of surveillance, investigation, and prevention activities, july 1996-DECEMBER 1999.

PURPOSE: From 1990-95, West Virginia (WV) had a work-related death (WRD) rate of 8.9 deaths per 100,000-the fifth highest rate among all states and twice the national rate. As a result, a Fatality Assessment and Control Evaluation (WV FACE) program was established to identify all WRDs, define workers at high risk for fatal injury, investgate selected causes, and formulate and disseminate prevention strategies.METHODS: Surveillance and investigation data were used to describe trends and rates and identify hazardous conditions, unsafe work practices, and management-leadership problems through the use of the traditional epidemiologic model and the Haddon temporal matrix. Prevention strategies were developed and disseminated utilizing various written media.RESULTS: From 7/1996-12/1999, 191 persons died from work-related injuries. The WRD rate was 7.6 per 100,000 compared to 4.7 for the U.S. (1996-98). 94% of the victims were male and all Caucasian. Mean age at death was 43 years. Leading external causes of death: motor vehicle (48), struck by object (38), machinery-related (24), fall from elevation (15), and homicide (10). WRDs occurred most often in the trans/public utilities (37; truckers-22), manufacturing (32; loggers-24), mining (28), construction (26), and services (25) industry sectors. 19 on-site investigations were conducted (10 logging, 5 machine-related, and 4 fall from elevation); no company safety programs, inadequate training, lack of oversight were consistently noted. Summary reports were prepared for employers, Fatal Incident Alerts written for workers, and a scientific article was published.CONCLUSIONS: FACE has contributed to a better understanding of fatal occupational injuries within WV and the importance of coordinated efforts by employees, employers, and safety and public health specialists to reduce the frequency and societal impact of these injuries.

Differences in alcohol risk profiles between college students and college-age non-students presenting for care in the emergency department.

PURPOSE: Determine whether college students and non-students seeking emergency medical care experience different lifestyle choices, alcohol-use patterns, and risk profiles.METHODS: Patients aged 18-25 seen in a university-affiliated ED between August 1998 and June 1999 who had >/=1 drinks within the past year were eligible. Patients scoring >5 out of a possible 40 on the Alcohol Use Disorder Identification Test (AUDIT) were considered at elevated risk for alcohol problems and were interviewed further to determine alcohol-use patterns and history.RESULTS: Of 1,436 consenting patients, students were more likely to screen positive for alcohol problems than non-students (55% vs 43%; 478/870 vs 245/566). Furthermore, among screen-positive patients, students were more likely than non-students to binge drink in the two weeks prior to screening (82% vs 65%) and to drink illegally (60% vs 38%). Students needed fewer drinks to feel the effects of alcohol (3.9 drinks vs 5.1) and were less likely to request a referral for alcohol treatment (2% vs 8%). However, students had lower baseline risk for alcohol problems than non-students (AUDIT = 11.2 vs 13.2). Students were younger than non-students (20.2 years vs 21.4), older at their first drunken experience (15.3 vs 14.7), and less likely to smoke (51% vs 76%) or have a family history of heavy drinking (5% vs 23%). (p <.01 for all comparisons).CONCLUSIONS: Students exhibit a higher risk than non-students for behaviors associated with acute alcohol-related problems. However, they may be at lower risk for chronic alcohol problems. This university-based ED seems an appropriate venue for early identification and brief, on-site intervention for students with alcohol problems.

Conjoint smoking and drinking: a case for dual-substance intervention among young emergency department patients.

OBJECTIVES: To better understand conjoint smoking and drinking among young adult emergency department (ED) patients, the purposes of this investigation were: 1) to assess the prevalence of conjoint use; 2) to determine the factors associated with conjoint alcohol use and smoking; and 3) to address the implications for future ED-based investigation of dual-substance intervention. METHODS: Data for this investigation were obtained from a battery of questionnaires administered to the routine-care patients during an alcohol screening in the ED, which was part of a larger alcohol intervention study. RESULTS: Study findings revealed that a majority of patients with self-reported alcohol-related problems were smokers. In fact, drinkers who smoked were likely to be pack-a-day smokers. Among the study sample, being female, having low education levels (e.g., high school education or less), having some emotional problems, and currently using marijuana were risk factors for conjoint smoking and drinking. CONCLUSIONS: Conjoint users were identifiable through brief screening. Given the prevalence of conjoint smoking and alcohol use among the ED sample and a specific set of risk factors, tailored intervention for alcohol and nicotine dependence may be an important and opportunistic clinical ED service.

Adolescent all-terrain vehicle deaths in West Virginia, 1990-1998.

West Virginia had the third highest number of ATV-related deaths and the highest death rate among all states from 1990-98. Adolescents were identified as a particularly high-risk ATV user group. Fatality data from the U.S. Consumer Product Safety Commission indicated that one-quarter (25 of 101) of the state's ATV-related deaths occurred among children 16 and younger. Only one victim was wearing a helmet at the time of their fatal crash and nearly 70% of the victims were males. The average years of potential life lost was 64.2. WV's adolescent death rate of 0.67 per 100,000 was 5 times higher than the national rate. Young ATV drivers exacerbate the inherent dangers associated with ATVs through poor judgment and risk-taking. Health care providers should utilize "teachable moments" to emphasize ATV safety to their young patients and their parents, but more importantly, adults must become role models by embracing and teaching practical preventive measures.

Work-related deaths in West Virginia from July 1996 through June 1999: surveillance, investigation, and prevention.

The National Institute for Occupational Safety and Health's Fatality Assessment and Control Evaluation model is used to identify and describe work-related deaths in West Virginia. Through a statewide surveillance network, this model identifies work situations at high risk for fatal injury, investigates selected causes (falls, machinery-related, and logging), and formulates and disseminates prevention strategies to reduce the frequency and impact of those injuries. A total of 163 persons died from work-related injuries from July 1996 through June 1999. Ninety-three percent were male, the mean age was 42, and 80% were West Virginia residents. Fatalities occurred most frequently in the transportation/public utilities (32), manufacturing (24), construction (23), and mining (23) industries. Extension of Fatality Assessment and Control Evaluation methodology to nonfatal injuries may contribute to a clearer understanding of the causes of these traumatic incidents and help to develop better prevention measures.

Nonfatal logging-related injuries in West Virginia.

A survey was conducted via mail among West Virginia certified loggers to determine the number of nonfatal, logging-related injuries received during the past 12 months that required medical attention or restricted job ability. Loggers were asked to describe injuries, safety training, and protective equipment use. Thirty percent (546/1816) responded to the survey, and 9% (42/481) of those directly involved in logging operations reported injuries. Leading cause of injury was being struck by a falling tree or limb (29%); leading body parts injured were the leg/knee/hip (31%); and the most common type of injury was bruising (43%). Seventy-six percent of the injured sought medical treatment. A majority reported using some type of protective equipment including hard hats, safety shoes, and goggles. Loggers reported that training in the proper use of equipment and machinery; use of a safety plan, acting on worker suggestions, and landing talks might improve safety.

Causes of death among U.S. military personnel: a 14-year summary, 1980-1993.

Data extracted from the Report of Casualty (DD Form 1300) of the Department of Defense's Worldwide Casualty System were used to describe the 27,070 deaths among active duty personnel for the 14-year period 1980 through 1993. Ninety-five percent of all military deaths occurred among males and 84% among enlisted personnel. Unintentional injuries were the leading cause of death among both males (61%) and females (52%). Diseases accounted for about 20% of all death and represented the second most significant cause of death for both male and female service personnel. Suicide was the third leading major cause of death among males (13%), followed by homicide (5%); among females this order was reversed, with homicide (14%) exceeding suicide (12%). About 2% of all deaths resulted from combat. The findings presented here are useful in identifying cause-specific high-risk groups in each of the four service branches and directing appropriate prevention strategies.

Occupation and suicide among males in the US Armed Forces.

During the period 1980 to 1992, 95% of the 3178 military suicide victims were men and 92% enlisted; of the men, 71% were aged 20 to 34, 82% were white, and 61% used a firearm. Information extracted from the Report of Casualty of the Worldwide Casualty System maintained by the Department of Defense was used to describe the occupational risk among military men. Occupations related to the use of or access to firearms were associated with a significant risk of suicide when compared to other military occupations. Collectively, military security and law enforcement specialists had a significant occupational rate ratio (1.25; 95% confidence interval: 1.02, 1.53; P < 0.05). This corresponds to findings from national civilian labor force fatality data where police and detectives are also at an elevated risk of suicide. Because the scope and work of these military high-risk groups may differ from service to service, additional occupational information should be examined to facilitate a better understanding of the complex etiology of suicide and to develop appropriate prevention strategies.