Making Microwave Oven Doors Child Resistant to Protect Young Children From Severe Scalds.

Most severe child scalds in the United States involve food and beverages. The wide variety of burn mechanisms, however, makes prevention challenging. Over the past 15 years, we have worked toward protecting young children from 1 specific mechanism: children opening microwave oven doors themselves and spilling the heated contents, resulting in often severe scalds. In our published research, we documented the frequency and severity of these cases and the vulnerability of young toddlers to be burned in this way. We have presented our findings and ideas for prevention at multiple national meetings and enlisted college engineering students to design microwave doors that would thwart a young child from opening them. In 2017, we became active members of a national task group convened by Underwriters Laboratories to address this issue, and two authors became voting members on the Underwriters Laboratories Standards Technical Panel for microwave ovens. We worked with microwave manufacturers and others for >1 year to address concerns of the industry, including those related to potential impacts on older adults. This effort resulted in the task group proposing a change in the standard, requiring "two distinct actions" to open the door of a microwave oven. On September 17, 2018, the panel voted to pass the measure, which will require child-resistant doors for all new microwave ovens in 2023. This report highlights how research can inform and support child injury prevention advocacy. Children will now be protected from this type of scald as microwaves with child-resistant doors replace current models.

Glass table injuries: A silent public health problem.

BACKGROUND: Glass tables can break and cause traumatic injury. This public health issue is avoidable by adequate regulatory measures. We describe the burden and characteristics of these injuries using the National Electronic Injury Surveillance System (NEISS) database and data from a level 1 trauma center. METHODS: NEISS data was extracted from 2009 to 2015. Injuries were classified by type, severity, and involvement of faulty glass using predetermined criteria. A retrospective chart review of a level 1 trauma center data was performed. Epidemiologic and outcomes data are reported. RESULTS: 3241 cases were reviewed from NEISS. 56% of injuries were attributable to faulty tables. 15% were severe. A bimodal age distribution of age under 7 and early 20s was observed. Commonly injured areas were the upper extremity and forehead. 24 trauma center cases were reviewed. 21% presented with hemodynamic instability, 34% had major organ, body cavity or joint space injuries, and 58% required surgical intervention. 30-day mortality rate was 8%. More than 54% required inpatient care. CONCLUSION: Glass table injuries are common, estimated at over 2.5 million per year. Regulation of glass quality may prevent injury. SUMMARY: Glass table injuries are more common than may be recognized and represent a public health problem that can be mitigated through proper regulatory measures.

Muerte accidental atípica. A propósito de un caso / Fortuitous atypical death. A case report

En la Medicina Legal se presentan con frecuencia casos que tienen como etiología médico-legal la accidental, en sus más variadas situaciones. Accidente es cualquier hecho o fenómeno traumático o morboso espontáneo que sobreviene en el individuo sano, o en el curso de una enfermedad. La amplitud de los términos de esta definición obliga a tener presente que los diferentes tipos de accidentes se hallan condicionados por múltiples fenómenos de carácter imprevisible e incontrolable. En el presente estudio, se expone un caso poco común y atípico de accidente doméstico, que lamentablemente culminó con la muerte de la víctima. Se trata de una anciana de 72 años que, según datos aportados por la instrucción policial, fue hallada en su domicilio, tendida en la cocina, con una herida incisa penetrante en la cavidad torácica. Tenía antecedentes de epilepsia desde la infancia, para lo cual seguía un tratamiento, y se pudo conocer que había manifestado sentirse mal antes de quedarse sola en la vivienda

In Legal Medicine, there are frequently cases having an accidental medico-legal etiology in its more varied situations. An accident is any spontaneous traumatic or morbid fact or phenomenon that happens in a healthy individual or in the course of an illness. The wideness of this definition terms obliges us to take into the account that the different kinds of accidents are conditioned by multiple phenomena of unforeseeable and uncontrollable character. In the current work, we expose an uncommon, atypical home accident, unfortunately ending in the victim’s death; it deals with an elder woman aged 72 years who, according with the data provided by the police instruction was found lying in the kitchen of her house with an incised penetrating wound in the thoracic cavity. She had antecedents of epilepsy since childhood, and for that was treated; it was obtained information that she referred feeling bad before staying alone at home

[Accidental ingestion of methadone by children and suggestions for better prevention]. / Akzidentelle Methadoneinnahme durch Kinder - Gedanken zur Verbesserung der Prävention.

Despite the medial attention attracted by the presented case in January 2012 and the determined measures taken to minimize the risk of accidental poisoning for children in the direct surroundings of substituted persons, we recently faced two more cases of methadone-intoxicated children in Hamburg. We believe that the most important step to increase awareness of the dangerous effects of methadone for children might be the storage of methadone in lockable boxes, which would make it safe from access by children and third parties. Moreover this way of storing reminds the patients of the risks resulting from their medication. Repeated and comprehensive instruction appears to be the best protection against cases like this to counteract careless handling of the substitution medication.

Exposiciones tóxicas a las cápsulas de detergentes de ropa en España / Toxic exposure to laundry detergent capsules in Spain

Introducción. Las cápsulas de detergente de ropa (CDR), tanto en forma de polvo compacto, como en polvo/líquido o como líquido han experimentado un gran auge desde su comercialización en España. El objetivo es describir las consultas por exposición a CDR que se han registrado en el centro antitóxico español de referencia. Material y métodos. Estudio observacional de casos de consultas telefónicas por exposiciones a CDR entre el 1 de enero de 2008 y el 31 de diciembre de 2014. La información se obtuvo de la base de datos del Servicio de Información Toxicológica. Resultados. Se registraron 806 casos en los que el producto implicado eran CDR, pasando de 9 casos en el año 2008 a 398 en el año de 2014. El perfil del intoxicado corresponde a un varón de entre 19 y 24 meses que ingiere el contenido de la cápsula. Conclusiones. Se ha producido tal incremento de las consultas por exposiciones a CDR que, debido a un mayor riesgo de efectos clínicos, es importante incidir en la necesidad de mantener este tipo de producto fuera del alcance de los niños (AU)

Introduction. Laundry detergents capsules (CDR, for its acronym in Spanish) in compact powder format (tabs), powder and liquid (caps), or liquid (pods), have experienced great marketing development since its release in Spain. The objective is to describe the consultations registered in the Spanish Control Center related to CDR exposure. Material and methods. A retrospective study of poison center calls due to exposure to laundry detergents in capsule format between January 1st, 2008 and December 31st, 2014. The information has been obtained from the Spanish Poison Centre database (Servicio de Información Toxicológica). Results. A total of 806 cases that implicated CDR were recorded, accounting 9 cases in 2008 and rising to 398 in 2014. The profile of the intoxicated/victim corresponds to a 19-24 month-old male who swallows the contents of the capsule. Conclusions. There has been such an increase of queries related to CDR exposure that, due to an increased risk of clinical effects, we have to insist about the need for this type of product to be kept out of children's reach (AU)

A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India.

BACKGROUND: Most burns happen in low- and middle-income countries. In India, deaths related to burns are more common in women than in men and occur against a complex background in which the cause - accidental or non-accidental, suicidal or homicidal - is often unclear. Our study aimed to understand the antecedents to burns and the problem of ascribing cause, the sequence of medicolegal events after a woman was admitted to hospital, and potential opportunities for improvement. METHODS: We conducted semi-structured interviews with 33 women admitted to two major burns units, their families, and 26 key informant doctors, nurses, and police officers. We used framework analysis to examine the context in which burns occurred and the sequence of medicolegal action after admission to hospital. RESULTS: Interviewees described accidents, attempted suicide, and attempted homicide. Distinguishing between these was difficult because the underlying combination of poverty and cultural precedent was common to all and action was contingent on potentially conflicting narratives. Space constraint, problems with cooking equipment, and inflammable clothing increased the risk of accidental burns, but coexisted with household conflict, gender-based violence, and alcohol use. Most burns were initially ascribed to accidents. Clinicians adhered to medicolegal procedures, the police carried out their investigative requirements relatively rapidly, but both groups felt vulnerable in the face of the legal process. Women's understandable reticence to describe burns as non-accidental, the contested nature of statements, their perceived history of changeability, the limited quality and validity of forensic evidence, and the requirement for resilience on the part of clients underlay a general pessimism. CONCLUSIONS: The similarities between accident and intention cluster so tightly as to make them challenging to distinguish, especially given women's understandable reticence to describe burns as non-accidental. The contested status of forensic evidence and a reliance on testimony means that only a minority of cases lead to conviction. The emphasis should be on improving documentation, communication between service providers, and public understanding of the risks of burns.

[Toxicological evaluation in the childhood]. / Evaluación toxicológica del menor.

Intoxications in infancy require urgent medical treatment within national health systems. In our country they represent 0.3% of paediatric urgencies. Most of them are accidental intoxications but is not infrequent to find some related to child abuse or to suicidal intentions, especially in adolescence. The objectives of the study are to evaluate both clinical health care and medical legal aspects in intoxications in infancy. Medical assistance is described and it includes clinical diagnosis, typology of the more common toxics, percentages and referral to social work and emergency care equipment units of the Ministry of Social Welfare and the Department of Health or, where appropriate, directly to prosecutors and courts for their intervention. In cases of detection of alcohol, drugs or medication in infants, the importance of the correct interpretation of the results of toxicological findings is discussed. Several studies for the interpretation of results concerning the detection of these toxics are reported. Both legal aspects and the forensic medical opinion are assessed. The findings will be analysed by the judicial authority in order to circumscribe responsibilities or to take appropriate decisions concerning the protection of infants' interests. In conclusion intoxication in infancy can lead to legal proceedings requiring specific actions for their protection. Both physicians and hospitals must comply with the legal requirement of the submission to the court of judicial parties. On the other hand, this information is an interesting step toward reinforcing public health surveillance.

Evaluación toxicológica del menor / Toxicological evaluation in the childhood

Las intoxicaciones en la infancia requieren la atención médica urgente dentro del sistema sanitario. En nuestro país supone el 0,3% de las urgencias pediátricas. La mayoría son intoxicaciones accidentales, pero no son infrecuentes las relacionadas con el maltrato infantil o las intencionales con finalidad autolítica, especialmente en la adolescencia. Los objetivos del estudio son valorar la intoxicación en el menor en los aspectos clínicos asistenciales y medicolegales. Se valora la asistencia médica que comprende el diagnóstico clínico, el tipo de tóxicos más comunes, su frecuencia y la derivación a las unidades de trabajo social y equipos de asistencia urgente, dependientes de la Consejería de Bienestar Social y Consejería de Salud o, en su caso, la intervención directa de fiscalías y juzgados. Se discute la importancia de la correcta interpretación de los resultados toxicológicos en los casos de la detección en los menores de alcohol, drogas o medicamentos y se describen varios estudios de interpretación de resultados relativos a la detección de estos tóxicos Se valoran los aspectos legales y el dictamen médico forense. Las conclusiones se analizarán por la autoridad judicial a fin de delimitar responsabilidades o tomar decisiones que protejan los intereses del menor. En conclusión, la intoxicación de los menores puede derivar en procedimientos legales que requieran actuaciones concretas para su protección. El envío al juzgado de los partes judiciales es un requisito legal que deben cumplir los facultativos y centros sanitarios. Al mismo tiempo, esta información supone una vía de vigilancia epidemiológica de interés en salud pública (AU)

Intoxications in infancy require urgent medical treatment within national health systems. In our country they represent 0.3% of paediatric urgencies. Most of them are accidental intoxications but is not infrequent to find some related to child abuse or to suicidal intentions, especially in adolescence. The objectives of the study are to evaluate both clinical health care and medical legal aspects in intoxications in infancy. Medical assistance is described and it includes clinical diagnosis, typology of the more common toxics, percentages and referral to social work and emergency care equipment units of the Ministry of Social Welfare and the Department of Health or, where appropriate, directly to prosecutors and courts for their intervention. In cases of detection of alcohol, drugs or medication in infants, the importance of the correct interpretation of the results of toxicological findings is discussed. Several studies for the interpretation of results concerning the detection of these toxics are reported. Both legal aspects and the forensic medical opinion are assessed. The findings will be analysed by the judicial authority in order to circumscribe responsibilities or to take appropriate decisions concerning the protection of infants’ interests. In conclusion intoxication in infancy can lead to legal proceedings requiring specific actions for their protection. Both physicians and hospitals must comply with the legal requirement of the submission to the court of judicial parties. On the other hand, this information is an interesting step toward reinforcing public health surveillance (AU)

[Postmortem detection of accidental methadone intoxication in a 10-year-old girl]. / Postmortale Aufdeckung einer akzidentellen Methadon-Intoxikation bei einem 10-jährigen Mädchen.

Intoxications in children still account for a large part of the cases reported to poison control centres. Among drug intoxications, substitution drugs have gained in importance lately. Careless storage of take-home medications puts children living in the same household at risk. The authors report on a fatal case of a 10-year-old girl who died from intoxication with methadone belonging to a carer. The accidental intoxication had not been diagnosed at the hospital where the girl was treated for suspected meningitis. The question of medical malpractice is discussed.

Poison politics: a contentious history of consumer protection against dangerous household chemicals in the United States.

The history of consumer protection against household poisons presents a key case study of the uniquely American struggle to balance public health and safety with the interests of business. By the late 19th century, package designs, warning labels, and state statutes had formed an uneven patchwork of protective mechanisms against accidental poisonings. As household chemicals proliferated in the early 20th century, physicians concerned with childhood poisonings pressured the federal government to enact legislation mandating warning labels on packaging for these substances. Manufacturers of household chemicals agreed to labeling requirements for caustic poisons but resisted broader regulation. Accidental poisonings of children continued to increase until the enactment of broad labeling and packaging legislation in the 1960s and 1970s. This history suggests that voluntary agreements between government agencies and manufacturers are inadequate to protect consumers against household poisonings and that, in the United States, protective household chemical regulation proceeds in a reactive rather than a precautionary manner.

Accidental mechanical asphyxia of children in Germany between 2000 and 2008.

Accidents constitute one of the greatest risks to children, yet there are few medical reports that discuss the subject of accidental asphyxia. However, a systematic analysis of all documented cases in Germany over the years 2000-2008 has now been conducted, aiming at identifying patterns of accidental asphyxia, deducing findings, defining avoidance measures and recommending ways of increasing product safety and taking possible precautions. The analysis is based on a detailed retrospective analysis of all 91 relevant autopsy reports from 24 different German forensic institutes. A variety of demographic and morphological data was systematically collected and analysed. In 84 of the 91 cases, the sex of the victim was reported, resulting in a total of 57 boys (68 %) and 27 girls (32 %). The age spread ranged between 1 day and 14 years, with an average of 5.9 years. Most accidents occurred in the first year of life (20 %) or between the ages of 1 and 2 years (13 %). In 46 % of cases, the cause of death was strangulation, with the majority occurring in the home environment. In 31 % of all cases, the cause of death was positional asphyxia, the majority resulting from chest compression. In 23 % of cases, the cause of death was aspiration, mainly of foreign bodies. Today, accidental asphyxiation is a rare cause of death in children in Germany. Nevertheless, the majority of cases could have been avoided. Future incidence can be reduced by implementing two major precautions: increasing product safety and educating parents of potentially fatal risks. Specific recommendations relate to children's beds, toys and food.

[Bumping into a knife--exculpatory statement or (tragic) accident?]. / Hineinlaufen in ein Messer--Schutzbehauptung oder (tragischer) Unfall?

Assessing stab wounds is a common task in forensic medicine. Quite often an accused claims that the victim bumped into the knife. Taking into account all the facts ascertained in the investigations conducted, such a statement can be rapidly disproved in most cases. The present case of a 14-year-old boy fatally wounded by his mother with a kitchen knife examines the aspect of walking into a knife. It is an example that this statement cannot always be regarded as implausible and that every single case has to be reconstructed in detail on the basis of all the investigation results.

Safe hot tap water: knowledge, attitude and practice of plumbers, students and regulatory authorities following the introduction of plumbing regulations in NSW, Australia.

Regulations to restrict the temperature of domestic hot tap water were introduced in NSW in 1999. This study investigates the impact of the regulations on the knowledge, attitude and practice of workforce professionals responsible for their uptake and enforcement. Telephone surveys were conducted with a random sample of 110 plumbers and 30 regulating authorities. Surveys were recorded, transcribed and coded. Written questionnaires were completed by 151 plumbing students. The regulations are well known and supported by the majority of plumbers, students and regulators; however 75% of plumbers reported customer dissatisfaction with them. Only a minority of plumbers (11%), students (7%) and regulators (27%) correctly appreciated the impact of a decrease in water temperature in reducing burns. This study identifies the need to improve plumbers and students' understanding of the safety issues underlying the regulations in order to promote more effective advocacy for homes not currently covered by the regulations, and to provide more public education to increase acceptance of them. As only houses built or substantially renovated after June 1999 are likely to have been impacted by the current regulations, there is a need to increase the scope of the regulations to include not only new installations, but also the replacement of existing heated water units if the goal of universal protection is to be achieved.

Hot tap water legislation in the United States.

Excessively hot tap water results in an estimated 1500 hospital admissions and up to 50 deaths in the United States every year. This study reviewed the current state of tap water temperature regulation in the United States, including the model plumbing code standards on which state legislation in this area is based; assessed the level of public awareness regarding the risk, prevalence, and severity of such injuries; and identified specific prevention measures. Relevant information was obtained from state legislative codes, model code development organizations, the US Consumer Product Safety Commission, and a survey of knowledge, attitudes, and behaviors related to tap water temperature safety. Model building and plumbing codes related to tap water temperature regulation and their subsequent adoption by state legislatures vary widely across the United States. The states also vary with respect to the authority provided to lower levels of government (counties or municipalities) to modify and enforce code provisions. Public awareness of hot tap water hazards and implementation of preventive measures are limited. A broader and more uniform application of codes for regulating tap water temperature in both institutional and residential settings can be achieved through input from affected users, government agencies, legislators, advocacy organizations, and the general public. Safer hot water temperatures and a reduction in scald injuries can be achieved through regulating hot water temperature level at the thermostat, installing temperature-regulating valves at the tap, and raising public awareness of hot tap water hazards.

[An evaluation of the pediatric medico-legal admissions to a tertiary hospital emergency department]. / Bir üçüncü basamak hastane acil servisine basvuran adli nitelikli çocuk hastalarin degerlendirilmesi.

BACKGROUND: This study aimed to determine the demographic and epidemiological characteristics and to investigate the outcomes of pediatric medico-legal cases who admitted to the emergency department. It was also aimed to contribute to the national survey. METHODS: Medico-legal charts of the pediatric cases were reviewed retrospectively. Patients were allocated into two groups as traumatic (Group 1) and non-traumatic (Group 2). Age, sex, presenting complaint and frequencies, local or multiple trauma frequencies, and localizations (based on the Abbreviated Injury Scale) and also admission, discharge and mortality rates were ascertained. Data were evaluated by descriptive methods, Kolmogorov-Smirnov and chi-square tests. Values of p<0.05 were accepted as significant. RESULTS: There were a total of 486 eligible patients. The mean age was 8.91+/-5.08 years (95% confidence interval [CI]). The majority (66.3%) were male. The group aged 5-9 years was larger (33.3%) than the others (in Kolmogorov-Smirnov test, p=0.000). Summer was the most common season for admissions. There were 153 patients in Group 1, and the most common complaint was accidental drug intake (13.8%). In Group 2, the most common reason for admission was motor vehicle accident (32.5%). CONCLUSION: Motor vehicle and home accidents in childhood are preventable health problems. To ensure a safe environment, continuous health education programs on injury and prevention for parents and children and legal controls will be effective in injury control.

Hospitalised hot tap water scald patients following the introduction of regulations in NSW, Australia: who have we missed?

Scalds from hot tap water are serious injuries that are potentially preventable by restricting the temperature of hot tap water delivery. In July 1999, regulations were introduced in NSW to require that all new hot water installations deliver water at temperatures not exceeding 50 degrees C to sanitary fixtures. This study investigates trends in hot tap water scald injury hospitalisations following the introduction of these regulations. Hot tap water scald cases for 1999-2007 were identified from hospitalisation data for all public and private hospitals in NSW. To investigate hot tap water scald hospitalisations over time, negative binomial regression analysis was performed. There were 845 hospitalisations for hot tap water scalds in NSW over the period of the study. Hospital admission rates for hot tap water scalds decreased by an estimated 6% (3.2-8.5, 95%CI) per year since the introduction of regulations. While those most at risk were infants, toddlers and the elderly, almost a third of hospitalisations were for adults (25-64 years). The majority of hot tap water scalds were sustained at home and a further 4% occurred in a residential institute or school. The majority of scalds were severe, and a quarter required admission for longer than a week. The introduction of regulations in NSW appears to have had a positive impact on the rates of hospitalisations for hot tap water scalds; however, scalds continue to cause significant morbidity and mortality. This highlights the need for a review of the scope and implementation of the existing regulations and ongoing education of the general public to the dangers of hot tap water.