Wildland firefighter deaths in the United States: A comparison of existing surveillance systems.

Wildland fire fighting is a high-risk occupation requiring considerable physical and psychological demands. Multiple agencies publish fatality summaries for wildland firefighters; however, the reported number and types vary. At least five different surveillance systems capture deaths, each with varying case definitions and case inclusion/exclusion criteria. Four are population-level systems and one is case-based. System differences create challenges to accurately characterize fatalities. Data within each of the five surveillance systems were examined to better understand the types of wildland firefighter data collected, to assess each system's utility in characterizing wildland firefighter fatalities, and to determine each system's potential to inform prevention strategies. To describe similarities and differences in how data were recorded and characterized, wildland fire deaths for three of the population-based systems were matched and individual fatalities across systems were compared. Between 2001 and 2012, 247 unique deaths were captured among the systems; 73% of these were captured in all three systems. Most common causes of death in all systems were associated with aviation, vehicles, medical events, and entrapments/burnovers. The data show that, although the three systems often report similar annual summary statistics, events captured in each system vary each year depending on the types of events that the system is designed to track, such as inclusion/exclusion of fatalities associated with the Hometown Heroes Survivor Benefits Act of 2003. The overarching and central goal of each system is to collect accurate and timely information to improve wildland firefighter safety and health. Each system is unique and has varying inclusion and exclusion criteria for capturing and tracking different subsets of wildland firefighter tasks and duties. Use of a common case definition and better descriptions and interpretations of the data and the results would help to more accurately characterize wildland firefighter traumatic injuries and illnesses, lessen the likelihood for misinterpretation of wildland firefighter fatality data, and assist with defining the true occupational injury burden within this high-risk population.

Geographic and temporal comparisons of ATV deaths in West Virginia, 2000-2008.

During the 9-year period from 2000-2008, West Virginia experienced 301 deaths related to All-terrain Vehicles (ATVs). The distribution of ATV deaths across the top 20 counties in West Virginia accounted for nearly seventy percent of the ATV-related deaths during the 9-year study period. Time-of-day was a significant predictor of population-based rates, and a 34% decrease in the fatality rate from 2.94 in 2006 to 1.93 in 2008 occurred. We opine that the decline in ATV mortality is possibly due to better enforcement of the (WV Code Chapter 17F), mandatory ATV regulations passed by the West Virginia State Legislature in 2004. Improved safety vigilance and ATV operator adherence to manufacturers' safety guidelines may have also contributed to the decreasing incidence of ATV deaths. While the current downward trend is most welcome, more attention should be directed towards high-risk behaviors including alcohol and drug abuse and driving on paved surfaces.

Nonfatal all-terrain vehicle-related injuries to youths living on farms in the United States, 2001.

CONTEXT: Use of all-terrain vehicles (ATVs) in agriculture appears to be growing. PURPOSE: To provide estimates of ATV ownership and exposure on US farms and an overview of injuries to youths as a result of ATV use on the farm in 2001. METHODS: Analysis of the National Institute for Occupational Safety and Health and US Department of Agriculture 2001 Childhood Agricultural Injury Survey. These data, collected via telephone surveys, provide information on nonfatal injuries that occurred to youths younger than 20 years living on US farms during 2001. The injuries included both occupational and nonoccupational incidents. FINDINGS: Of an estimated 1.1 million youths living on farms, 36% had operated an ATV in 2001. Youths younger than 16 years were more likely to have operated an ATV than a tractor on these farms. An estimated 2,246 nonfatal ATV-related injuries occurred to youths younger than 20 years on US farms during 2001. The majority of these ATV injuries (1,668, 74%) occurred to youths identified as members of the household. Males accounted for 1,145 (69%) of the ATV injuries to household youths. The majority of the injuries were to youths aged 10-15 years (1,170, 70%). Most ATV injuries were the result of recreational activities (970, 58%). In addition, many of these injury events involved youths riding without helmets and using ATVs that were larger than the recommended size for their age.

Readiness to change problematic drinking assessed in the emergency department as a predictor of change.

OBJECTIVES: The goal of this study was to determine if baseline readiness to change the drinking behavior (pre-contemplation, contemplation, preparation, and action stages) was predictive of change in drinking after unrelated emergency department (ED) visit and screening and interviewing for alcohol problems. METHODS: From August 1998 through December 2000, the Alcohol Use Disorders Identification Test (AUDIT) was administered to all consented ED patients aged 18 to 29 years. A brief motivational interviewing was provided to screen-positive patients (AUDIT score >5 of 40). Outcome at 3-month follow-up was measured as a decrease in the scores within the AUDIT domains of alcohol intake, harm, and dependency. RESULTS: Sixty percent of the screen-positive patients continued to drink at 3 months. Patients became more open to change their drinking behavior. Compared with patients in the pre-contemplation stage, those in the action stage were twice as likely to reduce their alcohol intake (OR, 2.24; 95% CI, 1.06-4.72), nearly 3 times as likely to reduce their alcohol-related harm behavior (OR, 2.80; 95% CI, 1.59-4.91), and almost 4 times more likely to decrease their dependency symptoms (OR, 3.59; 95% CI, 1.97-6.57). Compared with pre-contemplation patients, those in the contemplation stage were nearly twice as likely to reduce their alcohol-related harm (OR, 1.85; 95% CI, 1.02-3.33) and those in the preparation stage were more than twice as likely to reduce their dependency symptoms (OR, 2.20, 95% CI, 1.13-4.27). CONCLUSIONS: Stages of change at baseline appeared to be significant predictors of change in alcohol intake, harm, and dependency symptoms among young adult ED patients.

Counselors' reflections on the administration of screening and brief intervention for alcohol problems in the emergency department and 3-month follow-up outcome.

OBJECTIVES: The purpose of this paper was to explore how events that counselors endorsed occurring during an emergency department-based screening and brief intervention (SBI) for drinking discriminate patients who reported change in Alcohol Use Disorder Identification Test (AUDIT) domains at follow-up from those who did not. METHOD: Patients who scored ">5" on the AUDIT were eligible for SBI. At the end of each intervention, counselors completed the questionnaire indicating which parts of the intervention they just used. RESULTS: Discriminant function analyses indicated that "Referral made" discriminated for alcohol intake change (Wilks' lambda = 0.993, P < .05); "Did the patient set goals during intervention?" and "Referral made" discriminated for alcohol dependency change (Wilks' lambda = 0.940 and Wilks' lambda = 0.919, P < .05, respectively). "Intention to quit" (Wilks' lambda = 0.984, P < .05) discriminated for alcohol-related harm change. CONCLUSIONS: Making referrals to addiction treatment during motivational intervention discriminated for alcohol intake and dependency change. Working on intention to quit is an important point in changing alcohol-related harm. When conducting the SBI in ED, counselors may be mindful in making appropriate referrals to address alcohol use and examine intention to quit to maximize the efficacy of the harm-reduction approach.